A programme was due to be aired on 22nd July 2013 and then a royal baby was born so scheduled programmes were set aside. One of these was Long Live Britain – an hour’s episode at 9pm and then a follow up 45 minute programme at 10.30pm. The two programmes were rescheduled and aired on 5th August 2013.
Presented by Julia Bradbury, with former cricketer Phil Tufnell rounding up volunteers and Dr Phil Hammond providing the medical information, the programme aimed to assess the incidence of “three secret killers”: heart disease; type 2 diabetes and liver disease. I’m not sure why they’re “secret” – we should all have heard of them.
The first error came within 30 second of the opening of the programme as Julia Bradbury said: “We’ll be looking to see how many of them [the volunteers] have the warning signs of three killer diseases that can knock years, or even decades, off your life. But the good news is – they’re [the diseases] all preventable if caught early enough.” Julia claimed that “together they kill over 100,000 Britons a year and shockingly more than 10 million of us could develop them in the future.”
Alas no condition is preventable. We can take steps to minimise the likelihood of getting a particular condition but, for heart disease for example, age, gender and genetics will trump most lifestyles. Furthermore – unfortunately our current health advice will not help these conditions, let alone prevent them, as we will see:
A rugby match was taking place at Manchester’s Etihad stadium and Phil Tufnell’s job was to round up people to go into a level 1 screening room. In this first assessment people were interviewed by 50 volunteer nurses in orange T shirts and asked questions about their lifestyle and family health history. They were also weighed and their waist measurement was taken. ‘Andrew’ had a waist measurement of 54 inches – he thought it was 46 inches. He went off the weight chart too, as this only went up to 225lb. There was a useful ‘rule of thumb’ shared in the programme – your waist should be less than half your height. So, if Andrew had been 9 foot tall, he’d have been OK!
The first point that needs to be made is that the volunteer nurses looked as overweight and obese as the volunteers being tested. Julia asked volunteer Pat what it’s like having her waist measured and then talked to nurse C/Kathy about waist being an important measurement. The nurse’s waist looked bigger than Pat’s. If our public health advice works, the advisors need to be role models for it. I suspect many of them are following their own advice and therein lies the problem.
There were also 10 celebrities, although, unless you watch junk TV, you’d only recognise Edwina Currie as one of them. Edwina was the only one ‘discharged’ with good results. The three celebs then featured in the rest of the programme were Jodie Prenger (I’d do anything), Ricky Grover (Eastenders) and Crissy Rock (Benidorm). The celebs were chosen to feature type 2 diabetes, liver disease and heart disease respectively.
Type 2 diabetes
Let’s start with this condition, as the medical explanation from Dr Phil Hammond started off OK on this one. Jodie Prenger has a family history of type 2 diabetes. Both of her parents have type 2 diabetes. Crissy Rock and Ricky Grover were also found to have type 2 diabetes in the programme, but they were used to feature the other conditions.
We were 41 minutes into the first episode before sugar was first mentioned. I had lost count of the number of attacks on fat and cholesterol by this point in the programme.
Dr Phil started with: “It’s processing energy that’s the main problem with type 2 diabetes and some ingredients, like sugar, release particularly large amounts of energy when you eat them.” A jelly baby was then burned in a lab to show the amount of energy that it produces. “But it’s not just the obvious sugary things like jelly babies that release lots of energy quickly. Many carbohydrates, including some breads and fruits can do the same.”
Actually all carbohydrates break down into sugar – as Dr Phil goes on to say: “Whenever you eat carbohydrate, your body breaks it down into glucose to use as energy.” Not always glucose – carbohydrates can break down into other sugars, but glucose is the one that is the issue with type 2 diabetes.
I would describe type 2 diabetes as the body saying “enough’s enough”, as a response to our public health “base your meals on starchy foods/5-a-day” dietary advice. The body gets to the point where it simply cannot process the amount and frequency of carbohydrate/glucose being consumed and the body first becomes insulin resistant (the process just doesn’t work as well as it should) and then the body becomes type 2 diabetic, as blood glucose levels show that the body is no longer able to clear glucose from the blood stream effectively.
