An Access Advertising EconBrief:
Put Your Faith in Markets, Not Science: The Saturated-Fat Scandal
“Saturated fat does not cause heart disease.” That was the conclusion of a study published in the March, 2014 issue of the respected medical journal Annals of Internal Medicine. It is also the opening line of an essay in the “Review” section of the Saturday-Sunday, May 3-4, 2014 issue of The Wall Street Journal. The author, Nina Teicholz, is a journalist whose decade-long research on the relationship between dietary fat and disease will appear in the publication of her book, The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, due for publication on May 13.
Ms. Teicholz’s article tells the revealing tale behind the demonization of saturated fat as the leading culprit behind coronary artery disease. In itself, it is a morbidly fascinating cautionary tale of a scientific scandal. But the larger significance of her story is its status as one more exhibit in the intellectual case against science and in favor of free markets.
For over a century, Americans have been beguiled by a vision of science that accompanied the progressive political movement in the early 20th century. We have been entreated to embrace science as our only bulwark against ignorance, superstition, bigotry and obscurantism. Scientists in white coats have replaced clergy as the public repository for blind trust. Scientists are seen as disinterested seekers after truth, sworn to uphold the scientific method, wedded to the laboratory.
This attitude is difficult to reconcile with the story told by Ms. Teicholz, in which “nutrition policy has been derailed over the past half-century by a mixture of personal ambition, bad science, politics and bias.” Uh-oh. Is this an aberration – or is this really the way science does business?
Faithful readers of these EconBriefs will recall a previous column that blamed the nutrition establishment for our current “epidemic” of Type II diabetes. That story is now being told to mainstream America by professional journalists. We will put Ms. Teicholz’s cautionary tale under a microscope. Then we will put it on the scales of history and weigh its evidentiary content in the balance between science and markets.
“Eating Fat Makes Us Fat” – The Triumph of Intuition Over Experience
Personality isn’t supposed to play a role in science. Only results are supposed to count, obtained via the scientific method, scrutinized and verified by peer review after being subjected to the test of falsification.
Yet the evangelist against saturated fat, Dr. Ancel Benjamin Keys of the University of Minnesota, was “formidably persuasive and, through sheer force of will, rose to the top of the nutrition world – even gracing the cover of Time Magazine – for relentlessly championing the idea that saturated fats raise cholesterol and, as a result, cause heart attacks.”
Keys was “in an excellent position to promote his idea” because he headed up a study on nutrition and heart disease. Ms. Teicholz uses the word “promote” advisedly, since his approach resembled that of P.T. Barnum more than that of Jonas Salk. Keys had to pick countries from which to examine nutrition data. He chose the ones favorable to his preconceptions – Yugoslavia, Finland and Italy. He ignored those that would have overturned his thesis – France, Switzerland, Sweden and West Germany. Most outrageous of all was Keys’ research on the island of Crete.
Keys’ research subjects on Crete supposedly included relatively poor farmers who worked in the fields well into old age and whose diets were largely bereft of meat and cheese. In reality, the actual sample from which conclusions were drawn consisted of only a few dozen men rather than the initial random sample of 655. The diets were surveyed during Lent, when the men were giving up meat and cheese for religious reasons. And the research took place during the time of privation immediately after World War II, when shortages and rationing drove up prices and made meat expensive. Thus, meat was temporarily less attractive rather than traditionally shunned.
According to the precepts of science, studies should be available for replication and verification by peers. This is done to weed out bad science and discourage intellectual fraud. Sure enough, scientists reviewed Keys’ work in Crete – but they didn’t get around to it until 2002. “…By then,” Teicholz observes chillingly, “the misimpression left by his erroneous data had become international dogma.”
The snowball Dr. Keys formed gradually became an avalanche. He joined the nutrition committee of a sleepy organization called the American Heart Association. AHA was becoming prominent in proportion to the increasing prevalence of heart disease in the American population. In 1961, AHA issued the first in a long series of dietary guidelines warning against saturated fat in the diet. This attitude spread throughout the federal government to the Department of Agriculture.
Research trials using vegetable oils in cooking produced results favorable to the saturated-fat hypothesis. The controls on these studies, or rather the lack of them, made them suspect. Subjects migrated in and out of the studies, making their behavior difficult to monitor. Smokers were commingled with non-smokers, introducing a confounding causal variable. By today’s standards, the studies were shockingly lax.
