Author, obesity researcher .

Coca-Cola, Obesity and Conflict

Coca-Cola launched an advert about obesity. You can see the advert here as part of a short clip on ABC news. The ABC news item had an interesting factoid in it: “Sugary sodas are the number one source of calories in the American diet.”

The Coca-cola advert has a female voice over – that kind of warm, trustworthy sort of female voice – and this is what she says: “Today, we’d like people to come together on something that concerns all of us – obesity… we now offer over 180 low and no-calorie choices…” (If you’re bored you could always play ‘spot the obese person in the Coca-Cola advert on obesity’!)

Back to the ABC report and they have a brief quote from “a sports nutritionist recommended by Coca-Cola” – Dr. Russell Pate, Director Children’s Physical Activity Research Group. Dr. Pate says “I believe strongly that we will have to increase the physical activity level of our population if we want to overcome the obesity epidemic.”

Surely Dr. Pate is bright enough to have worked out that it is better not to consume empty calories than it is to consume them and then try to work them off (good luck with a “Big Gulp” – 32 ounce monster, by the way). Surely also that Dr. Pate should have declared that the University of South Carolina Department of Exercise Science, where he works, acknowledged in their spring 2011 newsletter (opening paragraph) “Recent new funding includes a large grant from Coca-Cola“.

Steven Blair is one of Pate’s colleagues – also an active global speaker delivering the message – obesity is not about what we put in our mouths, it’s about being too darn lazy. Check out this picture of Steven Blair . He’s either too darn lazy or he’s been having too much of his sponsor’s medicine! Blair’s loyalty to Coca-Cola has not gone unrewarded – he was a torch bearer at the London Olympics “recognized by Coca-Cola North America, one of the Olympic sponsors, for his ‘leadership in helping others live positively.’”

On October 15th 2012 BBC Newsnight did a programme about lawyers in the USA who are taking on the ‘food’ and ‘drink’ industry in the same way that they did the tobacco industry. One of the lawyers is the same one who did so well against the cigarette firms, Don Barrett. The parallels between the tactics of the cigarette firms and the tactics of the soft drink manufacturers are strikingly similar. It does us no harm to make the following parallel. The main argument presented by Coca-Cola in their advert is that they have introduced over 180 low and no-calorie drinks to their range. Notice that they have taken nothing away – they have merely added lucrative new lines for more people to have more options for consuming their products. Can you imagine the reaction to Philip Morris running an advert to express their concern for heart disease with the positioning that it’s nothing to do with them because they’ve introduced lots of new low tar options?!

What Coca-Cola is doing really is that manipulative and disgraceful.

Coca-Cola’s relationships

Coca-Cola’s relationships with obesity and health organisations are widespread. They are a sponsor of the American Dietetic Association. This is additionally worrying in America as dietitians have a legislated monopoly on giving dietary advice – check out their other sponsors in case you ever wondered where American official dietary advice comes from.

At the time of writing my book The Obesity Epidemic: What caused it? How can we stop it?, Coca-Cola were a sponsor of the UK Association for the Study of Obesity. Checking today on the web site Coca-Cola are not mentioned but Kellogg’s remain a “supporter”.

Coca-Cola is a sustaining member of the British Nutrition Foundation.

The International Life Sciences Institute (ILSI) “is a nonprofit, worldwide organization whose mission is to improve public health and well-being by engaging academic, government and industry scientists in a neutral forum to advance scientific understanding in the areas related to nutrition, food safety, risk assessment, and the environment. ILSI receives its funding from its industry members, governments, and foundations.” The board of trustees lists 31 members, including representatives from: The Coca-Cola company and Coca-Cola Europe. (All correct at the time my book was published stating this).

One of the reasons I am so outspoken about the government’s ‘Eatwell Plate‘, which I call the eatbadly plate, is that it panders to the food companies. Kellogg’s must love the cornflakes packet – it was a Kellogg’s branded cornflakes packet on the first version of the plate (The Balance of Good Health). Coca-cola must love the red cola can, labelled cola, in the segment showing that 8% of your plate should be covered with junk. As I showed in my obesity epidemic book, that 8% of intake by weight becomes over 20% of intake by calories – perhaps an unintended consequence of this bad advice.

You know that the government’s ‘role model’ plate for healthy eating is anything but when it is featured on web sites for numerous food and drink companies. I stopped looking after the first six companies that came to mind all endorsed the plate: Sainsbury’s; Kellogg’s; PepsiCo; Coca-Cola; Nestle and Premier Foods.

The Olympics was a wonderful platform for Coca-Cola to promote their products to a global audience, as one of the official sponsors of the games. Coca-Cola’s association with sport and slim, athletic looking people, reinforces their desired message – drink Coca-cola, exercise and you won’t get fat. As Coca-Cola says on its website, they are “proud to be the longest continuous corporate partner of the Olympic Games” – an involvement that dates back to the Amsterdam games of 1928.

The Scientific Advisory Committee on Nutrition (SACN) has a carbohydrate working group looking at the evidence for carbohydrate intake on cardio-metabolic health. A highly worthy review and one that I would expect to raise serious concerns about modern intake of carbohydrates, especially refined ones, and modern illness – not just heart health, but diabetes, cancer, bowel disorders and all illness that has accompanied our recent diet and lifestyle. The chair of this working group is Professor Ian MacDonald, and his research interests include nutritional and metabolic aspects of obesity, diabetes and cardiovascular disease. An excellent candidate for chair you would think. However, the SACN 2008 annual report lists Professor MacDonald’s declared interests as Mars Europe and Coca-Cola Europe.

Even the World Health Organisation is not immune. They were ‘outed’ last year as a recipient of Coca-Cola’s profit.

The bottom line

Coca-Cola is part of the problem, not part of the solution. It is not Coca-Cola’s job to resolve the obesity epidemic. It is Coca-Cola’s job to maximise profit for shareholders. In the fight against the obesity epidemic, Coca-Cola is the enemy, not a private army. We know this. Coca-Cola knows this. Their response to this unfortunate truth is to try to keep their enemies closer still. We need to keep ours as far away from our citizens as possible.

The British Heart Foundation & Flora pro.activ – an unhealthy relationship

The British Heart Foundation (BHF) describes itself as “a charity that aims to prevent people dying from heart diseases”. Until now, the BHF has remained relatively conflict free – a paragon of virtue in fact when compared with some other ‘heart charities’. Heart UK, for example, calls itself the cholesterol charity (cholesterol should have a charity for having become endangered, but that’s not what they mean!) Heart UK partners with drug companies, the very companies that profit beyond wild dreams from the lucrative war on this life vital substance, as their partner list confirms.

I receive a copy of the BHF magazine, which comes out six times a year. It is called “Heart Matters” and should be commended for having no adverts. It should also be completely ignored because the high carb/low fat/fear cholesterol advice is doing serious harm. However, at least the BHF has appeared free from conflict – until now…

On page 8 of the October/November issue there was an item entitled “Women’s heart health at risk” and the magazine proudly announced “We have teamed up with Flora pro.activ to encourage women to think more about their heart health.” It continued: “This month keep your eyes peeled for the partnership, which will reach women through information on special packs of Flora pro.activ, TV ads and online.” TV ads are seriously expensive – we can guess that Unilever has funded these? “One of the key things the campaign will encourage women to do is to get their cholesterol checked.” And once in the system, no doubt, the women can be frightened into fearing cholesterol and trying to lower it with statins or eating Flora pro.activ gunge or both. A web site has been set up in honour of this new partnership.

I first saw the advert on UK TV screens in January 2013 – you can see it here. A woman confidently asserts “A key risk factor for heart disease is high cholesterol.” My independent, unbiased, not-funded-by-drug-companies study of all 192 countries for which the World Health Organisation has data shows that the exact opposite is true. The higher one’s cholesterol level, the lower one’s risk of heart disease and vice versa. For men and women. For heart disease and all cause mortality. The graphs are on this blog here.

There are three critical things that the BHF needs to know about spreads that lower cholesterol – 1) how they are made 2) how they lower cholesterol and 3) the particular issues with targeting women.

1) How spreads are made

An entire industry, worth five billion dollars in the USA (2008) alone,[i] has been built on the irony of destroying the reputation of butter and then trying to reproduce the substance. The main fat in butter is saturated fat, making it naturally solid at room temperature. Butter also has a natural colour.

The first part of the imitation process is to take liquid oils, usually cheap and low quality vegetable oils, and then turn them into solid fats in some way. The chemical difference between fats solid at room temperature and fats liquid at room temperature is that the solid fats have hydrogen atoms in the right place providing a more solid and stable structure. This is why butter is one of the safest fats to cook with. So the spread manufacturers need to add hydrogen atoms to their liquid oils in some way. We used to hear about hydrogenated fats and then we had partially hydrogenated fats, but whether or not the attempt is to fully or partially hydrogenate liquid oils, the process is the same. If the spreads industry are turning liquid fats into solids in a new/non-hydrogenated way – I invite them to share how. (See Post Script)

In the process of hydrogenation, the oils are heated and pressurised and hydrogen gas is added, along with a catalyst, like nickel, to produce a chemical reaction. The idea is that the hydrogen atoms end up in the gaps where they would be in a more saturated fat. Of course, the hydrogen atoms don’t end up exactly where they ‘should’. Some end up on the wrong side of the structure and you end up not with a saturated fat, but with a completely new fat completely alien to the body. These are what is known as trans fats – some atoms have ‘transitioned’/crossed over and are not where they should be. (Do I think that putting alien chemicals into the human body can cause heart disease, cancer and all sorts of harm? I think that I would be naive not to think this).

