Big Fat Nutrition Policy | Nina Teicholz

okay thank you all for coming for 60 years now the authorities have told us we should eat less fat more carbohydrate and if we are eating less saturated fat more unsaturated fat like trans fats and this has been terrible advice which is at the very best coincided with this epidemic of diabetes and obesity and that worse has been causative rather than associative the extraordinary thing about this huge collective public error is that the person who has done more than anything body else to explode it nina is neither a scientist nor a doctor nor nutritionist and a fact perhaps it is necessary that she is in fact an invested journalists and perhaps it did take someone from completely outside the field to recognize that the entire field was flawed we're incredibly lucky that she's come to talk to us today and I welcome her on your behalf Nina thank you very much thank you very much it is lovely introduction and thank you for having me Kate oh hello to the audience and all the people who are watching online or maybe just one of you but so great so I got into this field because I wrote this book called the big fat surprise and it has the central thesis of the book is is what Taryn so eloquently described which is that it seems that the government had and our health authorities had really gotten it completely wrong on fat and especially saturated fat you know the kind of fat the reason we avoid Mead and cheese and whole whole milk so I wrote this book when I started I like everybody else was pretty much everybody else was following our current dietary recommendations these are them depending on your age you probably most of you probably grew up on the the food pyramid you know this is the food pyramid that we've all lived off of and you can see that it recommends that big bottom slab there is recommending that we the bulk of our calories really come from grains so you know bread pasta rice those are all grains mainly carbohydrates and and you know this has been this has sort of been our like our Bible in terms of everybody every schoolchild gets this everybody learns it every doctor teaches this every nurse every nutritionist every dietitian so and I followed this religiously I used to bake my own seven grain bread every day and make my own pasta salads every day for lunch and I would jog or bike or swim at least an hour every day and I got fat I got fatter than this but I'm not showing you that photo it's bad enough to show you this photo with that terrible haircut but I was you know I really tried very hard I was a vegetarian for over 25 years not a strict vegetarian I had no red meat no butter barely any cheese I'm from Berkeley California so of course I was a vegetarian and then from there I moved from to New York City other capital of vegetarianism so you know it really came to this with zero preconceptions as a journalist I really never thought I would end up putting a piece of red meat on the cover of a book much less eat any myself but what happened was is that I got assigned an article by a magazine I was freelance journalist and was assigned an article to write about trans fats in the early 2000s well what was trans fats I didn't know what they were I hadn't really studied anything about it but I I that took me into the world of dietary fat and you know fat is what we have obsessed about most in terms of our diet for Americans low-fat nonfat good fat bad fat high fat I mean we have just it has been a central preoccupation of our dietary guidelines and therefore of all of us and I discovered all sorts of things that really as a journalist made my ears perk up like talking calling up scientists and saying I can't talk to you about fat and hanging up on me or people I mean science scientists real scientists at reputable universities or scientists telling me they had been visited by officials from the margarine industry and told to yank papers from journals editors told to get rid of pet you know to pre-publication to take that paper out of a journal and I thought you know sometimes I would hang up the phone after these phone calls and sort of be shaking like am i investigating the mob or am i investigating nutrition science what is going on and I just you know as a journalist you realize there's just a very big story out there um and this took me I read thousands and thousands of scientific papers I interviewed hundreds of the top experts around the world and it took me a very long time took me almost a decade of my life to try to get to the bottom of this story I should say that I do not receive any industry funding and never have and so that's the only disclosure that I have one of the things that really interested in me when I started my research is how do you explain this what happened in 1980 that American obesity just shoots upwards that's very strange obesity is fairly low in the 1970s or not too aggressive and then something happens to take it tick sharply upwards in fact if you go back and look at pictures in the 1970s you know go look at the line of kids waiting to watch the latest Star Wars movie come that's come out like they are all thin not one fat kid among them and then you know now we live in a much different world what happened in 1980 well I want to tell you a story the story I tell in my book had a very abbreviated way of just how do we come to believe what we believe about fat and saturated fat and cholesterol so it all starts in the 1950s you can see that chart that's on your right that is the rising tide the sharply rising tide of heart disease in America which was terrifying President Eisenhower himself has a heart attack in 1955 is out of the Oval Office for ten days that is a huge and terrifying event for everybody and just imagine you know men are dying in the prime of their life right and left and this had not happened to their fathers this was something entirely new and it was really important that people try to understand why is this happening well there were a number of ideas about it maybe it was vitamin deficiency maybe it was Auto exhaust maybe is that famous type-a personality you know you yell all the time and then you just keel over with a heart attack these were all viable hypotheses but there was one hypotheses proposed by this man Ancel keys of pathologist at the University of Minnesota and what he came up was with what was called his diet heart hypothesis and his idea was that you would eat saturated fat and cholesterol in your diet so his meat cheese dairy and you would this would lead to you're having elevated cholesterol in your blood serum cholesterol this would clog your arteries like cold oil hot oil down a cold stove pipe and would give you a heart attack that was his hypothesis and it turns out that he was just a very kind of outsized personality he was very aggressive I mean he was called arrogant and a bully even by his friends and he could was said that he could argue anyone to the death he was fiercely a believer in his hypothesis and he was able to get himself into the to the nutrition committee of the American Heart Association which you see here that was at the time the really the only public health group that was dealing with heart disease and and and everybody was following your advice in 1960 they came in with a paper saying we really would like to tell the American public what to do to avoid heart disease but there no data Ancel Keys gets on the nutrition committee and one year later with no greater data in hand he's able to get this recommendation published which says you need to restrict your saturated fat and cholesterol in order to prevent heart disease and this is the first advice anywhere in the world telling people to cut back on saturated fat and cholesterol this is what I sort of think of like the little acorn that grew into the giant oak tree of advice that we have today this is where this idea first became institutionalized so this meant in practice that you cut out animal foods and I mean sort of the easiest thing to imagine here is replacing butter with margarine you replace it with you replace your saturated fats with unsaturated fats right so instead of butter which is saturated you have margarine which comes from polyunsaturated vegetable oils and I think it's harder to imagine what you how you have vegetable oils instead of meat for dinner but that was the idea and we just have to go back in history for a second to remember what were the original fats that people cooked with I mean vegetable oils