She is also the executive director of the Nutrition Coalition and she's and adjunct professor at New York University. And talking to her is a true experience, because you learn so much more about guidelines, about committees, about how decisions are made, about how evidence is either accepted or ignored and more importantly how that impacts our lives. I mean on the one hand, you can say how does that matter because I can still make my choices.
But no, these guidelines affect so many people, on so many different levels. And it's important to hear her message about why that is and important to hear her message about how we can influence this and how we can make sure that these decisions are being based on evidence, and when there isn't evidence there we need to know that.
And it's not always success, we're not always winning the battle to make guidelines more evidence based but as you'll hear there is a progression towards that. So, it's a fascinating interview and I wish I could interview her 10 more times, because there's so much more information there, but I think you're going to learn a lot from Nina Teicholz today.
So, enjoy this interview and if you want the full transcripts go to dietdoctor.com and you can also see all our other prior podcast interviews. So, enjoy this interview with Nina Teicholz. Nina Teicholz, thank you so much for joining me on the diet doctor podcast.
Now talking about the guidelines in a way seems a little counterintuitive for a low-carb community, because the reason people are going low-carb and doing well and feeling better low-carb, is because they're going outside the guidelines and they realize they can do better than the guidelines, but yet the guidelines are still very important.
So, tell us a little bit about why guidelines are so important and your journey in understanding the faults in the process behind them.
So, there is this appalling lack of science in the rigorous science in the guidelines and that is something that I think, you know, it's worrisome, I mean why does a low-carb person care at all about that? So, we have this terrible government policy but you know, I'm low-carb, I fixed my health, I have good foods, my family is healthy and we're all sort of my little world is healthy, but here's what I found out about the guidelines.
They control a tremendous amount of- they have this kind of straight jacket on so much of our economy and our professional, medical and nutritional advice. So one way they control, that people should care about is that, you know- the meal your child gets at school, that's controlled by the guidelines, only 1% milk and 55% carbohydrates and half of those carbohydrates still have to be refined.
So your kid is getting maybe donuts and that's okay with the guidelines, because they have to include refined grains because they are the only ones enriched and fortified. And one of the things about the guidelines that is shocking is that they're nutritionally insufficient, meaning they don't meet adequacy goals. Okay, so school lunches, maybe your kid goes to private school, so it doesn't matter.
What about if you go to the hospital? That food is controlled by the guidelines. You can find many pictures of people showing their so-called diabetic meal in a hospital and it's like 75% carbohydrates.
So, and they're the ones in control of the diet. The diet summer camp, the diet that you send your kid to. All the cafeteria food, you know, is pretty much controlled by the guidelines and big, big institutions. What about the military, that's supposed to protect us? There's a study out that people actually gain weight while they're in the military.
Well, you know our military is really fighting an obesity problem, and these are the people that we need, or maybe you have members of your own family in the military. Or if you care about, you know, women and infant children, poor people... I mean they get those wicker baskets, there's no meat in them at all. They've gotten rid of meat, no meat, no chicken, no fish, no kind of animal protein.
But then how can we say the guidelines are actually truly faulty, and that's where it took, not a scientist, not a doctor, it took you, a journalist, to come in and say the science is wrong. So, tell us, you've been sort of criticized for not being a scientist. Why should we believe you because you're not a scientist, but yet I think it gives you more strength, as not being a scientist, to come in and say, "Look at this." So tell us about how you see your role in pointing out the faulty evidence being used and the evidence being ignored from your background as a journalist.
One of the things that my book documents is all the scientists who did their own field orthodoxy, and their careers, you know their careers just disappear, research grants go away, and they don't get invited to conferences anymore, so they're just sort of ostracized.
And then young people coming up see that and they're careful to stay closely within the orthodoxy and not challenge it, and so you see that the movement that has been made in this field really comes from outsiders, it's had to. We're the only people, who can analyze, and who have freedom to really look at the science. And you would say, well, why a science journalist, rather than-? Why not a PhD or why not a doctor? And journalists are people like, what we do is we research.
You just have a unique ability as a journalist to approach with objectivity and you have the time and tools to really do the research. And, you know, when I started I was a vegetarian, I mean I came with zero biases, I didn't even think I was going to write the book that I ended up writing, I was going to write a book on trans fats.