The substance at the end of this process is grey, smelly and lumpy, so it is bleached, deodorised and emulsifiers are added to smooth things over. The mandatory vitamins are added in at this stage because none could have survived that process. Finally, the stuff needs some colour to make it look edible, so, of course, the preferred colour is butter colour. (Canada retained the strongest legislative position on not allowing butter colour to be used. As recently as July 2008 Quebec became the last Canadian province to repeal its law that margarine should be colourless).[ii]

The processed spread is much cheaper, despite all the industrial operations needed. Real butter needs to come from a real animal and the best butter is hand churned. I checked an on line grocery store at the time of writing The Obesity Epidemic: What caused it? How can we stop it?, and the cheapest butter that I could buy was nearly three times the price of the cheapest spread. The butter was sold in 250 gram packets. The spreads were sold in 500 gram, or one kilogram, tubs.

To conclude the ‘how to imitate butter’ process, you need a health claim, a name and a marketing campaign. The health claim should be twofold: a) this is not a bad saturated fat (tell them what you are not – don’t tell them what you are); and b) add some plant sterols and then ‘sell’ cholesterol lowering ‘benefit’. The name and the marketing campaign go hand in hand. While welcoming any attack on saturated fat generally, and butter particularly, the spread companies launch products called “Utterly Butterly”, “Butter me up”, “Butterlicious”, “You’ll Mutter It’s Butter”, “Don’t Flutter with Butter”, “You’d Butter Believe”, “You’ll Never Believe It, Believe It or Not”, all spawned from the original “I can’t believe it’s not butter.”[iii]

You just couldn’t make this up.

2) How spreads lower cholesterol

There is nothing in the spread itself that would lower cholesterol (please remember we should never try to lower the body’s own production of cholesterol – but we’re working through this scenario to see what these spreads actually do). It is the plant sterols mentioned above that can impact human cholesterol. These can be obtained in tablet form, so no one needs to consume spreads, even if they are misinformed enough to risk consuming plant sterol. (Why didn’t the BHF tell people this and not go near spreads?)

Think of plant sterols as plant cholesterol – just as we humans have human cholesterol. There are several types of plant cholesterol; together they are named plant sterols. A typical Western diet contains approximately 400-500 mg plant sterols, but little is taken up in the gut. Human and plant cholesterol compete for uptake in the gut. So, if too much plant sterol is consumed, human cholesterol falls.

I don’t know about you but I assume that my body is making the cholesterol that it needs and a plant is making the cholesterol that it needs. If we were supposed to be replacing human cholesterol with plant cholesterol I figure that there would be a natural process for this. But then ‘natural’ is rarely lucrative.

So yes, human cholesterol, which is what our blood test measures, will fall if we consume plant sterols but a) this is not natural b) we have no evidence that replacing our cholesterol with plant cholesterol will lower heart disease and c) we have no evidence that replacing our cholesterol with plant cholesterol is safe.

As Dr Uffe Ravnskov, founder of the International Network of Cholesterol Skeptics and author of several books about fat and cholesterol, says: “It is correct that cholesterol goes down if we eat much plant sterol, but that doesn’t mean that it is able to prevent heart disease, because no one has ever tested that in a scientific experiment. What happens is that our own cholesterol is exchanged with a foreign type of cholesterol, not only in the blood but also in our cells and cell membranes. Is it really a good idea? Isn’t it likely that the molecular differences between animal and plant sterols have a meaning? I think so, and science is in support of my view.”

Dr Ravnskov has led the way in trying to investigate what happens if we unnaturally ingest large quantities of plant sterols. He notes that David Jenkins and 16 colleagues had an article published in the Journal of the American Medical Association raving about the ‘benefits’ of consuming plant sterols.

Ravnskov uncovered their conflicts of interests as follows: “According to the Conflict of Interest Disclosures ten of the authors were supported financially by Unilever and several other producers of the food types used in the trial. Here is for instance Dr. Jenkins´ list:

“Dr Jenkins reported serving on the Scientific Advisory Board of Unilever, Sanitarium Company, California Strawberry Commission, Loblaw Supermarket, Herbal Life International, Nutritional Fundamental for Health, Pacific Health Laboratories, Metagenics, Bayer Consumer Care, Orafti, Dean Foods, Kellogg’s, Quaker Oats, Procter & Gamble, Coca-Cola, NuVal Griffin Hospital, Abbott, Pulse Canada, Saskatchewan Pulse Growers, and Canola Council of Canada; receiving honoraria for scientific advice from the Almond Board of California, International Tree Nut Council Nutrition Research and Education Foundation, Barilla, Unilever Canada, Solae, Oldways, Kellogg’s, Quaker Oats, Procter & Gamble, Coca-Cola, NuVal Griffin Hospital, Abbott, Canola Council of Canada, Dean Foods, California Strawberry Commission, Haine Celestial, and Alpro Foundation; being on the speakers panel for the Almond Board of California; receiving research grants from Loblaw Brands Ltd, Unilever, Barilla, Almond Board of California, Solae, Haine Celestial, Sanitarium Company, Orafti, International Tree Nut Council, and Peanut Institute; and receiving travel support to meetings from the Almond Board of California, Unilever, Alpro Foundation, and International Tree Nut Council.” 

In addition Unilever Research and Development provided the donation of margarines used in the study.

Without the luxury of being funded by spread makers, Dr Ravnskov has found that “several studies have shown that even a mild elevation of plant sterols in the blood is a risk factor for heart disease”. (Further information and references for these studies can be found in Dr Ravnskov’s September 2012 newsletter ).

Ravnskov gives this as a particular example: “Statin treatment lowers blood cholesterol, but at the same time it raises the level of plant sterols. In the 4S-trial [one of the best known statin studies] about 25 % of the patients had a mildly elevated level of plant sterols before treatment. In this group statin treatment resulted in a further increase of plant sterols and the number of heart attacks was twice as high compared with the patients with the lowest plant sterol levels. This means that for about 25% of the many millions of people on statin treatment, their risk of heart disease may increase, not decrease. ”

In spite of that, Unilever still advertise their margarine and other food products with high contents of plant sterols as “heart healthy” and now the British Heart Foundation is part of this scandal.

3) The particular issues with targeting women

Q) Why do eggs contain a lot of cholesterol?

A) Because it takes a lot of cholesterol to make a healthy chicken.

For women to make a healthy baby, they need a lot of cholesterol. The blog showing that high cholesterol is associated with low heart deaths and low overall mortality has details about the functions performed by cholesterol and why it is so utterly life vital to humans. When you understand the vital role that cholesterol plays in every single cell of the human body, not least the reproductive system, you can start to understand why cholesterol is so vital to all humans, and to women having or intending to have children especially. (You may also wonder why on earth such a critical substance for human health has been demonised so comprehensively – the next paragraph will give you a clue.)

Lipitor is the most lucrative of all statins. It has earned Pfizer in the region of $125 BILLION since 1997. The patient leaflet can be accessed here. The leaflet states “Do not take Lipitor
− if you are a woman able to have children and not using reliable contraception
− if you are pregnant or trying to become pregnant
− if you are breast-feeding.”

So, even the drug companies know that cholesterol should not be lowered in pregnant women, breastfeeding women or women who could conceive. What about cholesterol lowering products, as opposed to cholesterol lowering drugs? When Flora pro.activ replaces human cholesterol with plant sterols, what are the consequences? When the pregnant woman’s cholesterol level is lowered by taking Flora pro.activ, what are the consequences? Should cholesterol lowering spreads come with a health warning for pregnant women? Breastfeeding women? Women of childbearing age? Are they safe? Let alone healthy? Does Unilever know? Does the BHF know? Do they care? Do you know? Do you care?

Nature makes a natural product for using in any and all circumstances when Unilever would no doubt prefer people to use one of their processed products instead. The natural product is called butter, but then there’s no money for Unilever or the BHF in promoting butter. Shame on both of them.

Post Script: The wonderful Dr. Malcolm Kendrick has found that there is a way of solidifying liquid vegetable oils without hydrogenation. The process is called Interesterification and Wiki tells us how it is done: “Interesterification is carried out by blending the desired oils and then rearranging the fatty acids over the glycerol backbone with, for instance the help of catalysts or lipase enzymes. Polyunsaturated fatty acids (PUFAs) decrease the melting point of fats significantly. A triglyceride containing three saturated fatty acids is generally solid at room temperature and not very desirable for many applications. Rearranging these tryglycerides with oils containing unsaturated fatty acids lowers the melting point and creates fats with properties better suited for target food products. In addition, blending interesterified oils with liquid oils allows the reduction in saturated fatty acids in many trans fatty acid free food products. The interesterified fats can be separated through controlled crystallization, also called fractionation.”

Yummy!

(Zoe note – the idea that real saturated fats may not be desirable and these manufactured fats may be better suited for ‘target food products’ may refer to the fact that these ‘fake’ fats are cheaper and have a longer shelf life – fine properties for a ‘food’ company, but not for a human).

High intake of saturated fat & sperm quality in Danish men

“Eating a fatty diet could reduce a man’s sperm count by 40%” said the Daily Mail – enough to put every man off his bacon & egg. The Globe and Mail warned similarly: “Eating too much saturated fat may decrease sperm counts.”

The headlines came from a study published in the American Journal of Clinical Nutrition.” High dietary intake of saturated fat is associated with reduced semen quality among 701 young Danish men from the general population.” Unfortunately only the abstract is on free view – I’ve got hold of the full article to see what it’s all about.

As the article title confirms – the study involved 701 Danish men who signed up for military training between April 2008 and June 2010. The men “delivered a semen sample, underwent a physical examination, and answered a questionnaire comprising a quantitative food-frequency questionnaire to assess food and nutrient intakes.” The food questionnaire was intended to review the three months prior to the military training sign up appointment.

The full article states (in the introduction) “We therefore examined the associations between dietary fat intakes and semen quality among 701 young Danish men from the general population, hypothesizing that a high intake of saturated fat is associated with reduced semen quality.” So, the researchers hypothesised that saturated fat intake is associated with reduced semen quality before doing the study. As Einstein said, if you know what you’re looking for, it ain’t research!