came later but we will cook with tallow kitc comes from beef and suet which comes from sheep and they mainly the two main fats that that European populations used in Americans used before 1900s was lard and butter largest from pigs obviously and butter and oils did not come on to the scene they were they were actually the first oil that was sort of used was whale oil that was used to it was used to fuel the Industrial Revolution who was going to keep all those machines lubricated they used whale oil when they killed off all the whales they started to use cottonseed oil and then in the early 1900's somebody looked at cottonseed oil and figured out a way to harden it and send him em that looks a lot like lard why don't we try to sell that to Americans to eat and that was Crisco and that came into the American food supply in 1911 and sure and after that came that regular vegetable oils but these are new foods that used to be used to lubricate machinery and still are but in any case Ancel keys really won the day I mean the way to understand him is that it was a moment of complete panic in the United States there was a demand for some kind of answer he walked into this vacuum with a very strong idea and his idea became adopted by the American Heart Association and he was easily the most influenced the most influential nutrition scientist in the history of nutrition science so here he is on the cover of Time magazine in 1961 the same year of that American Heart Association recommendation but what was the evidence at the time well it really amounted to one study that he himself had did called the seven country study and it was funded by NIH in part I'm just going to so this is what it was it was a survey of nearly 13,000 men and women in seven countries around the world mainly in Europe but also in the US and Japan and he looked at Ancel keys and his team went around and they looked at serum cholesterol levels and they looked at diet and you know Ancel keys had gone into this study thinking I want to prove my hypothesis and he did in the end show a very weak correlation between saturated animal fats and your risk of having a heart attack and if you read if you are unfortunate enough to read 10,000 nutrition studies as I have done I would say 90% of them telescope back to Ancel keys is seven countries study it is the one of the most cited works ever and it was it's because it was really the only study of its day and because it launched a thousand ships and he so I took I spent an enormous inordinate amount of time looking into the details of his study I'm just going to give you a couple highlights of its methodological weaknesses for one it only measured the diets of fewer than 3% of its participants which is nowhere near a statistically representative sample so you really didn't know what these people were eating number two it was it was a kind of kind of study that only shows Association and not causation so it really can't ever prove that reducing animal fats was what caused the reduction in heart attacks number three it didn't actually show that that there was a reduced total mortality so people weren't daughter dying of heart attacks and maybe they were dying as something else anyway I want to share with you one particular other methodological flaw which i think is really more emblematic than anything else which is that it had to do with the Islanders of Crete so these are the people on whom the whole Mediterranean diet came to be based Ancel keys looked at the dietary records of about 32 or 33 of them that's the total population he looked at he went to this island he fell in love with them because they were just these seemed to him ideal they were they had they lived this life of a peasant it was a beautiful Unruh 'end crete not the hyper hotel crete of today and but it turns out if you read the fine print of his study that he went to Crete three times for a week each and one of those weeks he showed up turns out he turned he turned up during Lent when everybody is avoiding eating animal foods so he no doubt undercounted the amount of saturated fats that was being consumed by that population but as I said ultimately the ultimate problem was it was an epidemiological study it showed association it could not prove cause and effect and for those of you who don't really understand what that means I'm gonna give you one quick example about epidemiology epidemiology looks at things that are correlated many things are correlated so here we find that the divorce rate in Maine is correlated with your consumption of margarine so does that mean you should reduce your consumption of margarine to prevent getting divorced No that's what's called a false association there are many things that are associated with each other but they do not cause each other here's another example people with yellow fingers tend to die more of lung cancer we shouldn't avoid yellow fingers at all costs what causes yellow fingers smoking so you may be missing the thing altogether and I want to say that nutrition scientists in the 1960s they knew that that the seven countries said he was a weak study and that they needed to do random what's the more rigorous from a science called randomized control clinical trials and they did them governments around the world undertook for billions of dollars in randomized control clinical trials and these took place many of the I'm think Australia in England in most are in the US but in Finland and Denmark sorry Norway and many of them took place in mental institutions or hospitals where people were confined and these are the kind of experiments you cannot do now because they're considered unethical but the reason that they're such good trials is that you control all the food of everybody in that setting people are not allowed to go out down to the local bodega they you know you can see what people are eating and this is different than the many of the clinical trials that you read about today when somebody they're really just given a diet book and maybe they're given an hour of counseling you know once a week and they're given a support group but you really don't know what they're eating so these were well controlled trials there were on tens of thousands of people I mean this is a very conservative number I've put up there that 25,000 it's just but but if you if you depending on how you count you can get up to 50 60 thousand people who were tested in experiments lasting one to twelve years and what were the results there has no effect of saturated fats on cardiovascular mortality or total mortality and this is my summary of it but I can I'm there's you know a Cochrane review on this with the same results just no effect so and focuses hypothesis is actually the most tested hypothesis in the history of nutrition and heart disease and we can fairly say that the results were null which is they did not show him to be correct a recent the largest ever epidemiological study that was ever that's been done globally you know I don't normally quote epidemiological studies but I do and they have contrary results and this is one that is a truly global study they found that the more saturated fat people ate there the lower their risk of stroke so that's a contrary result in here this is Salim Youssef who is the immediate past president of the World Heart Federation saying I think we got it wrong unsaturated fats the other worrisome thing about these studies that I have just listed is that in a number of them nearly a dozen of them they had this side effect this is a results and one of them where you can see that the people who lower their saturated fat they they they died at much higher rates of cancer and this was a consistent finding across all these studies the people who had gone on the diets higher in vegetable oils and eating the margarine and the soy filled milk and the soy filled burgers were all dying at higher rates of cancer and the NIH was so concerned about this in the early 1980s they had four meetings they held four high-level meetings Ancel Keys wins his colleagues all went and they discussed this side effect of cancer that could not be explained and they could not find a an answer but they decided that the reduction in saturated fat and cholesterol was just so important for fighting heart disease that they were basically going to ignore the cancer side effects there were also huge government trials on the low-fat diet so just remember Ancel keys was particularly obsessed with saturated fats right he wasn't saying