So, you know, I just think that it's just- and as a journalist you're really trained to see all sides, all points of view, I mean, scientists are trained to do that too.
But as you know, you get that in any field, but the question about the guidelines, why did I take this deep dive into the guidelines and find out about the evidence based, was again, it was simply that they're so powerful, they control so much of our food supply, and you know one thing I didn't even mention before-hand, but even for low-carb people, the absence of food products we can buy, is because of the guidelines, like every food company wants to have- when you flip over a piece of any kind of packaged food, you look on the food fat panel... that all comes out of the guidelines.
But it is a kind of, an ugly world in terms of the way that orthodoxy is enforced and I think, coming back to the guidelines, what I found was that they had really- what they had done is they had ignored, since 1980 when the guidelines were launched, they had consistently ignored all of the rigorous clinical trials funded by the National Institutes of Health, you know tens of thousands of people, multi centers trials, that was really the big age of- you know, we had a big age of nutrition trials where people were- like 50,000 people were funded to be in a study. It cost $700 million.
So, it's kind of the collective fault of all these committees, you really can't blame the latest one, and you know, what would it require then to reject the entire guidelines, I mean that is- I think that would be very hard for a committee to do to turn around and say, "We've just got it completely wrong the last 35 years", but they've done clever things... It's like, I would say clever for them like they have- In fact when all those studies show that the low fat diet didn't work, not only that, but the 2015 dietary guideline report says that low fat diets actually increase the risk of cardio-vascular disease.
Well, that's terrible. We've been on a diet that seems to have been increasing cardio-vascular disease in America. So, what they did is, but they can't say, "We're no longer recommending a low-fat diet", they sort of tip-toe away from it. There's no press release, there's no marketing materials to the American public, to say, you know, "We're no longer telling you to eat a formal low-fat diet recommendation", and the reality is if you go and look at their formularies for what they're recommending, like...
What I mean the formularies like, what's the breakdown of protein and fat and carbohydrates that they send off to the schools, and say you have to follow this, they're still low fat, you know, they're still low fat. So, they're de facto still low-fat recommendations.
Scientists and PhD's need to publish to maintain their grants and their position in the university, so what's the easiest way to publish studies is to data mine and to do retrospective observation and trials, so that's why we have the majority of our data. But is that good enough to inform public policy and make a recommendation for what the world should be eating?
And those are very inaccurate tools for gathering information about diet and you know, people lie, because, "I'm not going to tell you, I had you know six candy bars." And so they take that very weak data and then they try and then there's- they do multiple comparisons with tons of outcomes and there's concern about mining the like- P hacking it's called, but it's statistically it's not very valid what they do.
And then there's all these confounders... you know, are you healthy in other ways that affect your eating and things we can't even measure and so nutritional epidemiology tends to yield results that are always super weak. The great success of epidemiology is in the finding that heavy smokers, a packet a day smokers have 10 to 35 times higher risk of lung cancer, than never smokers. 10 to 35 times, okay.
He says he eats meat once or two times a year and he talks at vegan conferences and he really believes in veganism for whatever reasons, I don't know, but that clearly affects their work. You barely, ever find a paper coming out of Harvard now that is not plant food that is better than animal food. Animal food - dangerous... plant oils, vegetables oils, you know, are better than animal fats. I mean, that it's almost impossible to see the constant stream of pro-plant publications and not think about the bias of the people who are behind them.
So, food companies and pharmaceutical companies and the supplement companies- supplement companies are a big player because, then remember, I said the dietary guidelines, are nutritionally insufficient. They depend, they sell those nutrients, they sell them in refined and enriched grains, and they sell them to consumers. And they say if you're not getting enough of this because you can't eat meat, because the guidelines tell you not to eat meat, here are the supplements, so how do they influence our whole process?
I mean at every level they've been doing this since the 1940s, was when the first organization was founded by food companies and their major goal was to influence nutrition science. And, you know, they are really clever.
For a start they fund their researchers, they give them grants or they fly them places, or they underwrite their conferences, or they pay for their journals to- or they pay for ads in their journals where the researchers want to publish their journals, and then they up, anyway, so they want to do it at the very, or they endow chairs, and/or they fund a research assistant. You know at Harvard, to go back to it again, and you know a research assistant that's funded by Unilever, one of the vegetable oil makers in the world.