“But there was no turning back: Too much institutional energy and research money had already been spent trying to prove Dr. Keys’s hypothesis. A bias in its favor had grown so strong that the idea just started to seem like common sense.” In 1977, Harvard professor Mark Hegsted’s testimony persuaded the U.S. Senate to recommend a diet low in saturated fat for the entire nation. “Important benefits could be expected, he argued. And the risks? ‘None can be identified,’ he said.”
This was the watershed moment. The imprimatur of the federal government was stamped on a scientific hypothesis that was given a blanket recommendation to the American public. That hypothesis was the product of shoddy science conducted by a fast-talking promoter. The benefits of the hypothesis were purely hypothetical. Its risks were completely overlooked.
This is exactly the sort of outcome that left-wing progressives have long ascribed to free-market capitalism. Their presumption provided the signature rationale for government regulation of private business. This sort of outcome is allegedly precluded by the safeguards implanted by the scientific method.
Yet this was exactly the outcome achieved by scientists themselves, operating within the government itself. And subsequently this outcome was ratified by thousands of scientists throughout the system.
The Degradation of Science
There may be readers who find this verdict too harsh. This was a one-time failure, they may feel, the result of a constellation of unforeseen and unforeseeable forces, no more typical of science than a serial killer is typical of humanity at large. Very well. Let us finish the story and bring our cautionary tale up to date by way of responding to these objections.
In the end, it will be all too clear that the saturated fat fiasco was not unforeseeable. “In fact, even back then, other scientists were warning about the diet’s unintended consequences. Today, we are dealing with the reality that these have [introduced].”
Eating less fat means eating more carbohydrates. Americans constantly face the charge of being self-indulgent, undisciplined eaters. The truth is that consumption of saturated fat has fallen by 11% since the 1970s. Meanwhile, Americans are eating 25% more carbohydrates since the 1970s. And consumption of grains has increased 50% since the 1970s.
Fat is one of the principal elements of taste in food. Remove it, and you take away much of the taste. Tasteless food does not sell well. The cheapest, easiest and most tasteful substitute for fat in food is something sweet. That means sugar in any of numerous forms: fructose, sucrose, maltose and others.
In addition to taste, fat also adds texture. This is where carbohydrates enter in other forms, such as grains and starches.
The substitution of sugars, starches and grains for fat was not condemned by the nutrition establishment. In fact, it was encouraged. Although sugar was considered basically non-nutritive – “empty calories” was the phrase most often used – it was viewed as lower in calories than fat per unit of weight. Teicholz notes that the AHA recommended “soft drinks” as a beverage snack until 1999 and “gum-drops” and “hard candies made primarily with sugar” in preference to fatty snacks as recently as 2001.
This was bad enough. But there was even more bad news in store. “The second big unintended consequence of our shift away from animal fats is that we’re now consuming more vegetable oils. Butter and lard had long been staples of the American pantry until Crisco, introduced in 1911, became the first vegetable-based fat to win wide acceptance in U.S. kitchens. Then came margarines made from vegetable oil and then just plain vegetable oil in bottles.”
Proctor & Gamble, the manufacturer of Crisco, helped raise funds for the AHA, which in turn created the image of cooking with “heart-healthy” vegetable oils. In contrast to the left-wing view of intractable, intransigent American consumers, we devote 7-8% of all calories in our foods to vegetable oils – “the biggest increase in consumption of any type of food over the past century,” according to Teicholz. In 1900, our consumption of vegetable oils was virtually non-existent.
If that sounds like a good thing to you, get ready for a shock. The earliest clinical studies – not recent research conducted by an author selling a low-carb diet, say – found that people who consumed larger amounts of vegetable oils were more prone to get cancer and gallstones. More bizarrely, they were also more likely to die in violent accidents and by suicide. Health officials still struggle to explain these results.
The earliest experiments on animals also revealed that oxidation of vegetable oils when heated by cooking produced cirrhosis of the liver and increased the likelihood of early death. For just these reasons, vegetable oils were turned into stable solids that were less vulnerable to oxidation during heating by a process called hydrogenation. If that sounds familiar, it should. Hydrogenated vegetable oils are now considered verboten due to their propensity to produce “trans fats.” Trans fats have now virtually vanished from the American food supply, but not before they the hardened vegetable oils that housed them “became the backbone of the entire food industry, used in cakes, cookies, chips, breads, frostings, fillings and frozen and fried food.”