lower your total fat content overall he was saying switch saturated fats for unsaturated fats but in 1970 the American Heart Association really said you know what let's just look let's lower all fats because fats are more grams per calorie than either inert carbohydrates so if we just lower now let me just lower the fat content of our diet we'll save calories that was though it was sort of a an untested theory but they they started recommending it to the American population and and subsequently that's not how policy is supposed to work you know you're supposed to do the clinical trials first and then do the policy but it happened in the reverse fashion when they finally did clinical trials including the Women's Health Initiative and to Boeing trials these are just two of quite a large number they didn't start taking place until the late 1990s by the way they could not find that the low-fat diet had any ability to fight obesity type 2 diabetes heart disease or any kind of cancer and in fact if people lower their fat too much they found that it actually made their HDL which is the good cholesterol go down and that meant they were actually increasing their risk of heart disease and that is why we no longer how many people here know that we no longer have a low fat diet recommendation well that's pretty good so you know the American Heart Association in 2013 and the US Dietary Guidelines in 2015 those are our two major sources of nutrition guidelines they have dropped any low-fat language so we don't actually have a low-fat diet anymore and they recognized that the reason was it doesn't lower your risk of heart disease and in fact may worsen it oh so why is this not more widely known you know people say to me oh you don't have any science degrees and that is true I did do pre-med and I thought I would become a doctor but I studied politics and I often say to people to understand the history of this story you must it is really at least half a story of politics and this is sort of my general politics of nutrition slide because I can't get into it in great detail but it shows you that's Ancel Keys who's seated on the left there and you know that nutrition science really was run by a very small group of men and all these these the National Institutes of Health the American Heart Association and then the US government was on board they really controlled the nutrition agenda and if you didn't agree with them you couldn't get grant funding it's very hard to get your papers published it's very hard to get you weren't invited to conferences and so they really controlled the agenda I mean I have many stories and interviews from scientists saying to me you know I tried to challenge keys but and then I am I I was told by NIH secretary that if I continue to do that I would lose my grant funding and then his grant funding disappeared so I mean it was a very real threat to to scientists to be critics of this and also that people who believed in this you know that this is the people who believed in this hypothesis answer keys obviously believed and if there was a whole kind of group who around him who strongly strongly really believe their hypothesis and so there was this kind of selection of data going on where they really I think genuinely they just did not see data to the contrary this is called in science that's called selection bias where you select things that agree with your adviser opinion and you disregard things that don't I mean we all do this where this is this normal human kind of instinct which is you see the things you want to see and you just don't see those other things but scientists are taught to think differently and be different they're taught to distrust themselves and they are taught to try to prove themselves wrong cuz it clearly did not happen in nutrition I put this slide that I have up is I think the most incredible example of selection bias that I ever found which was this was the largest the Minnesota coronary survey was the largest ever test on Ancel keys hypothesis it took place in five Minnesota mental hospitals so well controlled they controlled the diet it was on more than 9,000 men and women one of the few studies to include women half the people were put on a diet that was considered average in saturated fats at the time which was 18% which would seem like outrageous to us now but you know regular milk regular meat cheese the other half were put on 9% saturated fat which is about what we're recommended to eat now so soy filled milk soy filled cheese at the end of four and a half years of that experiment this was their conclusion there was no difference in the treatment and the control groups and and subsequently actually some researchers from NIH went back and looked at the original tapes that were in the basement from this study the original magnetic tapes and andrey analyzed them and found out that actually the more the men lowered their cholesterol the greater their risk of dying from heart disease and that had never been published in this original paper so those findings were not published these original findings were not published for 16 years this is an NIH funded study findings are not published for 16 years and then they're putting this out of the way paper that they know nutritionists will not read and this is pictured here as Ivan France who is one of the project investigators and when he was asked much later by a journalist well how come he didn't publish the results he said well there was nothing wrong with the study we were just so disappointed in the way it came out which in science I have to tell you is a kind of lying alright so how does this become our official dietary guidelines and our official government policy in the late 1970s Senator George McGovern had a select Senate committee on on nutrition and they were mainly looking at under nutrition but they decided to look at these new killer diseases coming up heart disease and now cancer was on the rise and he published this there that committee published this report there's quite an amazing story about how this report came to be published it was written by one Senate staffer with no background in nutrition who is sort of on his way to becoming a vegetarian and and you know didn't know about the subtleties of Epidemiology versus randomized controlled clinical trials very much influenced by the American Heart Association so they published this report and that is what becomes our Dietary Guidelines that's the basis of our dietary guidelines and that my friends is what happened in 1980 now this is just a correlation it's not causation it's a suggestive correlation there is you cannot say from this chart alone that the Dietary Guidelines caused obesity I think there are there's a number of other scientific studies that give weight to that case but it is it is a very inconvenient correlation for the people who crafted our guidelines and I want to talk to you about what is the evidence behind our guidelines and so I wrote this story for the BMJ and it actually went to them back to the most recent Dietary Guidelines the guidelines come out every five years the last set came out in 2015 and it came out right as my book was coming out and I went to read the extra report and I was like well where is all the science that I've been studying it just wasn't there like it was nothing there were no science in the in the report that I that I knew about so I went and I looked at I went and I looked at every single study that was cited to report the dietary recommendations that we are all currently following today ok so these are these are the USDA's three dietary patterns there's the us-style which is really - if you know what - the dietary to stop hypertension it's a Mediterranean diet and the vegetarian diet you can see in terms of their macronutrient makeup they're all pretty much the same and you would basically call this a low fat diet low fat diets have been described as being anywhere between 30 30 25 to 35 percent fat so it's still a low fat diet even though they're not calling it a low fat diet and that means that you're eating over 50% of your calories is carbohydrates this is just another chart showing in a slightly different way that you can see that in terms of the daily recommendations of food groups that the diets are all very very similar so I went and looked at you know what are what where where's the evidence for these dietary patterns that we're all following okay so so the first one is and I'll only looked at the major diseases