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Christine Daecher, DO

Book Review: The Big Fat Surprise

As a physician, one of my hobbies is reading books on health written for laypeople. I first read this book a few years ago, and I marked it up heavily. Nina has done a spectacular job citing all the research related to dietary fats and oils going back to the beginning of early research and even the early use of oils around the world. There are some things in this book that surprised me completely. In no particular order, they are...



Nina Teicholz's groundbreaking book, "The big fat surprise: why butter, meat, and cheese belong in a healthy diet." book
Nina Teicholz's groundbreaking book, "The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet."



Surprise #1: Olive Oil & The Mediterranean Diet


I was shocked—and disappointed—to learn what I learned about olive oil. First, we've been lied to about the use of olive oil in the diet for thousands of years. Yes, the oil has been used by humans for a long time, but mainly as a cosmetic, for soap making, and for ceremonial use. Significant oral consumption of olive oil appeared to actually start in the 1880s in Spain and 1800s in Greece.


For decades, everyone has been beating the drum for the Mediterranean Diet louder than any other diet. And by everyone, I mean medical associations, governments, WHO, medical training programs, etc. It is quite possibly the most recommended diet by physicians in the United States. As a physician, I have been versed in this diet, and it is the diet I'm expected to recommend to almost everyone. The author does an amazing job of giving the entire history of this diet. It was initially started by a Greek lady doctor and an Italian lady doctor who was pushing the diet for the sole purpose of preserving beautiful olive trees and regional traditional cuisine, respectively, and not for nutritional benefits.


Big olive oil got involved and funded much of the push for the Mediterranean Diet and the so-called benefits of olive oil. Efforts included conferences and meetings held on the Italian coast that were full-paid, 5-star excursions meant to woo the participants and get favorable bias. Participants included not just physicians, nutritionists, and researchers but also foodwriters and the media.


Concerning the touted metabolic benefits of the Mediterranean diet, one study did show a significant benefit in triglycerides, HDL, weight, insulin, and CRP. What the study did not promote was the third arm, which was a low-carb, high-fat diet group that had even greater benefits in all of the parameters. Every study comparing a high-fat Mediterranean diet to a low-fat diet did show that the Mediterranean diet was better, but again, it is kind of false advertising to call it the best when there are other diets that perform better, and it is compared to a known unhealthy low-fat diet.


Another surprise related to the Mediterranean diet is the low amount of red meat recommended. This is surprising since one of the Greek populations the diet was modeled after is heavy on red meat, mostly goat, beef, and mutton, and only occasionally chicken and rabbit.

Surprise #2: Palm Oil


Olive oil has gotten credit for what palm oil actually has done, be consumed by humans for thousands of years. The author does not say that palm oil is the best plant oil for consumption, but it might be. Unfortunately, big food companies and big soybean orchestrated a campaign against palm oil so that fryers in all fast food restaurants across the country would be filled with partially hydrogenated soybean oil. Later, when the problems with partially hydrogenated oils were considered, soybean oil and other vegetable oils replaced the partially hydrogenated. Very few restaurants have returned to palm oil.


Concerning the potential health benefits of palm oil, it does contain vitamin E and beta carotene. Some studies have shown it to protect against blood clots and to lower total cholesterol levels. Further evidence of the lack of adverse effects on health and cardiovascular disease may be in the proof that in Malaysia and the Philippines, where high amounts of palm oil and coconut oil are consumed, there is less heart disease than in Western countries.


Surprise #3: The Politics of Medicine, Big Food, Big Agriculture, and the American Heart Association


Well, I have to admit I'm not totally surprised by the politics of medicine. Nina does an amazing deep dive showing just how deep influences run. It is clear that much research on diet, nutrition, and new food products is bought and paid for, resulting in bias and influence that is not in our best interest. The book also makes it clear that plant-based oils/seed oils (with the above exceptions) were not used for consumption until approximately the 1910s in the southeastern US and the 1920s in the rest of the country. Promotion of these nouveau foods, was completely at the hands of big food in big agriculture.


When this book was completed in 2015, the American Heart Association was the most highly funded nonprofit in the entire world. The AHA has given terrible advice and made many mistakes over the years. A few include endorsing margarine, endorsing Crisco, endorsing the Dean Ornish diet, endorsing low-fat diets for all children, low-fat diets for overweight, endorsing hydrogenated oils, calling the Atkins Diet dangerous, and endorsing food industry bought-and-paid-for trials that are almost always getting a positive result for that food industry. It seems the relationships between AHA and Big Food continue. Today on the AHA website, dessert recipes have the first ingredient of trans-fat-free margarine. Thank you for letting us know you are trying to distance yourself from trans fats.




Teicholz, N. (2015). The big fat surprise: why butter, meat, and cheese belong in a healthy diet. First Simon & Schuster trade paperback edition. New York, Simon & Schuster


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