In order to avoid the imaginary perils of saturated fat in cooking, we went to vegetable oil – which led to cancer, gallstones, brain damage and cirrhosis of the liver. In order to avoid these, we went to hydrogenated oil, which led to Trans fats. Thus, the move away from butter and lard has been a disaster. And that isn’t all…
The Asymmetry Between Men and Women
It turns out that the phoniness of the war on saturated fat isn’t the only thing that regulators and nutrition officials have been keeping from the public. The famous Framingham study on heart-disease risk factors, which formed the basis for much medical diagnosis and policy over the last four decades, uncovered an apparent asymmetry between men and women that has since been confirmed by subsequent research.
Higher levels of total cholesterol among women over the age of 50 were not associated with higher levels of heart disease. In fact, the opposite seemed to be true. Teicholz calls this result “counterintuitive,” but that is not quite true. The key lies in the content of the word “total;” many older women with higher total cholesterol also have higher levels of protective HDL, the so-called “good” cholesterol. Finding ways to reduce the “bad” components of total cholesterol (LDL, VLDL) without also reducing HDL has been a leading problem perplexing pharmaceutical companies over the years. The point is, though, that low-fat diets seem to reduce HDL disproportionately in women, which is clearly counterproductive.
But the asymmetry did not find its way into the study’s conclusions upon original publication in 1971 and only recently has it been acknowledged. “The sad irony is that women have been especially rigorous about ramping up on their fruits, vegetables and grains, but they now suffer from higher obesity rates than men, and their death rates from heart disease have reached parity.”
The Valid Science of Weight Loss and Blood-Sugar Control
The legitimate science of weight gain and loss has been slow to develop. But this development has firm foundations. It has been buttressed by the experiences of millions of Americans who are inherently intolerant of carbohydrates or have developed latest diabetic tendencies. They have been driven mad with frustration by inability to lose weight on low-fat diets and are hungry for alternatives. Teicholz rehearses the details sketchily: “The problem is that carbohydrates break down into glucose, which causes the body to release insulin – a hormone that is fantastically efficient at storing fat…Excessive carbohydrates lead not only to obesity but also, over time, to Type 2 diabetes and, very likely, heart disease.” And according to Teicholz, recent research even implicates non-refined carbohydrates as culprits.
The reason why eating fat doesn’t make you fat is not actually explained by Teicholz in the Journal piece, but it is worth exploring. When we eat carbs in preference to fat, the carbs are quickly absorbed into our bloodstream. For many of us, this fast absorption causes the body’s level of blood sugar to spike upward. Human blood sugar must remain within fairly tight limits for good health. When the limit is breached on the upside, this is what triggers the release of insulin, which cures the blood-sugar problem by soaking up the glucose and storing it as fat. (This is an evolutionary response, probably linked to the scarcity of food and the need to store energy for the future.) But there remains a problem of what to do for energy, since the insulin has soaked up the blood sugar into which the carbohydrates metabolized. The body remains hungry; we eat more carbs, get fatter, and stay hungry and tired.
Reverse the above process by eating fat in preference to carbohydrates. Now the body does not store fat – even though we’re eating fat in significant amounts – because we’re burning it for energy. We’re not eating that many carbohydrates, after all, and the body is indiscriminate about where it gets its energy; it will throw whatever source is available into the furnace. Burning protein and fat for energy means that we store less fat; the stomach fills up quickly and the body burns the energy ingested in the form of food because protein and fat take longer to digest and do not trigger insulin-release and fat-storage.
Of course, it is theoretically possible to eat too much fat and protein and gain weight, just as it’s theoretically possible to lose weight on a low-fat, high-carbohydrate diet. In each case, the level of exercise could be low or high enough to tip the balance. But it is very difficult to do each of these, which is why millions of Americans are now switching to a low-carb regime, losing weight and regulating their blood sugar for the first time.
The Reaction of Science and Government: Stonewalling and Hypocrisy
When the truth came to light – first in the 1970s and more recently with the weight-loss science associated with low-carb diets – how did scientists and nutrition officials react? Did they move quickly and decisively to reverse their earlier errors? Did they disseminate good science as rapidly as they had earlier spread bad science?
“Seeing the U.S. population grow sicker and fatter while adhering to official dietary guidelines has put nutrition authorities in an awkward position. Recently, the response of many researchers has been to blame “Big Food” for bombarding Americans with sugar-laden products. No doubt these are bad for us, but it is fair to say that the food industry has simply been responding to the dietary guidelines issued by the AHA and USDA, which have encouraged high-carbohydrate diets and until quite recently said next to nothing about the need to limit sugar.”