that they're looking at what is the relationship between dietary patterns and risk of cardiovascular disease so what was their source of data for that well they studied the pretty med trial which is this huge trial on the Mediterranean diet that has been retracted and reissued but with so many problems that it's really the basic evidence has been called seriously undercut into question and then the - trials all the - trials let me tell you something that most people don't know about the - trials they have own - diet has only been tested on 1,200 people total in experiments lasting no longer than five months long they have never been shown to be able to help people lose weight they do reduce your blood pressure if you have high blood pressure and they will reduce your LDL cholesterol which is your bad cholesterol but at the same time they also reduce your good cholesterol your HDL so at best they're kind of a wash for heart disease and the evidence is very thin and that is the entire clinical trial base for this dietary powder this this recommending our dietary patterns okay oh this is just the - I didn't know how to slide on this oh I can tell you is mostly middle-aged men they tested most trials lasting no longer than eight weeks so next question what about body weight meaning can the dietary patterns help you lose weight here they've decided only one trial on 180 subjects that's the total evidence base for the for this recommendation that any of those dietary patterns will help you lose weight and now I'm saying when you go to the doctor and the doctor says you need to follow a Mediterranean diet this is the only to lose weight this is the only trial that that doctor will be able to cite and they didn't lose much more weight right they had about well what does that in pounds five six pounds okay so let's go on to diabetes can the dietary patterns help you reverse your diabetes fight type two diabetes or type one zero there are zero clinical trials to support this so that's pretty bad evidence what about the vegetarian diet that is the new diet that they came up with in 2015 to recommend to all Americans they could find no randomized controlled clinical trial to support the health benefits of that diet yeah I know it's very popular and probably everybody in the room knows somebody on this diet right now but there are no clinical trials to support its health benefits and they overall when they looked at all the data they had to give it the lowest-ranked that they could possibly give for available data so this is quite a surprise because in one of the things that that I did recently was look at the publication history of every of the 14 people in this expert committee who wrote this report and and before they were chosen for the committee 11 out of 14 of them which i think is around almost 80% but 11 out of 14 of them had published histories saying they believed the vegetarian diet was the best diet or than that I called a plant-based diet so they came into the committee with a bias for the vegetarian diet they couldn't find any evidence for it but they recommended it anyway so what is the evidence for the dietary patterns why do we why we why are we all following them and the answer is it's all epidemiological it's all this weak epidemiological data so this was something that that was sort of confirmed in an ash report by the National Academy of Sciences engineering and medicine who took they did really the first-ever outside peer review of the dietary guidelines the report came out in 2017 and they came to the conclusion that really they they were not prioritizing the science correctly and they lacked scientific rigor and they lacked transparency and they suffered from bias so that just tells a story that you know our dietary guidelines were born out of weak science and remain weak science and this is not what we're told though I mean what this is this is what we're told this is what the you know I think the mainstream journalists and experts will tell you this story which is your fault America that you're fat and sick because you failed to follow the guidelines and you don't exercise enough well I'm a journalist and I thought okay maybe that is true you know I should go and look at that data and see what that data says and here's what the data says actually this is the best available government data that you can find on this subject and it shows you what the trends are in food consumption I don't know if you can see this but so Americans eat 20 percent more fresh vegetables 35 percent more fresh fruits 28 percent more grains than today then and it's the years are from 1970 to 2014 we eat 87 percent more vegetable oils so there those are all the blue lines going up so everything we've been told to eat more of we eat more of and then the red line is going down or everything we took been told to eat less of we eat less of we eat I can't even see that number but I think it's about 25% less red meat I know that we 34% less beef now whole milk is down by 79% eggs are down animal fats are down by 27% butter is down and this is not a cherry-picked set of food groups here I can tell you that in every category you check for you know fish we eat more fish we eat more nuts we and everything that we are supposed to eat more of wheat more of you know and the vegetable category is not ketchup that is the biggest increase in in vegetable consumption has been in leafy greens so we've done a pretty good job of following the guidelines I'd say and this also turns comes out in terms of macronutrients we were told to increase our carb consumption and we did carbs are up by 30% we were told to decrease fat we did that down by 25% and I would say the more reliable numbers are from 1971 but but still you can see the trends we did and we did follow in big macronutrient patterns we we follow the guidelines what do I don't exercise is it the fact that we don't exercise as much as we used to well according to the latest one of the latest reports by the US CDC X Americans are exercising more than we used to so we are now we 50 more than half of us are meeting the government's physical activity guidelines and that's up from 41 percent in 2005 and so people are increasingly saying there's another report that says that unit that looked at sedentary behavior that could not find any evidence that vii sedentary behavior leads to obesity it doesn't mean it's not true but they just couldn't find any evidence for it which is good news in the meantime for us couch potatoes but as people experts are increasingly saying you really cannot exercise your way out of a bad diet it's really that that that obesity and other diseases are really driven by nutrition so what are the nutritional options you know look the ants loki's his diet was tested results came up null low-fat diet tested results did not show any benefit well there is now a new idea about diet a new hypothesis about what causes obesity and other diseases and it's called the carbohydrate insulin hypothesis and it holds that carbohydrates really of any kind even those two health healthy whole grains in your body they become glucose your body understands all of that as glucose which is sugar that triggers the release of pang of insulin from the pancreas and insulin is like the king of all hormones for making new fats you take insulin plus glucose and that is stuck away in your fat cells and if you have carbohydrates all day long if you're having cereal for breakfast and then your blood spikes to sugars and then you're hungry mid-morning and you have maybe have a piece of fruit and then your sugar spikes and then the lunch you have a sandwich and then mid-afternoon snack is some crackers or gummy bears and then for dinner you're having pasta that is carbohydrates all day long and over time your ability to produce insulin and respond to insulin and your body's ability to deal with insulin is just exhausted you become what's called hyperinsulinemic or you you just you can no longer process the insulin and that is when you become type-2 diabetic you have to shoot yourself up with insulin because your body can no longer deal with it no longer responds to the amount of insulin that itself can produce so what is the evidence supporting this new theory well quite a lot more than a hundred randomized controlled clinical trials on more than 7,000 people some of them are what we consider you know quite a few some more six of them are two years long that's considered long enough to flush out any side effects