The conclusions of the study were: “…men in the highest quartile of saturated fat intake had a 38% (95% CI: 0.1%, 61%) lower sperm concentration and a 41% (95% CI: 4%, 64%) lower total sperm count than did men in the lowest quartile. No association between semen quality and intake of other types of fat was found.”

Table 1

Table 1 in the full article shows the 701 men allocated into four groups – Quartile 1 (the lowest intake of saturated fat from the questionnaire) to Quartile 4 (the highest intake of saturated fat from the questionnaire). In Quartile 1, saturated fat intake was 11.2% of dietary energy intake or lower. In Quartile 4, saturated fat intake was 15.19% of dietary energy intake or higher. There were 174 men in Quartile 1, 179 in Quartile 2, 170 in Quartile 3 and 178 in Quartile 4.

For each quartile, there is information for a number of other parameters – the usual other things worth looking at – age,smoking, BMI, total energy intake, intake of other fats, physical activity, caffeine intake. There are also some factors particularly relevant to this study – the period of abstinence before the sperm sample was obtained and incidence of sexually transmitted diseases.

Here are the most relevant numbers from Table 1:

	Quartile 1	Quartile 2	Quartile 3	Quartile 4
Number in quartile	174	179	170	178
SFA as % of energy	<11.2	11.2-13.27	13.28-15.19	>15.19
Period of abstinence >96 hr	18	10	11	13
BMI <20 kg/m2	10	15	11	23
BMI 20-24.9	70	60	68	66
BMI 25+	20	25	21	11
Alcohol intake >21 units/wk	23	25	32	29
Weekly current smoking	43	45	49	52
Age >20 yr	24	22	21	28
Sexually Transmitted Diseases	7	11	9	19
Total energy intake (MJ)	8.6	9.4	9.8	10.6
Total fat (% of energy)	24	29	33	38
MUFA as % of energy	4.2	4.8	5.2	5.5
PUFA as % of energy	8.6	10.8	12.3	13.8

 

(NOTES: SFA is an abbreviation for saturated fat, MUFA is an abbreviation for monounsaturated fat and PUFA is an abbreviation for polyunsaturated fat. It is not always clear from the table what the numbers are and therefore looking at them relatively across the quartiles is more useful than trying to work out what they say absolutely. The BMI numbers are % of each quartile in each of the 3 BMI categories. So, in Quartile 1, for example 10% of people are <20 BMI, 70% are in the 20-24.9 range and 20% over 25 – this adds to 100% down the 3 rows – as do the other quartiles. The alcohol number seems to be the percentage of people in that quartile who consume more than 21 units a week – self reported. Smoking seems to be % who smoke and STD’s seems to be the percentage that confessed to having had a Sexually Transmitted Disease).

The above tells us the following:

Q4 had higher saturated fat intake (as a % of energy) than Q1 but it also had:

- higher energy (calorie) intake than Q1;

- higher total fat as a % of energy intake;

- higher monounsaturated fat as a % of energy intake;

- higher polyunsaturated fat as a % of energy intake;

- over twice as many people in the underweight BMI category (taking BMI of under 20 as underweight in this case);

- almost half as many in the overweight BMI category;

- higher incidence of higher alcohol unit intake;

- more smokers;

- more older people (over 20);

- almost three times the incidence of sexually transmitted diseases (STDs); and

- 50% fewer people who had abstained for more than 96 hours before the sperm sample.

Table 2

Table 2 is interesting. This has semen volume, sperm concentration, total sperm count and motile sperm (the latter gives an indication of the quality of the sperm – their ability to move effectively towards an egg) against the different quartiles for total fat, SFA, MUFA, PUFA and even gets down to omega-3 and omega-6 essential fatty acids. Let’s just take the part of the table for SFA vs the sperm measurements:

	Semen volume	Sperm concentration	Total sperm count	Motile sperm
	mL	millions/mL	millions	%
SFA <11.2	3.1	50	163	68
SFA 11.2-13.27	3.4	53	174	71
SFA 13.28-15.19	3.1	44	130	69
SFA >15.19% of energy	3.1	45	128	69

 

This tells me that the ‘best’ intake of saturated fat for semen volume, sperm concentration, total sperm count and motile sperm is 11.2-13.27% of dietary energy (a bit precise, but that’s what it suggests). There’s barely any difference between the third and fourth quartiles and the second quartile is ‘better’ than the first. This is notwithstanding all the variables stacked against the quartiles as they go up from 1 to 4 for everything else – alcohol, smoking, STD’s, age, being underweight etc.

Table 3

Table 3 tries to “take into account confounders”. However, it only tries to take into account BMI, alcohol consumption, smoking and the period of abstinence before the sample. It doesn’t appear to take into account the nearly three times higher incidence of STDs and there being more men in Q4 over 20 than in Q1. Even if all attempted confounders have been perfectly accounted for (and I can’t see how, from the SFA data in Table 2 being unremarkable and the different attributes in Table 1 being significant), surely the difference in age in Q4 and the highly significant difference in the incidence of STDs could alone explain any difference in sperm quality? (Again – not that the difference in sperm quality in Table 2 is much to get excited about).

The numbers in the media headlines come from Table 3, which gives “Adjusted differences in semen quality by percentage intake of total fats and major fatty acid groups from a multiple linear regression analysis.” The article doesn’t give enough detail for readers to be able to follow what has been done to get to this table, but you can see the 38% differential for sperm concentration and 41% differential for total sperm count at the top quartile for SFA intake as a % of total energy.

	Semen volume	Sperm concentration	Total sperm count
	mL	millions/mL	millions
SFA <11.2	Reference	Reference	Reference
SFA 11.2-13.27	0.1	-13.0	-13.0
SFA 13.28-15.19	-0.1	-27.0	-31.0
SFA >15.19% of energy	0.1	-38.0	-41.0

 

This doesn’t make sense to me. Table 1 tells us that quartile 1 has every advantage over quartile 4. Hence, if this is appropriately accounted for, differences remaining attributable to saturated fat intake (as opposed to alcohol, smoking, period of abstinence etc) should be tiny.

Table 2 tells us that the raw data for the sperm concentration and quality aren’t that different and that the ‘best’ SFA intake for all measures is 11.2-13.27% of energy (not the lowest SFA intake possible). For sperm concentration, Quartile 2 is 6% higher than Quartile 1 and Quartile 4 is 10% lower than Quartile 1 – no where near a 38% differential and these should reduce after allowing for confounders. For total sperm count, Quartiles 3 and 4 are approximately 20% lower than Quartile 1. Quartile 1 is approximately 7% lower than Quartile 2. Also not in the 40% differential range and also should reduce following allowance for confounders.

Table 3 also no longer mentions motility – that’s the statistic to get excited about if you’re trying to conceive – why was this dropped? Did it not give ‘the right’ answer?

It also makes no sense to claim an association with saturated fat and not total fat or any other fat. Saturated fat cannot be eaten alone. Every single food on the planet that contains saturated fat also contains monounsaturated fat and polyunsaturated fat – there are no exceptions. The extracted numbers from Table 1 confirm that total fat, monounsaturated fat and polyunsaturated fat all increased from Quartile 1 to Quartile 4 and yet we are led to believe that only saturated fat is associated with sperm concentration and sperm count. Not only is this not plausible, no plausible mechanism is offered for any possible explanation for proposed association throughout the article. How can saturated fat intake (alone from other fat intake and total fat intake) impact sperm concentration and sperm count?

If the period of abstinence tells us anything, a much more interesting headline could have been “Men who eat more saturated fat have sex more frequently!”

RCPCH launches vitamin D campaign

Rickets describes a condition where bones are abnormally weak and the skeletal structure is thus compromised. It used to be visually observable in Victorian times, as children suffering from malnutrition would exhibit ‘bow legs’ – curved deformity in their limbs. Today’s cases more typically manifest themselves in bones breaking easily, rather than visual signs. Rickets is a sign of vitamin D deficiency. There are two minerals that are also vital for bone health – calcium and phosphorus. Phosphorus needs vitamin D for its absorption, so these three nutrients work together to determine bone health. They are usually found in the same foods (meat, eggs, dairy products), which is nature’s way of ensuring that we get the nutrients that we need to complement each other.

We know that vitamin D is one of our most vital nutrients – we are continually learning more about this particular vitamin. We know enough already to be sure that it plays a critical protective role in heart disease and cancer, as well as the more obvious osteoporosis and the less obvious mental health.

Just over two years ago, a Telegraph article raised the topic of rickets returning in children.

Rickets was back in the news last week. The Daily Mail headline was “Return of rickets: Cases up four-fold in the last 15 years as pregnant women and children fail to get enough Vitamin D“.

Barbara Ellen, writing in The Guardian, made a non-evidence based claim in her headline: “So rickets is back. Blame poverty, not a lack of sun“.

The source of the story was a release from the Royal College of Pediatrics and Child Health (RCPCH): “RCPCH launches vitamin D campaign.” The position statement is here.

Cases of rickets have apparently risen fourfold since the mid-1990′s (from 183 to 762). Far more worryingly, the RCPCH reports that half of Britain’s white population, up to 90% of the ethnic population and a quarter of children are suffering from vitamin D deficiency.

Cholesterol and vitamin D

In our war on cholesterol we seem to have forgotten a critical route by which vitamin D is made – sunshine synthesises cholesterol in the skin and turns it into vitamin D. If we lack sunshine, or cholesterol, or both, we have impaired ability to make vitamin D. We can also obtain vitamin D from food, but we have demonised the foods most abundant in this vital nutrient: red meat, fatty fish, eggs and dairy products. Three ‘health’ dictats have thus contributed to the return of a disease that should have died with the Victorian era: 1) lower cholesterol 2) avoid dietary fat 3)  don’t go out in the sun and/or cover up with clothing/factor cream if you do.

