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There aren’t too many topics that really get me riled up anymore. I’m too old and too busy to care about debating the merits of stem cell research, the legalization of marijuana, or Proposition 8. Sure, I have strong opinions on all of these topics and more, but they are just that – opinions. Furthermore, there are enough other people out there, some reasonable, most irrational, already fighting those fights. So what does get me riled up? Every time I hear someone “assert” that saturated fat and dietary cholesterol lead to heart disease I have to bite my tongue. Why do I bite my tongue?
As Frederic Bastiat once said,
“We must admit that our opponents in this argument have a marked advantage over us. They need only a few words to set forth a half-truth; whereas, in order to show that it is a half-truth, we have to resort to long and arid dissertations.”
This is, unfortunately, quite true. When I’m at a dinner party and someone starts lecturing the table about the perils of saturated fat (or red meat, or eggs, or fill-in-the-blank), I’m at the point – after years of being kicked under the table by my wife – of just asking the “authority” at the table one question: Why do you believe this is true?
I figure, put the burden of proof on them, right? This week, and I apologize for how long overdue this post is, I’m going to get into the details of how this country (and many others who followed our lead) came to believe one of the most pervasive myths in the entire field of nutrition.
To write it all out would require a tome. In fact, such a tome already exists. It’s called Good Calories, Bad Calories. But for most people, especially the “authorities” who already “know” the answer, it’s a complex and lengthy book. Furthermore, it’s not exactly something you can just whip out at a dinner party.
I recently gave a talk at the UCSD medical school. I was asked to give a talk about “ethics.” While I have no professional training as an ethicist, I still think I have a good idea about what is and is not ethical. As I’ve learned more and more about this topic, it appears to me that the state of our current nutritional environment, with food policies based on just about everything but rigorous, experimental science, couldn’t make much ethical sense. I’m pretty sure if Plato, Aristotle, and Nietzsche were still around they’d be disgusted with how we got here. So, I was happy to take this opportunity to speak with a group of thought leaders on this important topic.
I gave a more recent (circa 2015) talk on the subject which captures both the video and and my slides, which I’ll share below. It’s about an hour long. But as Bastiat essentially said, if you want to overturn half-truths, you can’t do it with bumper stickers. Hopefully you’ll find this talk informative and useful for your dinner party discussions.
The link to this video can also be found here, for those reading this post on email or those wishing to view it in a larger format.
Photo by Irina Blok on Unsplash
Quick question—does your talk still make sense without the slides? I ask because I might listen while walking when I can’t watch a screen.
I think the saturated fat thing illustrates how most people form their opinions, or at least “learn truths”. They hear a piece of information enough times, assume those repeating it have done their due diligence, and therefore it must be right by its third or fourth airing.
Probably…but then you’ll be stuck focusing on my voice instead of the cool slides.
“They hear a piece of information enough times, assume those repeating it have done their due diligence, and therefore it must be right”
More regrettably, they falsely respect their government, media and educational institutions to publish correct findings. Once those findings have been misrepresented, even doing your “due diligence” leads you to very official (and seemingly credible) sources repeating the false conclusion. So it often isn’t possible for a layman to find the truth.
Bastiat quotes on a LCHF site?
It just doesn’t get better than this…
So glad I can teach AND entertain!
I’ve had a different experience, too–sometimes, once the conversation has gone on for more than a few minutes, the person (or people) involved say something to the effect of “yeah, I know, it really IS carbs,” often even followed up with “really the only way I’ve ever lost weight is by cutting carbs.” This has happened to me enough times that I think there are a lot of people who, deep down, “get” this–but it’s suppressed by all the flap about saturated fats that we hear daily.
In my experience these are 2 very different conversions. The “carbs-makes-most-people-fat” discussion is a much easier one to have than “there-is-no-good-evidence-saturated-fat-makes-you-fat-or-causes-heart-disease” one.
That’s a fair point. It’s probably not a good thing, but in my (and my friends’) age group (25-35), the latter doesn’t come up in everyday conversation much. I can usually allay any concerns that do come up by pointing people to your blog. (As you’ve said, don’t be afraid to outsource to the qualified!)
I hate it when the carbs this carbs that discussion comes up, it’s all a bunch of wank and in the end people go “ooh he’s on a low carb diet”. Well that’s not how I look at it, I also don’t eat glass or Nokia phones, so does that mean I’m on a low-glass/low-Nokia diet? No. I simply eat lots of fatty red meat, and the occasional veggie.