some of you probably knew this originally as the Atkins diet it used to be thought of it really lead to renal failure and bone loss and other kinds of side effects none of that that would have been seen in the two-year trials and none of those cytus have side effects turned out to be true low-carb nearly always results in more weight loss maybe not dramatically but always more and it's accomplished without any hunger or calorie-counting which is always one of these kind of unrecognized aspects about a low carbohydrate diet because like what if your doctor said and said I want to give you you've two pills to choose from this pill is going to make you hungry irritable tired cranky and constantly think about food all the time and this pill has no side effects which one would you choose you choose the you choose the pill you choose the diet that doesn't make you hungry doesn't make you tired doesn't need to you know lowered metabolism so and there are there's more than one experiment now that shows that that the diet can reverse type 2 diabetes quite quickly the the largest trial on this showed 60% reversal of diabetes in one year and by that I mean that it it the average blood glucose of these people fell below the diabetic diagnosis so they were no longer diagnosed as diabetes that does not mean it's a cure if they start eating carbohydrates again they'll get their diabetes back a study just came out showing it could reverse fatty liver disease and it improves most cardiovascular risk factors I hear you cry yes but we eat more calories it's about the calories it must be that we eat more calories and it's true we eat more calories now than we did 30 years ago but all those calories practically are carbohydrates so we cannot from this information alone say it's just the calories it could be the carbohydrates so looking at all that I founded a group called the nutrition Coalition which is based here in DC and our work is simply to try to get the guidelines to be evidence-based are it's very simple we just want them to be based on randomized controlled clinical trials on humans and not on this week epidemiological evidence because we believe that this would allow people to get healthy again and the reason that we're focused on the guidelines is they are incredibly powerful I know probably throughout this whole you know talk you're thinking I don't go to a.gov website to find out my dietary advice I go to the Internet or I asked my doctor but look how powerful the guidelines are they control all the your school lunch programs feeding programs for the elderly they controlled women infant children what's fed to them those are the biggest budget line in USDA budget they control all at K through 12 education they are downloaded virtually by all the medical all the associations the Diabetes Association the Medical Association nutritionists and on the Nurse Association and then they're so at every point of contact with patients and every office in every setting you're being told the guideline you're being taught the guidelines they direct food for the military we now have a bee city problem in the military and they change the whole food supply so all of cattle were bred to be leaner that's why we have lean on pretty much only lean meat in the supermarkets and and led to the creation of thousands and thousands of low-fat products they are really powerful and it's a problem you know and they haven't been helpful let's just say at least we could say is they have not been helpful and I want to you know I also want to say about them that they are really they remain this one-size-fits-all diet and you know one of our goals is simply to say you know beyond their being evidence-based we really need a diversity of diets and everybody in this room is different and and has unique and different kinds of nutritional needs responds to diet very differently children have different nutritional needs that elderly have different nutritional needs people who are obese or have diabetes or heart disease have a metabolic issue that requires a different diet so currently our dietary guidelines are only for healthy Americans did you know that so that applies to about less than 20% of America is still considered metabolically healthy so that is something else that really needs to change and and the final thing that needs to change is the Dietary Guidelines are currently they do not meet nutritional adequacy goals for potassium magnesium choline and something I'm forgetting but I mean it they should meet nutritional adequacy goals because people need nutrients in order to avoid disease and to grow and healthfully reproduce so that's the goal of the nutrition coalition it should be all of our goal and and so I thank you for having me here today I think I've landed on time Terrance so we wanted to have plenty of time for your questions and so I'd like to welcome any questions that you have especially the hard ones you ever hear so the question is that the dietary guideline committee has been formed for the 2020 guidelines it was just announced last week and am I happy with it that is a complicated question it's a 20-person committee it is definitely more diverse than any committee has been in the past there is an expert there who is an expert in animal proteins that's never been the case there is there's somebody who is I wouldn't say true expert in low carbohydrate diets but it's somebody who's knowledgeable about them and has done low carbohydrate diet experiments and is open to them that said there is a there is a seventh-day adventists who as a matter of religious belief whole believes in a vegetarian diet and I don't believe we should be mixing religion with good science or policy and find me somebody who does and there you know there are quite a few people on the committee who are really strong old guard people who have you know who have served on the committee before instrumental in creating the committee long long time people who have been employed by the USDA employed by FDA so very very close to the government and those will be the heavy hitters on that committee so I just don't know the question is how much can these sort of outside our up-and-comers have their voices be heard yes in the back number of nonprofits I'm looking for a new mission oh great - up power things coming at the coalition I don't know if your mic is on but the question is his gentleman in the back is looking for a new nonprofit and how are we doing at the nutrition coalition well we're solvent we were responsible for that National Academy of Sciences report that was the first ever outside peer review of the of the guidelines that was pretty much that was our work I mean nobody you can say anything for sure but but we proposed it and so that I think is quite an accomplishment we actively educated people at USDA about the need to include in their topics for this year the low carbohydrate diet and saturated fat as topics that needed to be reviewed and they did so again you never are sure if you've done something but I know that we're we are we were really the only group in the world right now that is advocating for evidence-based guidelines I mean we're it the the there's a tremendous kind of bottom-up movement of people who have gotten healthy by ignoring the guidelines and so but there you know and there there are hundreds and we have we have maybe 500 doctors signed up with us who and many many PhDs signed up with us who believe in our mission but it really hasn't translated into an advocacy effort until our group was formed so we could use your support yes woman in purple I did cut out carbohydrates and my blood sugar they go down however I've had high cholesterol for a long time should I take cholesterol medication or do you suggest anything else so I want to say that one of the one of the chapters that is one of the sections of my book that is worth reading is how women and the data on women and children have been has been ignored and how the data for women and children is very different than it is from middle-aged men and one of the findings that came out of the very earliest studies that looked at risk factors found that women especially women over 50 the higher their cholesterol the longer they lived but that finding in an effort to just sort of simplify the message that finding for women was just ignored so if you have I mean unless you have you know there are there are people with something called familial hypercholesterolemia which is super high cholesterol and they