Dr Phil instead creates a bizarre visualisation, which gets more bizarre as it goes along. Jodie has to imagine that footballs are glucose and footballers are the blood supply and several Dalek style dustbins are the body’s cells. Each bin has a lock on it as each body’s cell has a ‘door’ that needs to be opened to allow the glucose in. The key to that lock is insulin. All a bit convoluted, but not too far from the truth so far.
Then the ‘game’ tries to mimic a body with type 2 diabetes. Dr Phil claims it’s now the fat on the inside of the body that causes the problem with type 2 diabetes. Notice how a condition that is entirely related to carbohydrate and the body’s increasing inability to metabolise carbohydrate has become a result of ‘evil’ fat. Blaming fat on the inside of the body is a reference to body fat – but the analogy leaps seamlessly to implicate dietary fat – lard in this case. Dr Phil claims that the fat “gets over the lock on the cell” and the football game is then repeated – this time with blocks of lard on top of the locks on top of the bins – just to create a highly visual impression that fat is always the devil. It just goes to show that, when your public health mindset is that fat is bad and carbs are good – even when you know the medical facts are contrary to this – the belief system doesn’t let the facts get a look in.
The statistician on the programme, Dr Jennifer Rogers, also showed a shocking lack of understanding of the difference between association and causation – an absolute basic differential for a statistician. At the first results check – 16 minutes into the programme, after 168 people had been screened, Dr Jennifer claimed that “80% of people that we’ve looked at so far are at increased risk of diabetes.” “Why is that?”, asks Julia quite rightly. Jennifer replies “It turns out that 64% of people are overweight and 31% of people are obese… and obesity and overweight is one of the major risk factors for diabetes.”
Wrong! Type 2 diabetes may be associated with weight, but does weight cause/determine diabetes? or does diabetes cause/determine weight? or are both caused by something else? – carbohydrates for example. I think that carbohydrates cause both type 2 diabetes and weight problems and that having type 2 diabetes (by definition an inability to metabolise carbohydrates) can worsen weight problems. I think that the least likely path of causation of all is that weight per se causes type 2 diabetes.
In the second episode, the erroneous connection between fat and diabetes is made again as Dr Phil shows Crissy the 104 pasties she consumes in 4 months (crikey, that’s a lot of carbohydrate). The fat used to visualise the demonised saturated fat in Crissy’s pasties was lard – which, as any nutritional advisor to the programme could have shared, is mostly unsaturated fat. Monounsaturated fat being the main fat in lard. Never mind the facts, Dr Phil ignores everything in the pasty other than saturated fat and tells Crissy: “That’s the bad fat that gives you diabetes”.
As John McEnroe would say “You cannot be serious!”
You’ll see a common theme as we look at the three ‘silent/secret’ killers – as they are continually referred to throughout the programme – and that is fat.
Dr Phil’s comments about fat and liver disease were so wrong that they inspired this brilliant blog post by Dr Malcolm Kendrick. The blog is about the things that Dr Phil tells Ricky Grover, which are indeed “the most unutterable balls!”
First, in the follow-up meeting with Ricky, Dr Phil tells him “We did the scan on your liver that showed significant fibrosis, which is stiffening of the liver and that’s because it’s packed full of fat.”
As Dr Richard Johnson and Dr Robert Lustig explain in their many publications, the main cause of NAFLD – non alcoholic fatty liver disease – is fructose. The average Brit consumes 400 calories of sucrose daily. Sucrose is one part glucose and one part fructose. The glucose goes into the blood stream where they body has the increasing challenge of removing it from the blood stream and this is how insulin resistance and type 2 diabetes can develop (Ricky was also diagnosed as type 2 diabetic). The fructose goes to the liver where it is turned to fat. It is not fatty food that has harmed Ricky but the ‘good’ carbohydrates that we discover he eats when we see his intake of brown bread, jacket potatoes and fruit in episode 2.
Dr Phil takes Ricky to a waste recycling centre for another bizarre visualisation. There he tells Ricky “Fatty foods cause the liver an extra problem because it doesn’t just sort fats, it stores some as well… Your liver cells get choc full of fat and then they can’t work properly anymore.”