So yeah, unless someone bugs me about the metabolic stuff, I opt out of the carb conversations, however I do try to ask how/why someone thinks fat/meat is bad – and just like the reports in the media, I’ve never once heard an even slightly rational answer.
Wven my GF doesn’t know I’m “actively LC/HF/ketogenic”, she just sees me eating a lot of steak and when she cuts the fat/skin off her meat/chicken/fish I yoink it and devour it, which now and then leads to light-hearted discussions of “unhealthy fat” and stuff, but she’s quite open to my (mostly throwaway) observations on the subject. Then last night she actually ate the skin from her fish, I – with pouty face at missing out – asked her if it was any good, she was like “yeah delicious, and I figure it’s probably good for me”. So… win?
You are so right, Jacob. I followed Atkins but ate too much protein and too much so didn’t lose as fast as I should have, but I did succeed. I also new in my heart that carbs were dangerous but did Ornish (spit) four months in 1999 and gained 40lbs (didn’t over eat either; I’m a determined person, but in my defence, the bugger claimed such would happen and then would fall off)- fat intake was below 10%- hard to do better as even an apple has some fat in it. Tri’s went from boarder line to dangerous; Cholesterol the same. My MD handed me a bag of bad and a prescription, both of which joined burger rappers on my way to the car. Returned to the arms of Atkins, a saint, and lost it again. Still had my doubts until I saw the movie “First Do No Harm” on a ketogenic diet staring another saint, Meryl Streep. Bless her heart to do a TV movie she must have believed in.
The media and M.D.’s (Good Peter an exception) are powerful agents of evil.
Dr. Attia,
I appreciate your thoughtful essay. This is a difficult subject. We want people to throw away their old fears in a convincing simple way.
I subscribe to Dr. Conversation. A blog about ,well, better conversation. Recently he mentioned this very subject.
Not boring people with information but getting the gist across and planting a seed for more.
In my case I’m hiking the entire Pacific Crest Trail over many years in sections. I’ve bored a lot of people over the last nine years with my adventure. Confused most of them. Finally I’ve come up with an elevator pitch. “I’m walking to Canada. I’ve gone all the way to southern Oregon.”
This of course isn’t as difficult as saying “Everything you’ve heard about nutrition is wrong” but it’s a start.
You’ve picked a challenging subject for your life. Well worth it. I’m excited to be receiving your blog.
I’m thrilled to hear you’re in San Diego. I’m in El Cajon. I’ve got a daughter starting her residency in Pediatrics at Loma Linda. She eats low carb most of the time to control her weight. I’m forwarding your talk to her.
Magically,
Dana Law
Thanks, Dana. I’m still working on my 30-second version. I’m 1/120-th of the way there!
Nicely done presentation Dr Attia. Thanks. I was only disappointed that we did not get to hear the Q&A session.
It was very long. The Q&A was another 90 minutes! Perhaps another time.
I would love to hear the Q&A session. It would be very enlightening to hear the kind of reactions from those who’s groupthink popculture world vision was just challenged.
The Q&A was actually the best part, but it was somewhere between 90 and 120 minutes! People asked really great — and provocative — questions. Also, we only had my audio recorded, and not that of the questioners. Sorry…
I agree completely, please please please if you record more lectures catch the Q&A, its always the best part. Typically someone filled with the exact information you are disproving steps up with some novel piece of information, and the lecturer has a great ‘real world’ counterpoint. It’s something we yearn for to use in our real life conversations with these types of people in our families, among friends and co-workers, etc.
Will try.
Yes, PA, please post a link to the Q&A at some point. It’s too bad the questioners didn’t get recorded but I for one would love to hear it.
Perhaps this is a shameless plug, but I find it funny that I posted something just a few days ago that also considers such things in an ethical light: https://lyongroup.net/2012/07/14/the-importance-of-being-self-critical/. Clearly, your presentation is far more detailed, but I am very concerned about how the bias apparent in much of the history you present is becoming prevalent in experimental basic science research. Note that the intended audience of my post was graduate students in our PhD program, thus its particular tone – I am not a health and diet blogger by any stretch of the imagination. Anyway, nice job – I enjoyed the presentation tremendously and plan on disseminating this to my graduate students as an additional cautionary note.
Andrew, great timing. I like your post a lot. Very important and I hope some of the readers here can make the time to read it, too.
I have been trying to think of an appropriate bumper sticker and just keep coming back to Praise the LARD. In my case it is more Beef Dripping than Lard though.