are that's a genetic defect and treatment for that might be different but if you are a regular garden-variety high cholesterol that is a good sign if you are a woman yes that's good all right I think there's somebody in the back there who's had their hand raised for a while on the green cap well we might as well do those two in the back thanks so much a question about high fructose corn syrup which is generally entering to almost every processed food and I hear that it's used to fatten cattle but that is going throughout the food supply yeah I mean high fructose corn syrup you know high fructose corn syrup is really not that much different from sugar it's just one is in and evidence to show that it's really so much worse for health is is is not that strong I mean sugar is Ted correct me if I'm wrong here but sugar is like 50% glucose 50% fructose high fructose corn syrup is 55% fructose and 45% glucose is that a difference that really has a huge metabolic effect on the body it's not really clear so in general I mean I want to say something about sugar versus grains what fattens cattle is whether they've had a fatten cattle anybody know they feed them grains well that's what happens and that's why they go into feed Lots because just eating grass is not fatten cattle that efficiently so they stick them on a feedlot and they give them greens so remember the big bottom slab of the food pyramid what fattens humans very well be all those grains or grains plus sugar but I'm not convinced truly by the evidence to show that high-fructose corn syrup is so much worse than just regular sugar I think he's had his hand up for a while and then maybe down here you've had your hand up for a while yeah actually had a little different comment but to build on what you just said about fattening the animals in the feedlot the the way you get them fat is to feed them more grain the way you get them to eat more grain is to actually put less salt density in the grain because there is an inherent appetite for salt and so that's how they get them to eat more grain which gets me to the other question that I wanted to get to which is first of all congratulations I think you nailed the the political machinations and I'm more familiar with the salt questions than the fat ones but it's the same story and only the actors names changes the question I had was are you familiar with the latest research on the neural control of appetites there's a study that came out and a New England Journal just two or three weeks ago where it pointed out that for water for what was the third one got here water salt and for food generally quantities of calories are driven by appetites modulated by the brain activity so if you're not familiar with I'll share this story with you it's a fascinating story because there as I said a cow or a steer we'll have a inherent appetite for salt and that's how you deliver antibiotics to because you can meter it but it's it's there because the brain tells the keep eating why when you go to a low sodium diet as opposed maybe a little fat diet to but a low sodium diet people will keep eating the same amount of sodium and that you showed the chart about how we follow the guidelines salt is unchanged in the entire time of of that guideline except in the school lunch program where it's been required now to go down I'm sorry well no sorry finish your point and then I'll okay well the point I was making I think was that it's controlled by the brain and the brain will tell people keep eating whatever amount and it varies by individual their body needs and therefore if they tried to choose low sodium foods they'll just end up eating more foods so yes that is right I mean the the brain regulates appetite and it's the way I think about it is the body you know your body requires certain nutrients to survive and if your body is not getting those nutrients it sends a message up to the brain eat more so if you what I was saying is that you know that under the guidelines because they have they've reduced salt say in the school lunch programs that that mean there will be reduced salt in any of the USDA feeding assistance programs and that means that kids are likely well then if they can get it you know eat more food because they need the salt it's true of other foods too and and that's one of the reasons why people when they reduce carbohydrates and they increase fat and protein in mainly in animal food say they they won't eat as much or they won't what you know is a sort of a tautological term but they won't overeat and that's because their body is getting those foods contain the nutrients that they need and the fat that they need to be healthy so they find that but that the way to talk about is they say fat and protein are more satiating and they fill you up and they've done experiments where they put a stack of pork chops in front of people and say you know eat you must eat these people cannot overeat in pork chops or steak you know just like I'm full I'm really full and I can't eat anymore but you know what it's like to open a bag of cookies or crackers or popcorn or crisps or you know whatever you can you can eat that stuff forever and I know because I used to live on rice cakes and I could just never get to the bottom of the number of rice cakes that I could eat because I wasn't getting the nutrients that my body needed so your body is sending up that continual message just keep eating until you get what you need to feel satiated and what is satiating is the right amount of nutrients and and and and fat and protein so that your body can survive healthfully so so anyway so that's it's it's a complex subject about appetite but I think it's basically driven by our basic biological needs our bodies are not idiots you know these ideas like oh go fill yourself up with water before a meal or fill yourself up with celery or your body is not that dumb it's not gonna be filled up with celery you're just gonna get hungry later on and eat something else until you give it what it needs to live okay you've been waiting for a while and then yes yes the diet that made everyone sicker and I keep seeing this stuff over and over again and you pointed out the history of the American Heart Association why can't the ABA be sued into extinction because the amount of human misery that they're responsible for is just unbelievable I mean this tops anything you could talk about in the 19th century with respect to Medicine okay and why can't then they get away with it every time yeah yeah I mean um so first I want to tell everybody about this a little bit more about this study it's called the virtus study because it was funded by a company called verda --that made the the mobile app that was used to communicate with patients and that was a really good way of staying in touch with patients it's it's over 300 people who when they entered the study it's a university based study at the university of indiana when they started a study they had on average been suffering from diabetes for eight years that is very unlike other studies where people are pre-diabetic or or in the early stage of diabetes these people were had serious diabetes they were on multiple medications and after one year of going on a very low carbohydrate diet which by the way they tested with adherence by measuring their ketone levels which showed absolutely you cannot you cannot get ketones in your blood if you're not on a very low carbohydrate diet so they had excellent adherence 60% had reversed their diagnosis of diabetes and compared to the control group which followed the American Diabetes Association diet they have 0.1% reversal and that's because the American Diabetes Association tell us you eat carbohydrates but just match it with insulin so you know you're just trying to chase your carbs all day long matching it with insulin and then you ever more insulin and and your insulin is not a benign drug it makes you gain weight weight also so you're in this like negative loop of gaining weight getting more diabetic the American Diabetes Association is almost 100% supported by pharmaceutical companies that make insulin so it's just I mean I think it has just has to be said it's just a wholly captured organization that is not serving the public and why can it not be sued I don't know that it can't be sued I was told by one expert that if you have scientists legitimate scientists who will stand up on both sides of the debate that they can make a defense that this is scientifically justifiable legitimate