Monday, September 28, 2015

Saturated Fats, Conflicts of Interest, and Nutritional Partisanship

Last week saw the British Medical Journal publish an op-ed on the American dietary guidelines written by Nina Teicholz. I think a fair summary of Teicholz' piece is that she believes conflicts of interest and shoddy science led the Dietary Guidelines Advisory Committee (DGAC) to get everything all wrong in recommending diets lower in saturated fats.

I think it's important though to know, that Teicholz isn't just any old journalist, she's a journalist who recently authored a global, absolutely blockbusting, bestseller on diets, a fair summary of which, "Why Butter, Meat and Cheese Belong in a Healthy Diet", is included on its cover.

Oddly, despite her BMJ thesis being in large part about how conflicts of interest and personal biases clouded the DGAC's recommendations, in the embargoed version of Teicholz' BMJ piece that was shared with reporters in advance of publication, her conflict of interest statement failed to mention her million dollar (or more) baby,
"I have read and understood BMJ policy on declaration of interests and declare I have received modest honorariums for presenting my research findings to a variety of groups related to the medical, restaurant, financial, meat, and dairy industries. I am also a board member of a non-profit organization, the Nutrition Coalition, dedicated to ensuring that nutrition policy is based on rigorous science. This article was fully funded with a grant from the Laura and John Arnold Foundation."
What wasn't as odd, or at least not as unexpected as Teicholz' original lack of disclosure, was the passionate nature of responses to her piece, and then of course the passionate and rather partisan nature of the rebuttals to the rebuttals, and rich in all of them were cries of conflict of interest.

Coincidentally, on the same day that Teicholz' piece published, so too did a new saturated fats position statement from Canada's Heart and Stroke Foundation (HSF). The HSF, up until very recently, had some major food industry inclusive conflicts of interest, but over the course of the past few years the HSF has divested itself of those.

So what was the HSF's take on saturated fats? In summary, they argue that the current science on saturated fats would suggest that there may be health benefits if you replace them with unsaturated fats, and that,
"There is emerging evidence to suggest that the health effects of saturated fats could vary depending on the food sources in which they are found."
They then make a series of recommendations that eschew a threshold or limit for saturated fat and instead are reminiscent of Brazil's recently published national dietary guidelines - which can be boiled down to cooking more with fresh, whole ingredients while minimizing restaurant and ultra-processed foods.

Of Teicholz' and the HSF's takes, I'm with the HSF. That's not to say that Teicholz' concerns hold no water at all, but rather that they, perhaps consequent to her own clear and significant conflicts of interest, do the very thing she rages against - draw sweeping conclusions from less than sweeping data. The HSF on the other hand, at least in my opinion, are doing their best to summarize the unfortunate truth of nutrition research - that it's nowhere near as clear cut as it's often presented, and that our best evidence to date is supportive of benefits to broad patterns of eating that unfortunately haven't yet been drilled down to best diet style specificity.

The frustratingly partisan nature of the responses to Teicholz, and to the responses of the responses, I think is well summarized in this tweet by MPH candidate Sarah Kunkle Amen.

If you're interested in wading through them, here are a collection of responses to Teicholz' piece in order of their publication, including a newly launched petition for the oped's removal which was posted just a few hours ago (last in line):

BMJ Publishes Error-Laden Attack on Dietary Guidelines Report - CSPI

Medical journal’s bogus investigation could derail better dietary guidelines - The Verge

Expert is as expert does: in defence of US dietary guidelines - The Conversation

The DGAC's official response to Teicholz' accusations - The BMJ

An Open Letter to the BMJ Regarding US Dietary Guidance - Dr. David Katz

Nina Teicholz Reports in the British Medical Journal ~ The Conflicts & Funding - The Carb-Sane Asylum

British Medical Journal (BMJ) gives low-carb journalist Nina Teicholz an outlet to blast the Dietary Guidelines Advisory Committee (DGAC) - U.S. Food Policy Blog

Call for The BMJ to retract Teicholz article on Dietary Guidelines Committee and Science - Evelyn (CarbSane)

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