I’ll let you read Dr Malcolm’s dissection of this nonsense, but a few million people probably watched the TV doctor’s demonisation of fat and maybe a few hundred will read the truth in Dr Malcolm’s blog – that’s the extent of the damage that has been done by this programme.
It gets worse:
You would be left in little doubt following this programme that the only thing you need to worry about, when it comes to heart disease, is cholesterol. Even Crissy Rock’s smoking is couched in terms of “Cigarettes can also push up cholesterol”, as if smoking is not bad per se.
The messages about cholesterol in the programme were simply wrong and seriously harmful for humans to have taken on board. In reality they will simply have reinforced the ignorant messages about cholesterol that have been reiterated for years, but it’s about time that (TV) docs told the truth.
The first attack on cholesterol occurs 18 minutes into the programme. Dr Phil announces “It’s time for my level two screening. First up heart disease and I want to test two of my remaining ten celebs for too much damaging cholesterol.” No mention of the fact that cholesterol is utterly life vital, that humans would die instantly without cholesterol, that there would be no body cells, no digestion, no hormone production, no reproduction, no human life whatsoever without cholesterol. No. The message that you are given is that cholesterol is dangerous. Your body makes cholesterol, so Dr Phil would have you believe that this would be the first example of your body trying to kill you.
Dr Phil tells Chris Biggins “Your cholesterol ratio is 5.9 – we’d like you to be around 4.”
Why? Seriously – why?!
Why does the brain house 25% of the body’s cholesterol if this is not pretty flipping vital for memory, mind and cognitive function? To say nothing of the fatigue and muscle impairment that Chris could suffer without the cholesterol his body is making for good reason.
Does Dr Phil not know that the evidence for all 192 countries for which the World Health Organisation has data is that the lower the average cholesterol levels of a country, the higher the death rate for men and women for heart deaths and all deaths?
Does Dr Phil not know the sinister and deeply troubling conflict behind cholesterol target setting?
It’s when Dr Phil talks to Crissy about heart disease, however, that the cholesterol misinformation reaches a new level. Dr Phil takes Crissy to Severn Trent Water to try to convince her (and Britain PLC) that a sewage system is very similar to your circulatory system. Crissy is shown a pipe clogged up with fat, which has been put down drains. Dietary fat can clog up sewage pipes. Dietary fat cannot clog up arteries – unless you are intravenously injecting your food!
Dr Phil asks “Where does dangerous cholesterol come from?” If he had said “Where does life vital cholesterol come from?” and answered “The body makes it – because it is so utterly life vital, the body cannot leave it to chance that you could get it from food” – that would have been accurate. However, Dr Phil reinforces the irresponsible notion that cholesterol is “dangerous” and then answers his own question by saying “Well in fact we produce it in our own livers, particularly when we eat certain types of food.”
Then we go from daft to ridiculous. Let’s take the Dr Phil claims that follow and present the facts after each one:
Dr Phil: “There’s actually two types of cholesterol – there’s bad cholesterol and good cholesterol.”
Fact: The chemical formula for cholesterol is C27H46O. There is no bad version or good version.
Fats and water don’t mix (put olive oil in a glass of water and see for yourself) so fats do not travel freely around the blood stream (the latter being essentially water). So the body has things called lipoproteins to transport fats and waxy substances around the body to do their vital work. Think of lipoproteins as taxis travelling round the body carrying vital nutrients.
There are five lipoproteins – in order of size, from largest to smallest, these are: chylomicrons (Dr Malcolm Kendrick has introduced these in his post on the fatty liver); very low density lipoproteins (VLDL); intermediate density lipoproteins (IDL – you don’t hear much about these); low density lipoproteins (LDL); and high density lipoproteins (HDL). These lipoproteins all carry protein, triglyceride, phospholipids and cholesterol. Lipoproteins thus carry cholesterol (among other things). Lipoproteins are not cholesterol and yet, Dr Phil is teaching Britain that low density lipoprotein (LDL) is bad cholesterol and high density lipoprotein (HDL) is good cholesterol. Repeat after me – they are not even cholesterol.
Dr Phil: “The bad cholesterol is produced when you eat lots of saturated fat.”
Fact: How? In The Great Cholesterol Con, Dr Malcolm Kendrick asks (p35) “How can eating saturated fat raise LDL levels? It is not merely biologically implausible, it is biologically impossible. It always was and it always will be.”