Loved the video, watched it during my lunch break. I am looking forward to questioning my GP on why they think that Sat Fat is bad. But then I tend to ignore nearly everything my GP says.
I am reminded of my wife’s Health Check when watching and reading your info on Cholesterol. Here in the UK, once you turn 40 you get a free health check by the NHS and as part of it, they test your cholesterol… using the standard method of course. Anyhow, my wife was asking what the Health Check looks for and instead of the health nurse saying we check your cholesterol, she actually said we check if you need to go on statins or not. Seriously!
I bet the big pharma loves the way this is heading.
Eating Fat is Where It’s At!
One more time!
Travis,
Praise the Lard-witty!
An interesting posting.
Incidentally, I took myself off statins, they were turning me psycho, short tempered-more than usual(!), aggressive and antagonistic.
I wonder if others have noticed this?
Regards,
Nick Curry
Thanks for the laugh!
I recently came across your site and am grateful to you for your clear explanations and good use of metaphor. I am a 50-year-old active male (work out 4-5 times a week, hang glider pilot), and no matter how carefully I monitor calories, I’m overweight (6’1, 235). I am hoping that ketosis is the answer for me. Thanks again for making such a compelling case for it.
And one question, before my first comment has even been approved! (Sorry.) I know out there in the “paleosphere” there is much discussion that insulin/carbs/sugar is not at all the entire story, especially as they pertain to weight loss. Much of the discussion centers around either “food reward” or “gut bacteria” as the major players. I wonder what your thoughts are on these topics? Are these “second tier” concerns that we maybe ought to be worrying about only after “first tier” problems are addressed? Thanks!
These issues are not mutually exclusive, but we must keep Occam’s Razor in mind. What is driving the change to sub-optimal gut biota? What is triggering the food reward system? What is driving the hormone that drives fat accumulation? Furthermore, keep the idea of “ordered terms” in mind.
Your talk and slides are a really great tool to disseminate to folks who have read Why We Get Fat, but who couldn’t read GCBC because of the snooze it gave them in the first section. I always tell people that if they can get through that first section, it’ll piss them off enough about the impact on their health to read the rest, but most don’t. I’m always looking for a way to effectively convey this story because it’s been my experience that until people actually understand what happened in the science and public policy around low-fat and cholesterol, they can’t drop their fear of fat, which is DEEPLY conditioned. In spite of how few people currently trust doctors or the government, they still believe in the authority of low fat, and none of the other great low-carb diet books are effective enough in making the case. The movie Fathead did a good job, but your presentation is shorter and brings more gravitas to the examination of the studies I will be sharing your presentation a lot and thank you. I, too, would have liked to hear the Q&A.
While watching, I remembered what it was like to be in the middle of this jacked-up scientific consensus going on in the background while this freight train of the first food pyramid and the low-fat diet industry was taking over the country. Ornish published while I was in grad school, and those angiograms stopped everybody cold. How could you dispute those pictures? Even my department, which was really full out neurotic that we be critical thinkers about methodology, pitched Ornish’s findings as though they resulted from low fat, low cholesterol. My first job out of school was in a hospital obesity department, where we used Medifast, a ketogenic diet. The impact of carbs was obvious both on people’s weight problems and on weight loss, and led us to understand the problem with all of these new low fat foods as being high carb (I used to start my seminars by asking how much weight have you gained on the No-fat Snack Wells Diet?). But we were still keeping our ketogenic diets low fat, so they ended up being very high protein and low fat. People lost weight, and while they did not suffer hunger, they lacked vitality, many experienced depression in the latter phases of their weight loss when body fat was low and thought they had emotional issues related to their weight (rather than metabolic issues causing depression related to the low fat diet we had them on), and they did not maintain. I always thought we should have transitioned them off Medifast (which is still low-fat, btw) onto Atkins, because pretty much everybody came into the department acknowledging that it was their bread, pasta and sweets diet that made them gain weight and drove their hunger, but that was blashphemy. I wish I knew then what I know now about fat.
One of my favorite slides in your presentation, though, was the early one about health care costs. People talk about that a lot, but to see it in that graphic form is impressive for the argument to reform healthcare, and especially to lower obesity.