Ellen, in her Guardian article, wrote “No one seems to know why there is such a high incidence among certain ethnic groups.” If she had not been so quick to decide that rickets is about poverty, rather than lack of sunshine, the rationale for the ethnic dimension is obvious. Indigenously, darker skin people live nearer the equator and lighter skin people live further away from the equator. This is evolution. Those nearer the equator get more sunshine, but their darker skin lets less through to synthesise into vitamin D. Fair skinned Scandinavians get less sunshine, but their lighter skin allows more cholesterol to be synthesised into vitamin D.

The RCPCH position statement notes that “Sunshine (via skin photosynthesis) is the main natural source of vitamin D in humans. In the UK, vitamin D can only be made in our skin by the action of sunlight during the summer-time, and only during the middle of the day when the sun is high in the sky.”

Birmingham is the latitude, North of which we understand that sunshine is insufficient to provide any skin synthesis of cholesterol into vitamin D during the winter months. Hence any darker skinned people living in Birmingham, or further North anywhere in the world, are unable to make vitamin D during the winter time. They need to cover this with dietary intake in the winter months and get optimal sun exposure during the summer months. This doesn’t happen. Asian women particularly, cover themselves up all year round and deny themselves the gift that the sun is trying to give them.

Knowing the role that vitamin D plays in heart disease helps us to understand why Asians and black people, living outside their country of ethnic origin, suffer substantially higher heart disease. They literally have the wrong skin colour for their environment, reducing access to vitamin D. The ultimate irony is that the known higher incidence of heart disease in ethnic populations will have doctors place such people on cholesterol lowering medication and a low-fat diet and this will further reduce their chance of obtaining the very nutrient that they are missing. Our public health advice is bad enough for Anglo Saxons. For those of other ethnic origins, it is a death sentence.

The RCPCH call to action

We have brought this illness upon ourselves and the RCPCH should have pointed this out. Instead they listed nine points for action. You can see them for yourself in the position statement. They can be summarised as follows – my comments are below each recommendation.

1) We need more research.

No we don’t. We know how utterly vital vitamin D is not just for bone health, but for entire human health. The Department of Health[i], Dietary Reference Values for Food, Energy and Nutrients for the UK does not even have complete listings for the vitamin D Reference Nutrient Intake for adults. Where recommendations are made, the recommended daily intake is 10mcg. The USA recently revised their vitamin D Recommended Dietary Allowance (RDA) upwards from 10mcg to 15mcg.

The 2010 Family Food Survey[ii] reports that average UK vitamin D intake is 3.12mcg. We therefore have government evidence of substantial deficiency. (This survey is available annually and this deficiency has been observable for many years). Further research is not needed. We should revise the UK RDA upwards to 15mcg and take immediate steps to encourage sun exposure, cease all lowering of cholesterol and ensure that animal foods form the staple part of human diets.

2) Do surveillance to further understand the problem.

Research/surveillance – same difference. This is unnecessary procrastination. See the response to (1).

3) We should take supplements.

We don’t need supplements. We need to stop demonising fat, cholesterol and sunshine.

4) Paediatricians must work closely with other health professionals in ensuring optimal nutritional health of the foetus, infant and child.

Yes – by ceasing the demonisation of fat, cholesterol and sunshine.

5) Wait for the Scientific Advisory Committee on Nutrition, to report in relation to dosages and timing of supplements and wider food fortification.

No – this is the same as points (1) and (2). We have enough information. Don’t delay and act now.

6) Fortify fake foods.

This beggars belief. The position statement notes that margarine, infant formula milk and some breakfast cereals are fortified with vitamin D. Can we really be saying eat fortified, (hydrogenated), emulsified, bleached, deodorised and coloured margarine, with synthetic vitamin D added, instead of butter, which comes naturally with vitamin D? Can we really be saying that we should have sugary cereal, with synthetic vitamin D added, instead of eggs for breakfast, which come naturally with vitamin D? Can we really be saying that babies and toddlers should be having fake food (infant formula) during their most critical years, instead of breast milk and blended real food?

In my book The Obesity Epidemic: What caused it? How can we stop it?  I analyse an infant formula. The composition of Similac Isomil Advance, Soy Formula is 50% corn syrup, 14.2% soy protein isolate, 10.4% high oleic safflower oil, 9.7% sucrose, 8.2% soy oil and 7.5% coconut oil.[iii] If a baby is unfortunate enough not to be breastfed, the infant can be started on a diet of 60% sugar from the first moment something is put in its mouth

7) Make single vitamin D supplements – because vitamin D/A combinations are bad for pregnant women.

Puh-lease! The same government data that shows serious deficiency in vitamin D also confirms that we are deficient in retinol – the form in which the body needs vitamin A. We should not lose any sleep thinking that anyone in the UK is getting too many nutrients, let alone pregnant women with even higher nutrient requirements than average.

This point is also the same as (3) – take supplements. The answer is thus the same – no – just stop demonising fat, cholesterol and sunshine.

8) Use the “Healthy Start” programme to get supplements into children.

No – just stop demonising fat, cholesterol and sunshine

9) Practical signposting should be made to paediatricians about best guidance on treatment and prevention to-date and learning opportunities, specifically the RCPCH e-learning and teaching sessions on nutrition.

The RCPCH advice can be summed up as 1) get more information and 2) get supplements into people. On this basis, the less well known the RCPCH advice is the better!

I reiterate. We need to stop demonising fat, cholesterol and sunshine and promote all three as healthful instead.

Dietary sources of vitamin D

For those winter months when we don’t have access to the sun and for optimal vitamin D intake at all times, we need to consume vitamin D in our diets. Dairy products are good sources of vitamin D. Oily fish is better. Sardines have approximately 7 times the vitamin D levels of whole milk and over 20 times the levels in hard cheese (and hard cheese is better than soft cheese for the bone nutrients generally).

200g of sardines (a medium sized tin) would give nearly 15mcg of vitamin D in one go. Other oily fish are excellent sources of vitamin D (herring, halibut, catfish, salmon, mackerel etc), but sardines are exceptional. Vegetarians would need to eat 26 medium eggs each day (1,634 calories) to get 10mcg of vitamin D. Mushrooms, which have been exposed to sunlight, are the only conceivable option for vegans. Over two kilograms of such mushrooms would need to be sourced and eaten daily to deliver 10mcg of vitamin D. Ideally, but not an option for vegans, these would need to be consumed with butter to make them ‘bio-available’ to the body.

The final important point to note about dietary vitamin D is that it comes in two forms – D2 and D3. D2 comes from plant sources (like the mushrooms mentioned above). D3 only comes from animal sources. This is the form that has been shown to have the most health benefits for humans.[iv] Supplements tend to be in the form of D2 and are therefore no substitute for the red meat, eggs and butter that we have shunned.

Vitamin A is the same – it comes in the form of carotene from plants and retinol from animal foods and retinol is the form needed by the body. Vitamin K has a plant form (K1) and an animal food form (K2). The latter is the one most needed. It was researching nutrition to this level that ended my 20 year period as a vegetarian.

If we want to be healthy we need to eat animals and we need to get out in the sunshine. It’s what we evolved to do and rickets is a terrible reminder of how far removed from our evolutionary roots we have come. RCPCH we do not need more information or supplements. We need to stop demonising the cholesterol that our body is trying to make and to stop demonising the dietary fat and the sunshine that has sustained us since time began.

Just cut fat to cut fat?!

An article was published in the British Medical Journal (BMJ) on Thursday 6th December 2012. It led to a few articles in the media on Friday 7th December. The BMJ article was called: “Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies“.

It wasn’t exactly a headline story – the Mail covered it as shown here. New Scientist were not very scientific making this comment about the article “The pounds fell off when they changed to a diet containing less fat.” You’ll laugh when you see what the weight loss was after at least six months!

The study objective was “To investigate the relation between total fat intake and body weight in adults and children.”
No specific study was done to investigate this – instead the researchers looked for existing trials that compared ‘normal’ fat intake vs. reduced fat intake as a study intervention and included studies that followed up participants after at least six months.

The results were: “…diets lower in total fat were associated with lower relative body weight by 1.6 kg”. That’s 3.5lbs.

My points are as follows:

1.6kg is tiny!

Many of the interventions (listed in Table 1 in the BMJ paper) required fat intake to be no more than 15% of total calorie intake, as opposed to the more typical intake of 30%. That’s a heck of a dietary change to have an impact of a couple of pounds over several months. The record weight loss on Phase 1 of The Harcombe Diet^® is 17lb in 5 days. And that is kept off. I’ve got a BMI of 20.5 and I can lose 4lb in 3 days on Phase 1. My hubby can lose this much in one day when Wales are playing rugby! This really is inconsequential.

What is defined as fat?

There is no detail whatsoever in the BMJ article on precise dietary changes. Let us remember that our government authorities  don’t know the difference between fats and carbohydrates. The UK Food Standards Agency and National Health Service list of saturated fats feature[i]: pies, pastries, cakes, biscuits, savoury snacks, sweets, chocolate and ice cream.

They also list “fatty cuts of meat”, which is ignorant as meat is mostly water, then protein, then unsaturated fat and then saturated fat.  For example, a typical sirloin steak is 71% water, 21% protein, 3.3% unsaturated fat and 2.1% saturated fat (minerals etc make up the difference and rounding errors). Saturated fat literally is the last thing that steak is. They also list dairy products – which are a source of fat (and protein), but they are also an excellent source of calcium, phosphorus and the fat soluble vitamins, A, D, E and K.

The UK is not alone in not knowing the difference between fats and carbs. The Dietary Guidelines for Americans 2005 list: ice cream; sherbet; frozen yogurt; cakes; cookies; quick breads; doughnuts; margarine; sausages; potato chips; corn chips; popcorn and yeast bread as major sources of saturated fats. The Australian Government “Measure Up campaign” lists fatty processed meats and baked cereal based foods such as cakes, pastries and biscuits as sources of saturated fat.