And then, yes they do, they write around the table in the dietary guideline meaning- I mean I've spent time in Washington now, and it's really shocking to me. I mean the food companies are basically all over lobbying on this stuff, and you know we usually hear, I think the impression we get from media stories is like it's just mainly the meat industry that has manipulated the guidelines and I don't even understand that narrative because meat has been a big loser.
I mean if they're such a powerful industry, you know, their results are pretty bad, because they tried to take meat out of the guidelines in 2015 as a healthy food. But every industry is there, you know the beverage, the food industry, the sugar industry, you know, the vegetable oil companies, the grocery manufacturers of America, and so I actually went, I was invited to come to a couple of USDA listening sessions, where they have apparently listened to our point of view, and I was sitting around the table and I was the only person who wasn't from industry.
So, I mean there are other interest groups, but I think that they really have a place at the table.
You've really put your hat in the ring and said we're going to do something to change it and interestingly, it's where a lot of criticism against you has come as well, to say, you're just kind of pro meat and trying to push your agenda into the guidelines, when really your message seems to be, "We're trying to push science into the guidelines", and you're trying to make a difference. So, tell us, how your work at the Nutrition Coalition, is trying to improve this science of the guidelines?
And they said nobody who has served on the dietary guidelines committee can be on the panel that reviews it. Then came out with a decent report, that report said that, you know, sort of an echo of the work that I had done saying this, the guidelines lack scientific rigor, they don't use proper systematic reviews of the science, like there's- and in order to be credible, they need to be redesigned.
Well, that's a pretty powerful thing to say, and so that was a good report to have. Our group, our only agenda is to have evidence based guidelines and we just want the science properly reviewed, you know we want it- There's sort of a pyramid of science, like up at the top there's randomized controlled clinical trials, that's the gold standard because that can show cause and effect and kind of here down below is epidemiology, which only shows associations, which tends to be more wrong than right, when tested in more rigorous trials.
That's the pyramid, and the way that the dietary guidelines do it, they do it upside down. So we just want a proper systematic review of the guidelines, there's various standards, there's various systems of review, Cochrane, Gray, you know, there's like guidelines for how to do guidelines, and they just need to be followed.
And all we want is evidence-based guidelines. Wherever that evidence goes we will follow, but we have also said, you know, we think here's where the guidelines do not reflect the current evidence, and one of those is, we think that there should be just regular meat and regular dairy, not low-fat meat and low-fat dairy because we do not believe the science supports the saturated fat recommendations.
We do not believe the science supports the recommendations on salt, that you should eat lower is better on salt. It turned out there's a lot of science out there to show it's much more likely to be a J shaped curve, where salt consumption is, you know, a moderate salt consumption, a moderate amount is ideal in terms of cardio-vascular risk, right? Or we could at least say, if there's a scientific controversy, let's just back off that recommendation and say we really need to get to the bottom of this.
I mean that's the other thing, the dietary guidelines are supposed to be for all Americans, but you know we live in a world now, where according to the latest studies 17% of us are metabolically healthy, so that means 83% of us are not and we are not covered by the guidelines.
I mean I know that's sort of a hard question to answer with specificity but it boggles my mind why people on the committee don't realize that the epidemiological evidence is so weak and they need to be looking for better quality of evidence. It just seems really just commonplace and they should understand that.
So, the dietary guideline committee, like the last one, was more than half epidemiologists. There's only supposed to be one epidemiologist on the dietary guideline committee, I mean if you look at their- they want to have a variety of different kinds of expertise in the guideline, and now we have more than half.
And there's groupthink that has gone on, like it goes on in any field, but in nutrition, the groupthink is, you know, towards the plant-based diet. So, we did an analysis of the 2015 dietary guideline committee, it turns out 11 out of 14 of them were or had professed to believe that a vegetarian or plant-based diet or themselves were vegetarian.
And they really run this whole process, and then the political people, who you know, the ones that are now, are all put in there now by Trump, they have to decide is the guidelines going to be their top political priority, or they'll take on the entire pharmaceutical, medical and food establishment to do that. I mean, so the answer is... and these go around, because the 2020 committee has just been announced. The answer to that question is no.