One thing I forgot to mention in my post…can’t believe I forgot this! After my talk at UCSD a woman in the audience commented that she was one of the people in the 1984 NIH consensus led by Basil Rifkind. She said they were TOLD what the “consensus” was going to be while locked down in the room for 30 hours. In other words, Rifkind had his mind made up before the “consensus” meeting got under way. I couldn’t believe it, but I did some background checking and it checked out. Unreal…
@Peter, well I can only say from personal experience that the perpetration of that fraud and the power of authority brought to it by the government getting involved in food policy was mind bending for a lot of really smart people (me included) who were trying to help during that time. I mean, I understood the biochemistry of ketosis, but under the influence of all that authority, we missed connecting all the dots, and instead turned ketosis into something that got rid of all fat (because of the bias) rather than just recognized its ability to reduce the amount of unwanted body fat. Consequently, we hurt people, possibly even as much as their obesity was hurting them, maybe even more. And what’s worse, we turned them loose back to low fat prescriptive diets. I experienced a lot of cognitive dissonance about that, and frustration with the lack of maintenance. So I don’t work in hospitals anymore :)………and, my colleagues who are staff Diabetes Educators suffer the same. Even if and when they get it (which I have found takes a lot longer than you would think it would take smart people to see the reality of the basic science, but that institutional bias is insidious), they can’t implement it on the job because it violates the protocol. And you know, we can’t have that.
The best response to any conversation implying saturated fat or cholesterol is bad for you is to simply state that it is good for you. If the other person is a zealot, it’s the easiest way to get under their skin and put them on the defense. If the other person is someone who is just reiterating an “authoritative” statement, it is much more persuasive to demonstrate a dissenting opinion by the simple, mild expression of it.
Why is this an acceptable response? This concept it not at all backed by science. In fact, the overwhelming balance of evidence suggests that blood cholesterol levels are best kept heavily in check, and that saturated fat is an enormous risk factor for atherosclerosis and subsequent CVD and stroke. Unfortunately, Dr. Attia has painted an erroneous picture that the associations between cholesterol intake, saturated fat intake, and chronic diseases of affluence are meaningless. Please, Dr. Attia, explain why the ONLY dietary interventions which have ever proven capable of resulting in 1) permanent and long term weight loss; 2) complete reversal (e.g. cure) of type 2 diabetes, insulin resistance, and disorders of glucose metabolism; and 3) regression of atherosclerotic plaque, is a HIGH carbohydrate, very low fat, cholesterol-free plant-based diet? Please explain how you will refute the decades of interventional research that proves this by an entire genealogy of research physicians, such as Esselstyn, McDougall, Pritikin, Ornish, Barnard, and Fuhrman? How many studies are there that prove that ketosis and/or low carb and/or high fat/high cholesterol diets improve and or reverse parameters and symptoms of chronic disease? The answer: zero. And furthermore, low-carb diets have been strongly associated with early death.
This is in response to Caroline’s comment. Caroline, I would very much like to see this research that associates low-carb diets with early death. And I hope you do not mean those observational studies that make the association between meat consumption and early death, because those are highly problematic. As far as I know, all the “real” longer term studies (over 6 months) have come up with positive health indicators in every area that was tested, i.e., trig/hdl ratios, trig levels, belly fat, crp levels, etc.. I can offer quite a few references for this information if you need. Please refer me to the studies that support your hypothesis.
Excellent talk. I was reading a book about Fats & Oils by Mary Eades. In one section she talked about how the liver creates different SFA’s for use in the body as fuel. It occurred to me that if the body is making them, then why is there such a big fuss about eating them? Even if you don’t eat them (Ornish) your body makes them anyway. Your body knows what it is doing and wouldn’t be making these molecules on purpose if they were harmful to you. If that was the case, the epidemic of CHD would not be such a recent (last couple hundred years) type phenomenon.
I’m a family physician in Israel and have been recommending low carb diets since I read Gary Taubes’ books, other books on low carb science and your blog.
Thank you for this lecture! It really will make it rasier to explain this to my patients and friends, and maybe also to my colleagues. As you’ve probably experienced many times it’s really difficult to talk to other physicians about low carb high fat diets.
One comment – It would have been easier to follow the lecture if there had been some more slides on things you talked about but didn’t show on slides, like some more studies you mentioned. This is especially true for non native English speakers.
Mira, this was the very first time I gave this presentation. Hopefully, the more I give this talk, the better I can make it, especially if I can spruce up the slides a bit. Of course, you know what’s coming next, right? I just don’t have the time time….
Brad, No intent to hijack but if you cut your carbs to 20g/day, you WILL lose weight.
I’m 46 and dropped 20lbs in 5 wks ! Pretty efortlessly. No more stomach problems among
other things.