What nutrition was lost?

If people in the intervention groups cut back on pies, pastries, cakes, biscuits, savoury snacks, sweets, chocolate and ice cream, I am only surprised that they didn’t lose more weight. This would have been a positive intervention for weight and health, but it should have been reported as “Cut out junk to lose fat”. If participants cut back on meat and dairy products, they would have lost vital nutrients, essential fats and complete protein.

The government’s own data shows that the UK is badly deficient in fat soluble vitamins.[ii] If any reduction in real food has occurred, with its life vital fats lost, this will have a long term detriment to human health.

The fact is that we don’t know what people cut back on.

“People cut out olive oil, the darling of The Mediterranean Diet, and lose a couple of pounds” may have been an interesting headline.

“People cut out dairy products and suffer bone damage” may have been an interesting headline.

“People cut processed food, in the name of fat, and lose a couple of pounds” quite rightly didn’t make the front pages!

What could the intervention group have lost?

The tragedy of this study is twofold:

1) it continues to perpetuate the demonisation of fat (and real food), which continues to drive people down the route of eating more carbohydrate (and processed food) and

2) it is a huge missed opportunity. The combined studies involved 73,589 people. Imagine that we had been able to get this number of people to eat nothing but real food and compare them to a control group still following the government eat badly plate advice and thereby eating mostly processed food.

Imagine that we had been able to do this for a period of six months, to meet the minimum follow up criteria. People who have been following The Harcombe Diet^® for six months will most likely be at natural weight within this time, unless they have several stones to lose. Someone with six stone or more to lose can lose 50lb in six months – not a couple of pounds – and keep the weight off, as the diet does nothing to adversely impact hunger or metabolism.

“Eat real food, lose weight, gain health and stay that way!” Now that would have been a great headline!

The BDA attacks diets, but what about theirs?

The British Dietetic Association (BDA) did some self promotion last week – they had an article in the Daily Mail attacking some fad diets, which they said should be avoided in the New Year.

Two were so ridiculous that they involved being on intravenous drips – not something that the average dieter could try, let alone would. One called “Alcorexia/drunkorexia diet” is not a recognised diet – it’s a type of behaviour practised by some women who eat less at times to be able to ‘save the calories’ for drinking sessions. The binge drinking is the more damaging behaviour, rather than the eating less at times.

Only two of the diets are recognised diets, which are featured in books: The Six Weeks to OMG diet and The Dukan Diet. I have reviewed both in detail. My review of The Dukan Diet is here. I don’t think that Dukan is healthy, but it will work for those who can stick to it and it doesn’t deserve the BDA’s “worst diet award” for the third year running. Unhealthy as it is, it is healthier than the BDA’s own advice.

I have reviewed Fulton’s OMG diet in detail for our on line club. The BDA don’t appear to have read the book as I have done. The cold baths and black coffee are PR gimmicks – they don’t form part of the author’s diet rules. The Six Weeks to OMG diet could boil down to the following passage on p95, which is written exactly as follows – underlined, in bold and in capitals:

IF YOU WANT TO BE SKINNY, YOU MUST REALIZE THAT YOUR TOTAL DAILY CARB INTAKE IS THE BIGGEST DIET FACTOR TO AFFECT YOUR SUCCESS. THAT’S WHY I’VE USED BOLD TYPE AND CAPITALS!”

After these capitalised, bold, underlined words, Fulton says: “I can’t emphasize it much more than that!”

Indeed! The OMG book is all over the place, confusing, repetitive, annoying, gimmicky and all sorts of other things, but it’s essentially recognising that carb management is key to weight loss and I can’t disagree with that.

The BDA’s dietary advice

So let’s look at the BDA’s own advice to see if they are throwing stones from a glass house:

1)      The eatbadly plate

This cannot be called the eatwell plate. It is the antithesis of healthy eating. This is the BDA’s template for a healthy diet. The food groups are in proportions to indicate how much of one’s diet should be delivered from each segment.

Starchy foods (bread, potatoes, pasta, cereals etc)   33%

Fruit and vegetables                                               33%

Milk and Dairy products                                         15%

Non dairy protein (meat, fish, eggs, beans etc)         12%

Foods high in fat and sugar                                      8%

(101% due to rounding)

The proportions are by weight. I did an interesting calculation to see what this means for daily calorie intake:

I started with 100 grams of starchy foods and then calculated the weight of the other categories, to maintain the proposed proportions. The weight of fruit and vegetables would also be 100 grams; milk and dairy would be 45 grams; there would be 36 grams of non dairy protein and 24 grams of foods high in fat and sugar. I keep a database of common foods, derived from the United States Department of Agriculture (USDA) nutrition database. I averaged all my sample foods for each of the five categories: starchy foods averaged 333 calories; fruit and vegetables 42; milk and dairy 183; meat, fish, eggs, beans 188 and foods high in fat and sugar 595 calories (all per 100 grams). This would give the estimated calorie values (for the weights of each segment of the plate) of 333, 42, 82, 68 and 143 respectively. If these are then scaled up in proportion for a 2,000 calorie a day diet, for an average woman, the five groups end up with 997, 126, 247, 203 and 428 calories respectively.

Thus starchy foods make up 50% of one’s diet, fruit and veg make up a mere 6%, milk and dairy accounts for 12% and non dairy protein 10%. The supposedly smallest segment, being so energy dense, ends up being 21% of calorie intake. This means that nearly three quarters of the BDA recommended diet is starch and junk. The facts on the UK intake of flour and sugar confirm this. We eat an average 1,150 flour and sugar calories per person per day – thanks to the BDA telling us to eat starch and junk.

2) The calorie theory

This document from the BDA “Want to lose weight and keep it off?” trots out the classic definition of the calorie theory: “One pound of fat contains 3,500 calories, so to lose one pound a week you need to eat 500 less (sic) calories a day.”

My academic book, The Obesity Epidemic: What caused it? How can we stop it, completely dissects the calorie theory and shows that it has no evidence base whatsoever. One pound does not equal 3,500 calories and we will not lose one pound if we create a deficit of 3,500 calories. The formula fails at every level.

The BDA statement above is wrong at another level – it fails to cover the concept of deficit. It means that someone could eat 500 fewer calories a day, but still consume more than they need and therefore gain weight, let alone fail to lose. But all of this is unimportant, as the whole formula is nonsense.

I wrote to seven government and obesity organisations, over the summer of 2009, and asked for the source of the calorie formula and proof of it. The BDA was one of the seven organisations asked. Their response was: “Unfortunately we do not hold information on the topic that you have requested.”  No source, no evidence, no proof – none of this has stopped the BDA stating the formula as fact.

3) There are no bad foods, only bad diets

Dieticians have many well worn slogans:

- “Five-a-day” (a marketing campaign started by the fruit and veg industries, not an evidence based nutritional message);

- “Base your meals on starchy foods” (i.e. “Base your meals on fattening and nutritionally inferior foods”);

- “Meat is full of saturated fat” (A typical sirloin steak is 71% water, 21% protein, 3.3% unsaturated fat and 2.1% saturated fat [minerals etc make up the difference and rounding errors]. Saturated fat literally is the last thing that steak is.)

- “There’s no such thing as a bad food, only bad diets” (please explain sugar, therefore).

Another article in the media last week was about how Buy One Get One Free offers (known as BOGOF’s) are fuelling the obesity epidemic. Towards the end of the article we find the following phrase: “Andrew Opie of the British Retail Consortium, which speaks for supermarkets, said: ‘There’s no such thing as an unhealthy food, only an unhealthy diet.’” Spoken like a true dietician.

When the food industry and dieticians are so beautifully aligned, you know that our official dietary advice must be terribly wrong. This is also not surprising given that the BDA partners with Birds Eye, Danone and Abbott Nutrition (get them as babies) and has informed me that that they have been delighted to work with the Sugar Bureau (the sugar industry).

The BDA dietary advice is what has made UK PLC fat and sick. The BDA then attacks diets that reject the conflicted BDA love of sugar and flour, with the kind of arrogance, ignorance and closed mindedness that I have come to know dieticians for. (There are a couple of lovely exceptions, but they are rare).

One of the slogans that dieticians most often repeat is “Trust a dietician to know about nutrition”. Fat chance!

Traffic Light Labelling – how does it work?

UK food retailers have apparently bowed to pressure and are on the verge of introducing the traffic lights food labelling system, which a number of campaigners have been demanding for a few years.

With Sainsbury’s long on board and Aldi, Tesco and Lidl having been announced as recent joiners, Morrisons and Iceland are the retailers continuing to oppose the introduction of the Food Standards Agency (FSA) preferred system.

Let us take a look at how traffic light labelling actually works, what the standards are and the inevitable law of unintended consequences…

Traffic light labelling scheme

This is the FSA document detailing the standards of the scheme. This tells us that the red, amber and green ‘rules’ are as follows:

For food (per 100g):

	Green (low)	Amber (medium)	Red (high) (Note 1)
Fat	≤ 3.0g/100g	> 3.0 to ≤ 20.0g/100g	> 20.0g/100g	> 21.0g / portion
Saturated	≤ 1.5g/100g	> 1.5 to ≤ 5.0g/100g	> 5.0g/100g	> 6.0g / portion
Sugars[i]	≤ 5.0g/100g	> 5.0 to ≤ 12.5g/100g	> 12.5g/100g	> 15.0g / portion
Salt[ii]	≤ 0.30g/100g	> 0.30 to ≤ 1.50g/100g	> 1.50g/100g	> 2.40g / portion[iii]

(Note 1) In addition to the per 100g criteria, there are ‘per portion’ criteria for food. The per portion criteria ensure that any food which contributes more than 30% (40% for salt) of an adult’s recommended daily maximum intake for a particular nutrient is labelled red (high).