scientific debate and therefore they have their protection against they a lawsuit but you know I would love to see somebody test that if there are any lawyers in the room here you go back to your second last slide yes that one I'm looking for the one where the dietary guideline goes in third the one that has a low B City okay very guidelines go in in 1980 and in 1981 we have seen a 4% increase in obesity I don't think people get obese that fast so there so there something was going on prior to the initiation of the guidelines that was going to predispose people which for the American Heart Association recommendations what it was yes so the official policy people started to change their eating habits starting with the American Heart Association in in 1961 they told everybody they told men to cut back on saturated fat and cholesterol and then they said then they expanded that to all people because they were basically their logic was it's just easier for a housewife to cook one meal for everyone so that's all let's all take care of the dad and and maybe we're preventing heart disease for everybody else in the family too in 1970 they start recommending the low-fat diet and everybody starts learning through newspapers and magazines and echoing that message to start lowering their fat and they did I think it is true that is a very sharp incline that you see there but you have to remember that the US guidelines the whole food industry is swiveling around to respond to them literally I mean the USDA puts out a notice saying we need in the next two years we need 3,500 more low-fat products on the shelves is they what it probably the federal registered it says to the you know to the whole food industry and all of cattle start to be you know they change all the cattle to be bred to be leaner and they change everything that's sold in the in the stores but but there had been this whole you're right there had been 20 years prior where the American Heart Association was getting out these messages and they're going out through it magazines and and so people are already changing the way they eat over here the so yeah 1997 was the the report by the Senate Select Committee on nutrition so and that came out and there was a lot well actually in the years that after right after that came out there was a lot of controversy around it and there was I would say there were a couple of years where there was just a tremendous amount of debate but yes so that was definitely sort of brought it all to the fore for the public and made it more um all these issues all more known good point all right you've been waiting for quite a while over here in the corner the question is am i calling for a rejection of epidemiological evidence or more skeptical I of it so epidemiology is really a science that is meant to generate hypotheses to be tested so it really is meant to say like hey we found an association between you know meat and cancer so let's go out and test that in a clinical trial that's what it's meant to do you're not supposed to take the epidemiological finding as a basis for public policy I mean the level of certainty that you need to have for public policy of an entire population it ought to be very high a high standard for telling people you know you were telling a healthy in 1980 we were still a fairly healthy population so you're telling a healthy population to change their diet and need a very high level of evidence so in general when you're looking at data there's these data pyramids that they have at the top are usually rent you know randomized controlled clinical trials or meta-analyses of those trials at the bottom are epidemiological studies and the critique of the dietary guidelines is that it's ignored these trials and elevated the epidemiology clinical trials you know populations populations you know it sounds like you're saying take you know epidemia off the table rather than considering all of the available evan it's given its strengths and its weaknesses and and i'm just trying to clarify you know you know is the position that you're putting forward that should not play a role in this policy I think for public wide population wide policy recommendations you need to have more than epidemiology epidemiology to make them you need to have replicated randomized control clinical trials on humans because the epidemiology has been shown demonstrated time and time again to be unreliable let me give you an example let me tell you what I mean by that just so everybody understands in two separate studies where they looked at nutritional epidemiological findings which include in the past you know take vitamin E supplements hormone replacement therapy take beta-carotene you know there's a cup there's a long list of them when they test those epidemiological findings in rigorous clinical trials they have been shown to be correct to zero to 20 percent of the time that means that eighty to a hundred percent of the time they're wrong so we can't I don't think it's fair to bet the public health on those kinds of odds like I just think that's irresponsible and we can see how we have gone wrong because the advice do you know all that advice not to eat cholesterol in your eggs and your shellfish and the reason we avoided all those really nutrient-dense foods was based on epidemiology that turned out to be wrong same thing with low-fat diet turned out to be wrong so I think we cannot and and not just wrong but harmed people hormone replacement therapy killed women so I think that we cannot afford to be that wrong like and we should not we should not risk our public in these kinds of experiments it would be better I mean according to the medical dictum it is better to do no harm so better to remain silent man in the back in the corner it's a great presentation thank you very much thank you so a couple questions first one is do you follow the Cleveland Clinic and dr. esselstyn's perspective on yes heart disease do you feel like that somewhat conflicts with probably have followed the China Study which yes you know those people have very high life expectancies and they're mostly vegan the third thing is you know the the meat and and and dairy that our forefathers ate is different from the kind of food that we get these days right I mean these cows are laced with hormones and antibiotics and then also if we bring in sort of where we are with our climate I know this is Cato and they're not exactly advocates for climate change but you know it's reality and you know so do we think about those things and yes appreciate yes so so there's a number of arguments about you know for the vegan diet so at the Cleveland Clinic there's somebody named Caldwell Esselstyn who recommends a vegan diet he's done one uncontrolled experiment so no control group on a very small number of people and was not welcome you not not controlled in terms of how he followed up on them so I think his data is not strong and it's why the dietary guideline committee didn't cite it they also did not cite the China study because that was never published in a peer-reviewed journal and has been there's been a number of problems found with that study which is in the end an epidemiological study never peer-reviewed never published in a peer-reviewed paper so there are problems with that literature the the question about meat and dairy being different today than they were previously you know I think that people always have the choice if they have the income to go and get you know higher quality meat and and higher quality dairy if they if they feel like that's where that I looked personally into where the question of whether there are actually hormones in our milk and they're not that turns out to be a sort of a myth that's been perpetrated but I don't know who but so you know if you can afford it but I mean I think given the choice of buying conventional meat which a lot of you know still contains folate selenium b2 all the B vitamins zinc iron compared to having pasta for dinner which contains none of those things in their natural form and it's full of carbohydrates I still think the better choice for a family on a budget is is the meat because its nutrient dense and it allows children to grow healthfully this the question of climate change and whether or not meat animal agriculture drives climate change is I think one I can just say it's one of unsettled science right now there are many things that we you know it's it's been promoted by people flying on private jets around the world but no I mean