Ms. Teicholz has come to the nub of the comparison involving science, government and markets. Scientists and government regulators portray themselves as noble truth-seekers and watchdogs, disinterested umpires with only our best interests at heart. But Ms. Teicholz now states that these people are put “in an awkward position” by the revelation that saturated fat is not, after all, unhealthy and the cause of heart disease. A noble, disinterested truth-seeker, faced with this truth, will immediately broadcast it to safeguard the public and prevent further damage to our health. Noble truth-seekers are unconcerned with their image; they care only about truth, justice and public welfare. But the scientists, regulators and policymakers who were faced with this choice stonewalled, dissembled and hid the truth. And they did it by the dozens, in administration after administration, for decades. This is the decisive refutation of the defense that this outcome was just an exception. Dr. Ancel Keys may have been an exception, but the scientists and regulators who conspired to conceal his bad science were the rule, not exceptions. Once Keys got a foothold within the system of science and government, that system worked to perpetuate him, not to discredit him.
Notice that the first thoughts of the nutrition officials are not for their constituents, but rather for themselves and their political sponsors. Again, this is the supposed paradigm followed by private business in free markets: denial, cover-up, embarrassment and concealment of the truth. But the people who actually get away with it are the supposed seekers after truth in science and government.
Somehow, it is difficult to work any sympathy for the awkward situation faced today by nutritional officials in view of the incidence of obesity, diabetes, heart attacks, heart disease and hunger cravings suffered by the constituents whose welfare was trampled on by the system.
How Was the Truth Discovered?
The vital missing link in the saturated fat scandal as told thus far by Nina Teicholz is the route to the truth. She alludes to valid research dating back to the 1970s, but makes it clear that it was drowned by the tsunami of anti-saturated fat propaganda generated by the nutritional establishment. So how did today’s counterrevolution occur? When did the scientific community wake up and smell the coffee?
The answer is that they didn’t. They were dragged kicking and screaming to the truth by the public and the free market. The same profit-motivated, greedy, self-interested, unscientific private sector that scientists and government constantly warned us to fear and mistrust proved to be our salvation. The counterrevolution was led by a medical and nutritional renegade who founded the low-carb diet in the 1970s, Dr. Robert Atkins. It was Atkins who first preached that carbohydrates of all kinds promoted obesity and heart disease. It was Atkins who insisted that a low-carb diet was not only an ideal way to lose weight quickly but actually the right long-term maintenance diet for healthy living. And for being a pioneer, Atkins paid the typical price paid by pioneers: He was demonized, ostracized and declared unfit for civilized society. Even today, the same doctors who now prescribe his methods to their patients refuse to acknowledge him as the nutritional savior of America.
It is true that Atkins did not have all the nutritional science down pat. But we can hardly blame him for only getting some of the facts straight when the nutritional establishment got virtually all of them wrong. When one of the country’s leading cardiologists, Arthur Agatston, can nonchalantly confess in his book on the South Beach Diet that “the prevailing view of nutrition [until very recently] is wrong based on what we know now,” it is not going too far to call Atkins a hero. (Agatston’s only objection to Atkins’s diet is its high saturated-fat content – an objection that we now know to be wrong.)
And like Simmelweis and other medical heroes of the past, Atkins did not live to earn the acclaim and vindication he richly merited. But the popularity of his books and the success of his readers on the Atkins diet kept the low-carb diet alive until its validity could be established beyond question and the pernicious potential of sugar and starches could be finally proven beyond doubt.
Science and government didn’t merely fail. Together, they worked hand in glove to create the problem in the first place and perpetuate it. But the free market overcame the awesome power they wielded. Truth, justice and virtue finally emerged triumphant.
Free markets work not because their participants are noble and virtuous, but because somebody will almost always have an interest in seeing the truth exposed. In turn, that gives markets an interest in finding the truth. That interest is monetary, profit-based, self-interested; this strikes many people as ignoble and base. But it works. In contrast, the noble proclamations of disinterest and devotion to the scientific method too often give way to prejudice, politics and bandwagon-jumping in lieu of rigorous science. It happened in nutrition. It is still happening in climate science.
What Can We Believe In?
Faith is the substitution of belief for proof. The 20th century saw a gradual trend toward secular societies throughout the Western world. Faith was transferred from belief in an unseen religious order – as transmitted by its worldly representatives – to faith in science and government. As we are now learning, science and government can fulfill our hopes only when they are disciplined. Science must be restrained by the same competitive forces faced by private business.
Free markets are scarcely better understood by the public today than science. But if we are to place our faith – that is, our belief – in any institution, it should be free markets. Not science. And certainly not government.