The colour code for sugars is determined in terms of both the total and added sugar components as follows[iv]: -

- Green if total sugars are less than or equal to 5g/100g.

- Amber if total sugars exceed 5g/100g and added sugars are less than 12.5g/100g.

- Red if added sugars are more than 12.5g/100g.

For drink (per 100ml):

	Green (low)	Amber (medium)	Red (high)
Fat	≤ 1.5g/100ml	> 1.5 to ≤ 10.0 g/100ml	> 10.0g/100ml
Saturated	≤ 0.75g/100ml	> 0.75 to ≤ 2.5 g/100ml	> 2.5g/100ml
Sugars[v]	≤ 2.5g/100ml	>2.5 to ≤ 6.3 g/100ml	> 6.3g/100ml
Salt[vi]	≤ 0.30g/100ml	> 0.30 to ≤ 1.50g/100ml	> 1.50g/100ml

The colour code for sugars is determined in terms of both the total and added sugar components as follows: -

- Green if total sugars are less than or equal to 2.5g/100ml.

- Amber if total sugars exceed 2.5g/100ml and added sugars are less than 6.3g/100ml.

- Red if added sugars are more than 6.3/100ml.

Here is what happens with some example foods:

All per 100g/100ml	Fat	Sat fat	Sugar	Salt
Olives[vii]	11.6	1.7	0.1	1.5
Rump steak[viii]	13.5	5.8	0	0
Whole mackerel	16.3	3.3	0	0.13
Cheddar cheese[ix]	32	20.8	0.1	0.72
Whole milk[x] – 100ml	3.6	2.3	4.7	0.06
Sunflower seeds[xi]	49.2	12.2	3.7	trace
Apples – English cox	0.1	0.01	11.8	0.003
Shredded wheat (68.5g carbohydrate)	2.2	0.5	0.7	trace
Diet Coca-Cola	0	0	0	0.005
White flour[xii] (73.5g carbohydrate)	1.9	0.4	1.9	0.0025
Bread – multi grain[xiii]	3.5	0.45	3.5	0.4
Bread – white[xiv]	1.7	0.28	3.9	0.4
Pasta[xv] (70.7g carbohydrate)	1.3	0.3	1.8	0

(Red lights have been put in bold for extra differentiation from the amber indicators).

The law of unintended consequences

All real foods in the table above have at least one red/amber traffic light warning and olives and cheese have three. The former being a good source of natural fat – especially the much eulogised monounsaturated fat – and the latter being an excellent source of calcium and the other bone nutrients vitamin D and phosphorus.

With one exception, all processed foods in the table above have green lights for fat, saturated fat and sugar. Multi grain bread gets an amber for fat content – because of the highly nutritious seeds that it contains. White bread scores better than multi grain.

Diet coca-cola gets a green light despite containing aspartame – the dangers of which are well documented. Flour, bread and pasta get green lights despite being nutritionally poor and extremely high in carbohydrate.

Worrying about salt is pointless – our simple message should be “don’t eat processed food” and then we have no need to worry about salt. Real food has sodium and potassium in natural balance, as these two minerals need to be.

A bag of sugar, with no nutritional value whatsoever, would get green lights for fat, saturated fat and salt – an obvious red light for sugar. Sweets generally would get green lights for fat, saturated fat and salt. They would get red lights for sugar only – appearing healthier overall than olives and sunflower seeds on first sight.

The ‘at a glance’ consumer will reach for processed, rather than real, food. The ‘food’ companies must be delighted.

The traffic light system clearly reinforces the government dietary advice to “base your meals on starchy foods”. This is despite these foods being uniquely fattening and nutritionally incomparable to the meat, fish, dairy products and seeds with red and amber flags in the table above.

Here is a table comparing the nutritional value of some of the products in the table above (the highest value for each nutrient is highlighted – sunflower seeds – one of the two real foods to get two red lights – is the most nutritious product in the table below overall. If liver had been in this table, it would have won on most nutrient comparisons, by the way):

(All per 100g)	Sirloin steak	Milk (whole)	Cheddar cheese	Apple	Sunflower Seeds	Flour (white)
Calories	154	60	403	52	584	364
Protein Quality	94	85	125	31	88	43
Vitamins
A (IU)	0	102	1,002	54	50	0
B1 (mg)	0.1	0	0	0.0	1.5	0.1
B2 (mg)	0.1	0.2	0.4	0.0	0.4	0
B3 (mg)	7.2	0.1	0.1	0.1	8.3	1.3
B5 (mg)	0.6	0.4	0.4	0.1	1.1	0.4
B6 (mg)	0.6	0	0.1	0.0	1.3	0
Folic Acid (mcg)	13	5	18	3	227	26
B12 (μg/mcg)	1.2	0.4	0.8	0.0	0	0
C (mg)	0	0	0	4.6	1.4	0
D (IU)	0	40	12	neg	0	0
E (mg)	0.3	0.1	0.3	0.2	33.2	0.1
K (μg/mcg)	1.2	0.2	2.8	2.2	0	0.3
Minerals
Calcium (mg)	27	123	721	6	78	15
Magnesium (mg)	22	10	28	5	325	22
Phosphorus (mg)	193	91	512	11	660	108
Potassium (mg	323	143	98	107	645	107
Sodium (mg)	54	40	621	neg	9	2
Minerals (T)
Copper (mg)	0.1	0.0	0	0.0	1.8	0.1
Iron (mg)	1.5	0.0	0.7	0.1	5.2	1.2
Manganese (mg)	0.0	0.0	0	0.0	1.9	0.7
Selenium (mcg)	24.1	3.7	13.9	0.0	53.0	33.9
Zinc (mg)	3.9	0.4	3.1	0.0	5.0	0.7

We should also note strongly in this post that singling out saturated fat from the three different fats: saturated, monounsaturated and polyunsaturated – is absurd. Whenever fat is found naturally in food, all three fats are found – there are no exceptions. Meat, fish, eggs, dairy products, avocados, olives, nuts and seeds all contain all three fats: saturated, monounsaturated and polyunsaturated. Saturated fat is simply the most stable fat chemically (the carbon chain being fully saturated with hydrogen atoms) and therefore the safest to cook with, as it does not mutate at high temperatures.

There is only one food group with more saturated than unsaturated fat – dairy products. Meat, fish, eggs, nuts, seeds and even lard (ha ha) all have more unsaturated than saturated fat. Not that one is better or worse than another – but just to set the record straight. There are 13.5 grams of fat in our example rump steak above. 5.8 grams of this are saturated; 7.7 grams are unsaturated. The idea that 44% of the few grams of fat in this steak – the saturated portion – is trying to kill you, while the other 56% – the unsaturated portion – is heart healthy and trying to save you is about as stupid a nutritional notion as can be made up.

Nature is not trying to kill us! This traffic light system will drive us down the desired route of basing our meals on nutritionally useless starchy foods. That’s why we’re fat and sick.

Postscript

The only labelling policy that we need is this:

“Don’t eat any product that requires a label”!

References

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[i] The Agency has asked SACN to review and advice on intakes of sugars as part of its future work programme.

[ii] Sodium from all sources expressed as salt.

[iii] To be reviewed in 2008 to reflect progress on salt reduction work

[iv] For the purposes of the Agency’s front of pack nutrition signpost scheme, added sugars is defined as any mono- or disaccharide or any other food used for its sweetening properties. This would include, but is not exclusively limited to: sucrose, fructose, glucose, glucose syrups, fructose-glucose syrups, corn syrups, invert sugar, honey, maple syrup, malt extract, dextrose, fruit juices, deionised fruit juices, lactose, maltose, high maltose syrups, Agave syrup, dextrin and maltodextrin.

The sugars contained in dried fruit are assumed to be intrinsic and are not included as added sugars. The sugars in milk powder are not included as added sugars, in line with COMA dietary guidelines which deemed sugars in milk as a special case and did not set guidelines to limit their intake.

[v] The Agency has asked SACN to review and advice on intakes of sugars as part of its future work programme.

[vi] Sodium from all sources expressed as salt.

[vii] Waitrose essential pitted green olives

[viii] Duchy original organic British rump steak

[ix] Waitrose essential English mature cheddar cheese strength 4

[x] Waitrose 3.5% fat (blue top) whole milk

[xi] http://www.waitrose.com/shop/ProductView-10317-10001-3079-Waitrose+sunflower+seeds

[xii] Duchy original white flour

[xiii] Waitrose farmhouse multigrain bread http://www.waitrose.com/shop/ProductView-10317-10001-20316-Waitrose+farmhouse+batch+multigrain

[xiv] Waitrose soft white bread http://www.waitrose.com/shop/ProductView-10317-10001-38210-Waitrose+soft+white+medium+sliced

[xv] Essential waitrose macaroni http://www.waitrose.com/shop/ProductView-10317-10001-8289-essential+Waitrose+macaroni

Conflicted nutritionists defend bread

“Not a grain of truth: Bread has been ‘demonised by TV nutritionists and is a vital part of our daily diet‘” screamed the Daily Mail headline on Friday 14th September.

I was pretty disgusted by this on a number of levels:

1) Conflict of interest

The article talked about nutrition scientists and then went on to explain that by this they meant people working for the British Nutrition Foundation (BNF). They even called them “Researchers at the British Nutrition Foundation” and this was a quotation from the article: “Researchers at the British Nutrition Foundation said that people are instead going without vital vitamins and minerals that are contained in each loaf.”

Here are the sustaining members of the British Nutrition Foundation. Check out Coca-Cola, Danone, Sainsbury, Kellogg’s, Kraft foods, Nestlé, PepsiCo, Tate & Lyle, The ABF Grocery Group and Unilever. The Associated British Foods (ABF) member alone is the conglomerate behind Allingson breads, Kingsmill breads, Speedibake bakery products, Sunblest breads, Burgen breads and Tip Top breads and baked goods. Kraft and Sainsbury’s will similarly welcome any support for bread – as will Unilever, as their sales of hydrogenated, bleached, deodorised and emulsified gunge – also known as margarine or spreads – needs to go on bread.