Dr Phil needs to explain how this can happen, let alone that it does. He also needs to take care making the common mistake of talking about saturated fat and showing images of cakes, chips, pizza, pastries and pies – all higher in carbohydrate than fat and most higher in unsaturated than saturated fat – not that one real fat is better or worse than another, but just to set the record straight. I would totally agree that cakes, chips, pizza, pastries and pies etc are not fit for human consumption. However that’s because of the sugar, white flour, vegetable fats and modern ingredients that they contain – not because of any small amount of natural fat that may be in junk food.
Dr Phil (with reference to the cakes, chips, junk carbohydrates on one table): “So that makes the bad cholesterol that clogs up your arteries. However, this table is full of vegetable fats and fish fats and they give high levels of good cholesterol. Good cholesterol that stops your arteries from getting clogged up.”
Fact: Where to start with this one!
1) Any food that contains fat contains all three fats – saturated, monounsaturated and polyunsaturated – there are no exceptions. Sirloin steak, for example, is approximately 71% water, 21% protein, 3% unsaturated fat and 2% saturated fat. Is the unsaturated fat trying to raise HDL, while the saturated fat is trying to raise LDL? Which shall prevail?! How can any of this happen, let alone why would it?! It really is beyond absurd.
2) Mackerel has over twice the overall fat of sirloin steak and one and a half times the saturated fat – so why is Dr Phil recommending fish, if he’s so concerned about saturated fat by some miraculous and unknown mechanism turning into LDL and clogging up arteries?
Dr Phil: “Bad cholesterol can stick to the artery walls just like fat in sewers. So, over time, your arteries, like your drain, can get clogged or even blocked. That’s where the good cholesterol comes in. It helps prevent blockages because it carries the bad cholesterol away from the artery walls and back to the liver where it can be flushed away.”
Fact: Going along with the nonsense that Dr Phil is talking about LDL and HDL here, because there is no such thing as bad and good cholesterol, LDL would more accurately be called the carrier of fresh cholesterol and HDL would more accurately be called the carrier of cholesterol for recycling. When arteries are damaged (by smoking – Chissy, or sugar – Jodie, or stress, or as a result of many modern lifestyle factors) cells have an LDL receptor and the damaged cells will take LDL ‘taxis’ from the blood stream, with all the repair tools that the lipoproteins contain, and the damage can be repaired. Any cholesterol found at the scene of the damage is there to repair the damage – it did not cause the damage anymore than police found at the scene of the crime caused the crime.
And HDL carries protein, phospholipids, triglyceride and cholesterol back to the liver – not as Dr Phil says “where it can be flushed away”, but so that cholesterol – and the other lipids – can be recycled by the liver. Cholesterol is too valuable a substance for the body to waste any.
The visual for this part of the programme featured pink swimmers representing bad cholesterol and green swimmers representing good cholesterol and I found the nearest wall to bang my head against.
I had a brief moment of humour, when I had finished banging my head, as Crissy was interviewed and confessed “Before today I was very ignorant”. Oh Crissy dah-ling – before today you were blissfully unaware. Now your head has been filled with complete ignorance about tooth fairies, father Christmas and good and bad cholesterol…
Conflict of interest
A cholesterol bashing programme would not be complete without some conflict of interest. I’m not aware of any among the presenters, but Heart UK were one of the ‘charities’ featured on the programme. Heart UK describes itself as “the cholesterol charity” and I’ve joked before that cholesterol needs a charity, because it’s an endangered species! However, that’s not what Heart UK means.
Heart UK is the partner of just about every company that makes zillions out of trying to lower cholesterol – from the statin companies (Pfizer, Astra Zeneca, Kowa Pharmaceuticals, Merck, Roche) to Unilever (Flora) and even the Food & Drink Federation – the organisation that must love the eatbadly plate.
Remembering that one statin alone, Lipitor, has been worth $125 BILLION to Pfizer during its patent lifetime, the rationale for cholesterol demonisation is clear. Shame on the BBC for perpetuating the biggest crime that has been inflicted on man by mankind – lowering cholesterol in the name of profit beyond wild dreams.