They've just never seen this information, and they're like nobody has ever presented these arguments, so I'm like an argument is, actually people follow the guidelines, and they follow the exercise, you know, the recommendations pretty well, the problem is not that people are lazy and fat and don't follow the guidelines, the problem is in the guidelines themselves.
And so a lot of people respond to that argument, because many people really have a not too distant memory of their grandfather or something, you know, surviving on bacon and eggs every morning, like you know you're right, you know, that's never made sense to me.
So we do have a lot of support but we have to recognize that this is the first step and this is the first time these people have heard any of these arguments, and you know, so I would say, you know, between my giving testimony as USDA and talking to people, they announce the list of topics to be reviewed for the dietary guidelines, this year ahead of time and on that list was for the very first time low carbohydrate diets and saturated fats, and in my testimony I specifically recommended they do that.
Then we sent in a whole bunch of comments during the comment period, we were responsible for half of all the public comments.
I mean the two top-people in the world, like John Ioannidis from Stanford University, who is just, I mean he is just the rock star of this, and in Canada, sort of his counterpart in Canada, his name is Gordon Guyatt, he founded the term evidence based medicine. And sort of a descendant of David Sachet, some people may know that name, but they're like amazing people.
We help prepare their nomination packages, I can't tell you what it's like to take down a 600 page resume and try to reduce it to 15 pages, which you have to submit for the nomination and like, they have no conflicts of interest. So, like, they're the most incredibly qualified people to be on that committee.
And they would act I think, you know as you're saying, why doesn't the committee make the right decisions, I think these people could act a little bit like referees in the room, you know, like they could say great point, but the epidemiological study, what is the randomized control trials say? So, we failed in, I mean, we got thousands of people to write Sonny Purdue and we did not get either of those people on the committee and I was told by somebody at the USDA that we didn't want that level of disruption.
Is she a Jeff Volek or a Sarah Hallberg? No, but she is certainly someone who has been in the field and there's a woman named Heather Leidy, I can't remember where, but she's somebody whose research focus is on how increased protein might be able to help fight obesity. So somebody, who is sympathetic to animal proteins.
So, again the yin and yang of all of this. On the other hand there's a lot of old guard people on the committee who are really committed to calories in, calories out and energy balance people who have- from been promoting the guidelines to people who have been on the dietary guidelines committee before, some of them twice, so that's what I consider a pretty- and they're senior, they're not young.
So, but I think they're still an opportunity during this period, to try to educate people and try to get good information to them and you know we'll keep doing that and if that doesn't work, you know, we'll have our million metabolically wounded march on Washington.
So now I just literally mute those people, because I feel like it's a distraction. And I also know that, I mean I have nothing against vegans, I just think that should just start, follow their diet, and that's fine, and let people who are healthy on different kinds of diets, follow their diets, but it's been complicated and become more complex now.
The money behind veganism has become much more significant and I mean vegans, in some way, there are many of them who are pure and ideological, but they are being used by a set of corporate interest now and there's a vast amount of money behind them. So, and that is sort of the animal right activist money, which is massive, the people who just believe we should not kill animals at all.
Pharmaceutical money, you know anybody who's threatened by low-carb is going to get behind veganism because veganism is sort of the antithesis of the low-carb movement. So, Big Pharma they do not profit if people get healthy from nutrition, you know, average Americanism 5 pills, those pills go away and that's a zeroed out profit line for those pharmaceutical companies, which you can't be too cynical about, they need to make a profit... and how do they do that?
And there's the environmental movement now that's behind them, saying it's better for the planet and the chemical companies who are the real polluters, they would love to have an agenda whereby they could blame all global warming on cows rather than their activities. And of course, you know, what I call big carb, but, most of the products in a supermarket are made up of a grain, sugar and vegetable oils.
That's what most products are made of and all those interests including the supermarkets themselves and all the grocery manufacturers, they depend on people buying those products.
But what troubles me is when they're all blurred together, when they're all brought together to try and push an agenda and I think that's kind of what happened with the Eat Lancet report. So Georgia Ede has done a phenomenal job of dissecting the science or lack thereof, of the Eat Lancet report but it goes beyond the science because there is sort of an agenda, to where I think you've really promoted a lot of information that wasn't known, just by reading the report.
So tell us a bit about the background of the EAT Lancet report and what you see as the motivation behind it.