Einstein famously said that “It isn’t research if you know what you’re looking for.” I do not accept that the conflicted BNF would bite the many, many hands that feed them and therefore they will undertake ‘research’ into bread with the clear goal that it must be eulogised as an outcome.

Those were just the sustaining members. The BNF also has even more just plain members. These include the major supermarkets that benefit from selling bread: ASDA; Marks and Spencer; Morrison’s; The Co-operative Group and Waitrose. Then we have bread makers: General Mills (Pillsbury dough); Kerry Foods (Homepride); and Warburton’s. We have the bread retailer Greggs – is there anything in Greggs that is not made from flour? Just as we had Tate & Lyle (sugar) as a sustaining member, so we have British Sugar as a member – have you ever tried to buy a loaf of bread that does not contain sugar? United Biscuits are also a BNF member, as is The National Starch company. Finally, you may not even recognise Nabim as a member. Nabim, as their web site proudly states: “is the representative organisation for the UK flour millers and represents virtually 100% of the industry, which uses around 5.1 million tonnes of wheat a year to produce 4.1 million tonnes of flour.”

That’s the scale of the financial alliances held by the BNF, which need to be protected from naughty (TV) nutritionists advising people to avoid bread.

The ‘research’ should have openly and clearly declared this conflict of interest – as the ‘researchers’ would have to have done had this been published in a journal. No such declarations were even mentioned.

2) Adding vitamins & minerals does not make a fake food healthy

Back to the absurd quotation from the ‘researchers’: “Researchers at the British Nutrition Foundation said that people are instead going without vital vitamins and minerals that are contained in each loaf.”

Warburton’s is the biggest bread brand in the UK and, conveniently, a member of the British Nutrition Foundation. Revenues are in excess of £700 million – mouth watering levels.

If you check Tesco on line shopping, Warburton’s has nine white bread variants and four brown bread variants available. Normally virtually the only nutrients in processed bread are vitamins and minerals that have been added in by the manufacturers. Interestingly there is no sign on the ingredients list that Warburton’s have even bothered to add any nutrients to their white bread ranges. Here’s an example, which has the ingredients Wheat Flour, Water, Yeast, Vegetable Oil, Salt, Flavouring, Soya Flour, Preservative Calcium Propionate (added to inhibit mould growth), Emulsifiers E471, E481, Flour Treatment Agents Ascorbic Acid (Vitamin C),  E920. Vitamin C looks to have been the only vitamin added, which means that the white bread will have the nutritional content of its main ingredient – white flour – which is negligible – see below.

Warburton’s brown bread also has no evidence of added nutrients. This has a very similar ingredients list with wholemeal flour in place of white flour and dextrose (sugar) in this one: Wholemeal Flour (57%), Water, Yeast, Dextrose, Vegetable Oil, Salt, Wheat Gluten, Emulsifiers E481, E472e, E471, Soya Flour, Preservative Calcium Propionate (added to inhibit mould growth), Flour Treatment Agent Ascorbic Acid (Vitamin C).

Most breads in the UK do have vitamins and minerals added, but this does not mean that the product is healthy. You may as well take a vitamin/mineral tablet and save yourself the unhealthy intake of flour, sugar, vegetable oil and emulsifiers. Better still – eat real food! Steak, salmon, eggs and cheese don’t need vitamins and minerals to be added – they are found in abundance naturally in these products.

Here is a nutrient comparison between some real foods and white and brown flour – the main ingredient in the bread being defended by the BNF:

(All per 100g)	Chicken Liver	Sirloin steak	Sardines	Eggs	Flour (white)	Flour (brown)
Calories	116	154	208	143	364	364
Protein Quality	149	94	148	136	43	54
Vitamins
A (IU)	11,077	0	108	487	0	9
B1 (mg)	0.3	0.1	0.1	0.1	0.1	0.4
B2 (mg)	1.8	0.1	0.2	0.5	0	0.2
B3 (mg)	9.7	7.2	5.2	0.1	1.3	6.4
B5 (mg)	6.2	0.6	0.6	1.4	0.4	1
B6 (mg)	0.9	0.6	0.2	0.1	0	0.3
Folic Acid (mcg)	588	13	12	47	26	44
B12 (μg/mcg)	16.6	1.2	8.9	1.3	0	0
C (mg)	17.9	0	0	0	0	0
D (IU)	neg	0	272	35	0	0
E (mg)	0.7	0.3	2	1	0.1	0.8
K (μg/mcg)	0	1.2	2.6	0.3	0.3	1.9

Please note that the highest value has been highlighted for a quick glance as to the highest calorie foods (flour) and the most nutritious foods (liver and sardines).

You will notice that brown flour is slightly better than white, but neither can hold a candle to liver and sardines. I wonder why the BNF are not in the Daily Mail raving about these super foods, but perhaps a check of their member list will explain why.

Please note that the above table is comparing 100 grams of each product. Flour has over three times the calories of liver, making flour products even worse if you compare them on a calorie for calorie basis.

3) If you want to be slim and healthy – ditching bread is a great idea

Did you know that the average UK citizen is consuming 1,150 calories a day from just two ingredients – one with no nutritional value and one with so little that it is subject to fortification legislation, with a requirement to add back in nutrients removed in processing?[i] World Health Organisation data tells us that the average UK citizen consumes 38 kilograms of sugar per year.[ii] Statistics from the Flour Advisory Bureau note that UK per capita flour consumption reached 74 kilograms in 2008/9.[iii] This represents a few calories short of 1,150 per person per day from those two ingredients – when did that become a healthy balanced diet?

If anyone asked me for the top substances to remove from their diet, my number one tip would be sugar – no nutritional value whatsoever – and my second tip would be flour – virtually no nutritional value. The brilliant book Wheat Belly by Dr William Davis will also give you several reasons for avoiding wheat – from belly fat to arthritis with many other ailments in between.

Without exception, people I work with to lose weight and gain health do better without wheat. They have found wheat addictive in the past, as it is the main ingredient in biscuits, cakes, pastries, pies, pizza, pasta – things that they have craved. They come off wheat, drop pounds in days, banish bloating, overcome food cravings and report many other ailments clearing up – from Irritable Bowel Syndrome to joint and muscle aches. They lose virtually nothing nutritionally, as the facts have now shown. In fact they gain masses in terms of vitamins and minerals because – as the rare people in the UK not consuming 1,150 calories of sugar and flour daily, they are having those calories in the form of steak, salmon, cheese, vegetables, seeds and so on instead. So they lose weight and gain health. As they lose lbs, the fake food companies lose £’s – hence the need for this article.

So, don’t listen to representatives of the multimillion, if not billion, pound bakery industry, otherwise known as The British Nutrition Foundation. The facts are that bread is pointless nutritionally compared to real food and has some pretty nasty fake ingredients in the processed loaves that adorn the supermarket shelves.

If you want to eat bread – either bake your own with the highest quality, most natural whole wheat flour you can find. Add yeast, olive oil and a few sunflower seeds and that’s it. You may also be able to get a decent wheaten dense kind of loaf from a farm shop or farmers market. Give the packaged stuff a wide berth and don’t believe anything that comes from The British Nutrition Foundation.

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[i] http://www.opsi.gov.uk/SI/si1998/19980141.htm.

An excellent summary is available at: http://www.sustainweb.org/realbread/flour_fortification/

[ii] http://www.whocollab.od.mah.se/expl/globalsugar.html

[iii] http://www.fabflour.co.uk/content/1/31/facts-about-bread-in-the-uk.html

People can be fat yet fit, however…

“People can be fat yet fit, research suggests” was the BBC headline.

“People can be fat AND fit as study finds obesity doesn’t automatically lead to ill-health” claimed the Daily Mail.

“Fat but fit people as healthy as normal weight ones: research” was The Telegraph’s take on the study.

And the story was covered from America to India.

You would imagine that the study had followed a number of fit and fat people and a number of unfit and fat people, over a long period of time and looked at absolute differences in disease (heart disease and cancer were the major focus of the study) that they went on to suffer. You would be wrong.

The study

There are only a few studies in the world that have been done with a large number of participants over a long period of time. A couple of examples are the Health Professionals Follow-up Study (1986-2008) involving 49,934 men and the Nurses’ Health Study (1980-2008) involving 92,468 women. As these take a lot of time and are very expensive, the data is made available to other researchers to look at things that they may want to investigate.

This is the case in this latest article in the European Heart Journal. The team have taken the Aerobics Center Longitudinal Study (ACLS). This study is 98% Caucasian,  well educated, and comprises people who have worked in executive or professional positions, so the researchers do accept at the outset that it may not be applicable to the whole population.

There were 43,265 participants in this study (24% female). They joined the study any time between 1979 and 2003 and were followed up for an average (median) of 14.3 years.

When each person joined the study they had one health check – I repeat – one health check. This health check (called the  baseline assessment) gathered data on blood pressure, blood lipids, blood glucose, questionnaires for smoking/alcohol – usual stuff – and recorded BMI and Body Fat. The participants also took part in one fitness test – a treadmill exercise – which they all had to score at least 85% on, or they were excluded from the study. Hence a level of fitness was pre-selected. This was not a study comparing fit and unfit. It was a study looking at 85% of maximal performance on a treadmill test and higher.

This is confirmed in the researchers’ own words. The journal article states: “All participants completed a detailed questionnaire and underwent an extensive clinical evaluation, including a physical examination, fasting blood chemistry analyses, personal and family health history, body composition, smoking and alcohol use, and a maximal exercise treadmill test between 1979 and 2003.” i.e. each participant did one treadmill test between 1979 and 2003. Participants were only included in the study if they were “achieving 85% or more of the individual’s age predicted maximal heart rate during the graded modified Balke treadmill exercise testing.”