I take it as a serious issue it's just that I think that you know we need I mean my basic point is we need to we have a tremendous obesity and diabetes crisis in this country you know diabetes alone without even the side effects cost three hundred and twenty two billion dollars a year we are unhealthy we are suffering it is a huge economic cost so I think the the question that I ask myself is what is the diet that will make us healthy for which we have the evidence that makes us healthy and how do we make that diet sustainable we cannot enshrine this diet or the diet you know the diet that is making us unhealthy and make that the sustainable diet that that create that puts in place ever rising rates of obesity and diabetes which i think is unacceptable or should be unacceptable to us I don't know who is next to you here thanks for the presentation you know as you said your book is a lot about politics and there's a lot in your book that in a way isn't really limited to nutrition it's about academia and it's about rivalries and jealousies and studies and people saying I can't talk to you about that and that sort of thing as a result of your research do you think we should all have a more skeptical attitude just in general about what is or is not settled science I mean does does it give you a perspective on questions like you know the vaccine controversy and whether or not it's such a slam-dunk or we shouldn't at least have a grain of skepticism about whether or not that's settled science and if you're asking me if I have any trust left in the world not very much like I really distrust most claims now that I've seen how science can be distorted and how I think the process of doing science is so it there's so it's so deeply flawed not by the scientists themselves necessarily but by the way it becomes institutionalized hypotheses are adopted by institutions and then they become the favorite hypotheses and then it is almost impossible to be a dissenter or a critic and so the voices of the critics become marginalized and this is happening at a shockingly fast rate now that we have you know the the way that scientists and academic institutions have learned how to play into the media and and and do PR for their science and they because they know that's also how they'll get more research grants so it does make one me very skeptical about the ability to trust science so unfortunately yes I need to be one of those people that like goes off and lives off the off the grid yes over here I was wondering how does fast-food fit into all of this because in 1980 besides Reagan becoming president I think it's the food industry really started to take off so how does food so yeah a question about fast food I think is an excellent one which is we we have seen over the you know we've seen the great rise in manufactured foods but it really started and then in the 20s and 30s working to the rise of standard biscuit company and Heinz and they're all that's really when those companies started coming into being and then they really I am you know went into overdrive I think in the last thirty years so we're surrounded by what people call a toxic food environment and it is really hard for people to resist that that's definitely a factor in what's driving obesity but it's also true that there are many overweight and sick people who are trying really I'm saying junk food is not the only explanation and there are a couple data points that I want to give you on that consumption of sugar has actually been dropping since 1999 so has the consumption of refined grains consumption of whole grains has been rising since 1999 those are trends in the right direction yet we see no difference in obesity maybe there's a lag time response I don't know and it's also true that there are many many people who have had non junk food Laden diets in other words those nearly fifty thousand women who all went on the Women's Health Initiative they were not told to eat junk food they were told to eat fruits vegetables whole grains and they did not get any healthier this of course dovetails with my own experience making my own bread and having lots of fruits and vegetables and not eating sweets and being extremely good and and I only got fatter and sicker so I think there is I think that junk food is one component but it is not the only story here about why we are so unhealthy any other questions okay lady in purple in the back do you want it reading about how vegetarian and vegan diets are good for the planet you know because they don't use up as much land and water I mean do you have any comments on this so you know I'm not an environmental scientist so the question about vegetarian diets being better for the planet I think that you can look at you know the argument has always been there's you know it takes more inputs to create a pound of meat than it does a pound of plants right and that's always it so why should we be eating meat because this is much cheaper but if you calculate in a pound of plants comes with obesity diabetes heart disease maybe cancer that all of a sudden looks like a very expensive pound of plants maybe they you know a pound of meat without all the disease would be a better investment of our resources how about back there on the green hat oh sorry - I'd miss you out here hi I just wanted to kind of piggyback on a question comment from earlier is that one of the things that I'm a health fitness in that profession and one of the things I find incredibly disturbing and really frustrating is how like you were saying these methodologies methodologies and opinions become institutionalized and particularly in in the lack of nutrition education medical professions like my dad has diabetes recovered from prostate cancer is kind of borderline dementia and I have to argue with him against his own doctor's advice on what he should be eating like he's being told I advocate a low-carb higher fat and it's going against his doctor's advice his primary care physician he's different doctors and you know even several friends are doctors and they have a primary care doctor and an anesthesiologist have the same amount of nutrition education and it's really it's it's it's we're up against something like that is so heavily ingrained in and and how to go about changing that yeah medical schools yeah it's so wrong well this is why our strategy for change is to change the guidelines because you know the doctors are are taught the guidelines I just and they and they must fight if you're in a large medical practice you must follow the guidelines or you risk you know being sued us Medical while we have a doctor the audience who told me story is we're not allowed to not teach the guidelines another friend of mine who's in medical school and wrote and said I just sat through you know they get like one or two days of nutrition training in medical school and then they are taught the guidelines and he says our teacher is telling me teaching the guidelines and I just I just you know I'm on a low-carb diet and I and I just can't I can't believe what he's teaching us and he went to him after the lecture and said how come you don't mention anything about you know other kinds of dietary patterns and the professor himself said well I myself I'm on a ketogenic diet but I'm not allowed to teach you anything else and that's because of the medical associations which goes back to the diet of the guideline the guidelines are considered the gold standard they're considered the gold standard worldwide and until that changes it imposes such rigidities on our whole medical system and I you know actually feel sorry for doctors because you know it's not their fault they're really like they're just doing what they've been told and and so you know but but they are there is a rigidity imposed upon them but they you know most people can't can't break out of so I agree it's a somewhat tragic state of affairs yes thank you very much we've just had 40 to 60 years of collective error destroyed in just 45 minutes of excellent and elegant disruption is actually brilliant and the questions could tell how engage the audience we're thank you very much for a wonderful wonderful talk and then upstairs there are drinks and I'm glad to say lots and lots of cheese thank you very much [Applause]

Channel: The Cato Institute

Views: 88,327

Rating: 4.718576 out of 5

Keywords: keto diet, fat, is fat healthy?, low carb diet, diet, paleo diet

Id: hzQAHITIUhg

Length: 80min 19sec (4819 seconds)

Published: Thu Apr 04 2019