Book Review; Big Fat Surprise by Nina Teicholz

Review by Debbie Cook and David Haslam


Big Fat Surprise by Nina Teicholz is a revelation; an enjoyable book whose author is not afraid to court controversy about how the food we are eating can be damaging to our health. She follows a tradition of brave writers prepared to go out on a limb with ideas which would challenge the accepted mantra. In 1972, John Yudkin courted ridicule by claiming that sugar was ‘Sweet White and Deadly’. In more recent years, Yudkin’s reputation has been re-established, partly by the work of Gary Taubes, Robert Lustig, John Briffa and others: sugar has been identified in some quarters as a major player in the obesity, and also the type two diabetes epidemic. Others, notably the food and sugar industry have rejected the idea, and Government have instead considered measures to reduce fat intake in the nations diets, including fat taxes as well as ‘nudging’ companies in the right health direction with pledges and the ‘Responsibility Deal.’

More recently, the assumed wisdom has been challenged in various areas; the Action on Sugar campaign has emphatically pointed the finger at sugar, ‘sweet poison’,  as a culprit in the obesity epidemic, and demanded Government action in the same way as the over consumption of salt has been tackled.

The UK is ready for the revelation that sugar is toxic, and that refined carbohydrates and fruit juice are detrimental to health, and has taken it fairly well. But the next big shock wave – that another macronutrient is an important, healthy and necessary part of the diet: namely saturated fat – may take some swallowing. For some time it has been whispered quietly. The entrenched dogma that saturated fat is entirely without nutritional benefit is now being challenged. Some clinicians have long believed certain nutritional tenets – saturated fat can be beneficial; repast doesn’t arrive on our plates as a ‘macronutrient selection’, but as whole food, packaged as a meal.  They have felt for too long that they have been part of an underground resistance movement afraid to speak for fear of ridicule. But now they have a champion; Nina Teicholz book ‘The Big Fat Surprise’ elegantly presents robust evidence of the benefits of certain dietary fats in what she describes as a ‘Nutritional Thriller’, exploring the paucity of evidence which lead to initial dietary guidelines, in comparison to today’s convincing large-scale trials.

Teicholz takes us on a twisting journey encompassing board room drama, political hefties and questionable evidence, in the wars of nutritional science where only the big food companies are winners. In a meticulously well researched book, we are informed and educated about why the modern world faces an epidemic of obesity, why generations of Americans religiously followed the nutritional dogma fed to them by researchers of questionable integrity. Research funded by food companies. ‘

Tiecholz, drawing heavily on and expanding from Gary Taube’s book ‘Good calories Bad calories’, manages to explain the science in such a way that the book becomes appealing to both clinicians and non-medics who are interested in both their own health and that of their patients. The book provides a very detailed catalogue of references which underpin her argument; that meat, eggs butter and cheese all belong in a healthy diet and should never have been consigned to the ' only eat on rare occasions' pile. In doing so she does not pillory the pro-sugar lobby but rather insists that we would all be healthier if we ate less sugar and carbohydrate and more saturated fat instead.

Delving back into decades of nutritional science, and the reason why the call to eat less fat and more carbohydrate ever existed (Ancel Keys, principally) for so many American’s, she delicately picks apart some of the better known, massive epidemiological studies and also some of the less well known, smaller studies. Her ability to translate the science into something altogether more digestible shines through the pages of this book. Apart from meticulous research, one of the more appealing aspects of this lengthy tome is that she has managed to turn a potentially dull subject- what we should all be eating to stay healthy and avoid cardiovascular disease, diabetes and obesity, into something of a thriller. The story itself becomes as important as the outcome and the refuting of the traditional dogma.

By the end of this book, utterly convincing as it is, you will begin to questions the old accepted science. I recommend every health care professional to read this book and help to sound the death-knell for the ‘one size fits all approach’. Fat can belong in a healthy diet. Fat, meat and eggs, should not be demonised and we should not be forced to adopt a unitary approach to nutrition therapy. This well- crafted and well written book should form another stepping stone in the quiet revolution against the out- dated nutritional advice that a low fat diet is the only path to follow for optimum health, which is surely helping to fuel the twin scourges of modern society, that of obesity and type two diabetes.