And Arnold Schwarzenegger speaking out on it in New York. That all takes a lot of money and it all came from those companies, all of whom stand to benefit, if they can, they stand to benefit if they can demonize low-carb, right.
They stand to benefit, if they can blame cows for global warming, so they hold different interests, but they all come down together on this. So, then I also looked at the financial conflicts of interest behind Walter Willet, who is the chief author and really I think, maybe even the architect of this report, but he was certainly the leading scientific author on it and he's the one head of the heart school public health for over 20 years, just retired, but has become a vegan himself, ideologically motivated I think.
But I decided to also look at his financial conflicts of interest and you know came up with a seven page document and about, you know, that the hundreds and hundreds of thousands of dollars he gets from all the nut industry, over the years, and Harvard gets-
So, I went- there's just a massive amount of corporate interest into shifting Americans onto this plant-based diet, from a multitude of different interests.
So it's kind of- I didn't even mention that the Barilla Pasta Foundation, who has- you know, Barilla is the biggest pasta maker in the world, a huge food company in Europe, they're one of the members behind EAT and the EAT Lancet report and they have this foundation that has been for, three of four years now, funding scientific conferences on why you should eat more carbohydrates, why you should move to a plant-based diet and they're the ones, I think who came up with this whole double pyramid idea that the pyramid to improve health was also the pyramid to improve reduction in global warming, you know reverse global warming.
So, there was this idea, better for you, better for the planet, like that's a great catchy slogan. Better for you, better for the planet, so I saw like 50 news stories when they came up with that idea, I think it was in 2015 and I thought, oh wow. This is, so now it's multiple friends, which is a really smart tactic.
So, you know, the science is really on our side in terms of what is a healthier diet. There are interesting fact, you know, the last dietary guideline committee came out with a vegetarian diet recommendation. They were as I said 11 of 14 of them were following or advising a vegetarian diet at the time. They must have gone looking pretty hard for them. They could find zero randomized controlled clinical trials to support a vegetarian diet for any kind of health outcome.
I mean that's the other thing, depending on how you measure it, what variables you include and don't include, it's easier to twist the message, that's really concerning, because I don't think we're getting the full picture, but the way they package it, certainly sounds very convincing.
And I'll just give you the one example, you can take a tiny example of when they calculated the global greenhouse gases for animal agriculture they included all of the externalities and all the various kind of knock-on effects, and all the inputs.
When they did it for transportation, they only included the immediate effects, without looking at any of the larger externalities or larger picture, you know, what about the steel that makes the car? So, it's just an area where the best you can say is that the science is unsettled. So, let us not rush to policy.
They are a potent force, they are passionate, they, you know- I hear from them all the time, I'm sure you do too and they want change and like there's just nothing I think to people as recovering your health, when you've been a lifelong depressive or a diabetic or I didn't have to amputate my leg after all and so that's an enormous passionate group of people that is growing.
The science is growing, you know, I mean, really month to month, there's some paper about, oh you know what Virta's latest data, on at two years, they maintain their reversal rates on diabetes, and then you know papers are coming out, showing it's sustainable or it works.
You know the science is evolving and I think that to an increasing number of people, I mean especially medical doctors, who come with a more open mind and are taught about evidence based medicine and they are responsive to the data and they- So I think that's another way in which we will see the paradigm shift happen.
I mean because that's the story I hear from most low-carb doctors, "Wow, the difference I saw in the health of my patients was shocking to me", and that's what carries the snowball effect, that's what my hope is from that perspective.
So, I think that's going to change and I see the change and you know wherever I go, you know, if I have a book signing and there are 100 people in line, you know, half of them come up to me and the first thing they say is like, "Well, 50 pounds down." You know, went on a low-carb diet and some of these are just farmers, and they are- I would say when I started out in 2014, nobody, nobody had like any idea what low-carb was or a ketogenic diet was or had thought about saturated fats.
So, you really see this change sweeping across the land and we do have this fight at a really high level, I think that it involves trying to change the way that influencers think, media thinks, policymakers think, but I think even the moderate success we've had so far, and I think that we, you know, I think we will get there, now it's interesting even when I go into an office, in a congressional office or if I go and meet somebody, somebody in the room will be ketogenic.
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