@Bill, eh maybe not always if you’re a postmenopausal female, and I quite appreciate Peter delineating that metabolic universe in his talk.
Bill, Thanks….I appreciate the encouragement.
Peter, as much as I like your well-structured talks and especially the very content, please consider taking a look at state-of-the-art slide creation, i.e. as in “Presentation Zen” or “slide:ology”. Even if you have (chronically) little time on your hands, thinking about presentation design will really benefit you (and your listeners) in the long term.
I could use all the help imaginable… Hopefully once NuSI is up and running, I can have a person working on this full time.
Godspeed to NuSI! 🙂
I am am between MS1 and MS2, and it is atrocious the way medicine and nutrition are taught. First, we had PhDs teach our entire physiology course (except the maternal fetal section, which an MD taught very well). The GI lectures (and for that matter each organ system) did not integrate well with the Endocrine lectures, but it was possible to step back and see the big picture. Sadly, that was not tested and many of my less health-conscience classmates did not get the message of carbs, fats, insulin etc or spend the extra time to ask what it means practically. Biochemistry and metabolism was just as bad because we only looked at pathways and cells, not really understanding how they integrated.
All that said, the worst was nutrition. Medical school sucks at nutrition, everyone knows that, but we were taught by the nutrition students! It was a non-tested “extra” set of lectures. They railed off guidelines by government think-tanks (with shady ties to the agricultural industry, but conspiracy theories aside). I am certain they don’t understand the difference between equality and causality and how the former makes for very bad science. I guarantee they don’t understand anthropology or the implications of the agricultural revolution on the human body.
You inspire me, though at this point (in my naivety) I still want to do patient care. Specifically, I want to do primary care because this message needs to be given by the GP. My current summer research is on the prescribing tendencies of family physicians with respects to LDL, and while I loved your multipart series on cholesterol, proper understandings of the integration and implementation of physiology, biochemistry, and nutrition would do more good than even the greatest statin.
P.S.
I am sure Bastiat would agree that a misconception this ingrained is the product of a government too involved in the agricultural, medical, and basic science industry. He would commend people like you, striving to give the gospel of evidence based (and properly interpreted) knowledge in action.
Mark, if it makes you feel any better, every 2 years I need to re-certify my medical license by taking CME courses. Can you imagine what I have to emotionally go through on the “nutrition” section? I actually have to take an exam and knowingly answer questions incorrectly.
BUT…don’t lose sight of the fact that you and your classmates are the future of medicine. Challenge your professors. Get your peers to do the same. Demand the best of your education and never lose sight of why you’re doing what you’re doing.
Wait, there were bumper stickers in Bastiat’s day? You must be mixing metaphors!
Good point…
Dr. P. Attia,
I am a Type 1 Diabetic and have been learning more in the last month from your site than 11 years of doctor visits. Thank you. I first came here through Mark’s Daily Apple and have been reading both blogs daily for several hours while standing at work (I have catching up to do) . Since going primal/high fat and training in Ketosis I have enjoyed awesome blood sugar levels (1st time in …forever). I ran 18 miles for the first time this weekend and did not need any carbs to maintain my blood sugar levels. In fact I left the house at 69 and had my CGM on and stayed rock solid. Your information is impacting my health in a very big way and I wanted to say thank you so much. I am very excited to see you up-and-coming blog on T1D.
You just made my day. This is remarkable! One thing…please don’t get upset at me if your boss gets upset for your use of work time!
Wow, that is just the best!
That is so fabulous! Do you think you could write up your story as a testimonial for MDA or Robb Wolf’s blog? Sometimes in the comments of these blogs I’ve seen readers assert that type 1 diabetics just need to throw away their insulin and eat a ketogenic diet and they will be fine, and I worry that some day someone will actually follow that advice and get into serious jeopardy or even die. I know people get really excited about this stuff but I feel like we demonize insulin too much–it’s not that insulin is out to kill us, it’s all about eating too much carbs. Some of the blog readers seem not to realize that type 1 is very different than type 2. Anyway, it’s great that you are doing so well!
I second that.
Its perfect that you quoted Bastiat, makes sense. Have you read “The law”?
Ha, funny you should ask! Just bought for my ipad. I assume you approve and recommend? Does it warrant getting bumped up in the line?
Don’t worry, I am a paper pusher for the Gov. and my boss is an Attorney who would allow me to make my case that this is time well spent in that it is increasing my health and longevity and therefor ensuring the quality of his employee and keeping health care costs for the tax paying people lower.