The participants were not then allocated to groups according to fit vs. super fit (85% on the test vs. say 100%). They were allocated to two groups depending on the number of characteristics of the metabolic syndrome that they displayed at the time of this one-off baseline health check. (The metabolic syndrome is the term given to people displaying a number of health symptoms – high blood pressure, high blood fats, high blood glucose and so on -  which are believed to be an indicator of overall health.)

Those who had 0 or 1 condition associated with the metabolic syndrome were deemed metabolically healthy. Those who had 2 or more of these health markers were deemed metabolically abnormal (no judgement there!)

Once people had been allocated to these two groups – the researchers for this article looked at how these two groups performed on the one treadmill test done when they joined the study.  Figure 1 in the paper (if you want a copy of the original article please let me know) shows the different performance on this test between metabolically healthy and obese and metabolically abnormal and obese people. The comparison is made in METs, metabolic equivalents, (1 MET = 3.5 mL of oxygen uptake/kg/min.) Reading across on the graph, it looks like the MET figure for the metabolically healthy and obese is 9.5 and the MET figure for the metabolically abnormal and obese is 8.9 – not huge and this is a one-off baseline test.

So – the original cut for the data was not about fitness. It was about the metabolic measurements taking at the baseline assessment. This would be like allocating people to those under 5′ 5″ and those 5′ 5” or over and then measuring their chocolate consumption. The headline might then be “People who consume more chocolate are shorter”. No! The chocolate consumption is what it is – the two groups being reviewed are those with 0-1 metabolic factor and those with more than this.

Absolute vs. relative risk

We then have the absolute classic error, made in every journal article that I review -  researchers will present relative, not absolute risk. I can double your chance of winning the lottery by advising you to buy two tickets. You still have a 1 in 7 million chance of winning – but that is twice as good as a 1 in 14 million chance of winning. If I played with this the other way round and told you I could half your risk of heart disease – this would make headlines. However, I will have played with the numbers in exactly the same way as this lottery example. It is bad science. It is omnipresent and, frankly, unforgivable from so-called scientists.

There were 1,779 deaths during the study period i.e. over an average 14.3 year follow up of 43,265 people. This is an annual incident rate of 0.28% i.e. fewer than 3 in 1000 people. Claiming that the risk factor is 30-50% lower for ‘fat & fit’ as opposed to ‘fat and not fit’ can mean that 2.8 people in 1,000 died in any one year in the fat & fit group and 3-4 people in 1,000 died in any one year in the ‘fat and not fit’ group. Hold the front page!

The article claimed that “no significant differences were observed between metabolically healthy but obese and metabolically healthy normal-fat participants”. This is what gave rise to the headlines such as “Fat but fit people as healthy as normal weight ones: research.” This is the researchers playing with absolute, and not relative, risk when it suits them.

Table 3 in the article shows that metabolically healthy but obese people have a higher all cause mortality rate vs. metabolically healthy normal weight (Body Fat comparison) people. 216 metabolically healthy, but obese people died during the study, out of 5,959 in this category. That’s a 3.6% overall death rate, or a 0.25% death rate per year. 584 metabolically healthy normal weight people died during the study out of 21,023 in this category. That’s a 2.8% overall death rate or 0.19% death rate per year. The absolute risk differentials look very small – 0.25% vs. 0.19%. However, playing with the numbers in the way that the researchers did to get their headline – 0.25% is 30% higher than 0.19%. We should therefore say that metabolically healthy but obese people have a 30% greater chance of dying from any cause than metabolically healthy normal weight people. That’s not “Fat but fit people as healthy as normal weight ones”.

Do I think that it’s better to be fit and fat than fat? Yes – but a) this study has not proven this and b) it is still better to be normal weight. One treadmill test, since 1979, does not a fitness study make!

As a final thought – those who know me know how passionate I am about conflict of interest. Genuine research is sadly rare nowadays, as only those who stand to gain from something provide funding and people dependent on funding (the authors of this article, for example) don’t bite the hand that feeds them.

Would you be interested to know that this study was funded by “…an unrestricted research grant from The Coca-Cola Company”?! The key message that the ‘food’ and ‘drink’ companies want to get across is that – we shouldn’t worry about consuming their junk – the reason that we are fat is because we are lazy – not because of their empty calories. What a wonderfully authoritative article – in the European Heart Journal no less – to enable Coca-Cola to deliver their core message.

Egg yolk consumption, carotid plaque & bad science

“Egg yolks linked to heart disease” screamed the headlines on Monday 6th August 2012.  The newspaper article came from a journal article called “Egg yolk consumption and carotid plaque“.

I really have got better things to do than to continually dissect articles from so called scientists, but, when the item under attack is the super food called egg, someone has to leap to its defence. So here goes….

The study

I have a copy of the full article – sadly it’s not on free view. You can see the abstract on this link. The abstract tells us that 1,262 people were involved in the study with an average age of 61.5. 47% were women. (The full article says that 1,231 participants were involved – discrepancies like this should be corrected before publication.)

The results were summarised as: “Carotid plaque area increased linearly with age after age 40, but increased exponentially with pack-years of smoking and with egg-yolk years. Plaque area in patients consuming < 2 eggs per week (n=388) was 125± 129mm², versus 132 ± 142 mm² in those consuming 3 or more eggs per week (n=603).”

The Canadian authors – David Spence, David Jenkins and Jean Davignon concluded: “Our findings suggest that regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease.”

The authors have invented the term “egg-yolk years”, which is defined as egg yolks consumed per week times number of years of consumption. They compare this with “pack-years of smoking”, which is defined as number of packs per day times number of years smoking. Yes – this article really does place one of the most nutritious foods on the planet alongside one of the most harmful man-made drugs – and conclude that they are just about equally evil…

“Our data suggest a strong association between egg consumption and carotid plaque burden. The exponential nature of the increase in TPA by quintiles of egg consumption follows a similar pattern to that of cigarette smoking. The effect of the upper quintile of egg consumption was equivalent in terms of atheroma development to 2/3 of the effect of the upper quintile of smoking. In view of the almost unanimous agreement on the damage caused by smoking, we believe our study makes it imperative to reassess the role of egg yolks, and dietary cholesterol in general, as a risk factor for CHD.”

These Canadian guys have been after eggs for some time – as this November 2010 article shows.  Thankfully the brilliant Tom Naughton was around to respond to that one .

Eggs

The entire study is about egg yolks. There is no evidence presented in the paper that these 1,231 people throw away egg whites. The paper has simply assumed that there can be nothing in egg whites that could cause any concern whatsoever so we don’t need to even think about egg whites. As someone interested in nutrition, here is the comparative nutritional information for whole eggs (which normal people eat); egg whites (which people who don’t value vitamins and minerals eat) and egg yolks (which people who do value vitamins and minerals eat).

(All per 100g of product)	USA RDA/AI	Whole egg	Egg yolk	Egg white
Vitamins
A (IU)	3000IU	487	1442	0
B1 (Thiamin) (mg)	1.2mg	0.1	0.2	0
B2 (Riboflavin) (mg)	1.3mg	0.5	0.5	0.4
B3 (Niacin) (mg)	16mg	0.1	0	0.1
B5 (Pantothenic Acid) (mg) (AI)	5mg (AI)	1.4	3	0.2
B6 (mg)	1.7mg	0.1	0.4	0
Folic Acid (Folate) (mcg)	400mcg	47	146	4
B12 (mcg)	2.4 mcg	1.3	1.9	0.1
C (mg)	90mg	0	0	0
D (IU) (AI)	400IU (AI)	35	107	0
E (mg)	15mg	1	2.6	0
K (mcg) (AI)	120mcg (AI)	0.3	0.7	0
Minerals (M)
Calcium (mg) (AI)	1000-1200mg (AI)	53	129	7
Magnesium (mg)	420mg	12	5	11
Phosphorus (mg)	700mg	191	390	15
Potassium (mg) (AI)	4700mg (AI)	134	109	163
Sodium (mg) (AI)	1500mg (AI)	140	48	166
Minerals (T)
Copper (mg)	0.9mg	0.1	0.1	0
Iron (mg)	18mg	1.8	2.7	0.1
Manganese (mg) (AI)	2.3mg (AI)	0.0	0.1	0
Selenium (mcg)	55 mcg	31.7	56	20
Zinc (mg)	11mg	1.1	2.3	0

So the egg yolk is where we find the nutrition in an egg. Please bear this in mind as we go on to talk about egg-yolk years alongside pack-years of smoking…

The data

Table 2 at the end of the paper has the baseline characteristics of participants in the study (1,231 people) by quintile of egg-yolk eaters.

	A	B	C	D	E
Egg yolk years	<50	50-110	110-150	150-200	>200
Age at first visit	55.70	57.97	56.82	64.55	69.77
Eggs per week	0.41	1.37	2.30	2.76	4.68
Total cholesterol	4.93	4.94	5.00	4.90	4.81
Triglycerides	1.88	1.84	1.96	1.94	1.85
HDL	1.34	1.33	1.33	1.29	1.35
LDL	2.76	2.75	2.81	2.73	2.67
BMI	27.62	27.42	28.71	27.00	26.31
Smoking (pack years)	14.14	14.37	16.57	13.88	17.00
Female	48.60%	51.70%	44.80%	45.00%	46.70%
Diabetic	11.80%	14.50%	11.80%	13.40%	14.60%
Plaque area (mm2)	101.45	110.35	113.58	135.76	175.77

The article notes that: “carotid atherosclerotic plaque burden increases linearly after age 40“. This means that plaque area increases directly with age – this is not surprising and by far the most obvious relationship in all of these variables. (Please note that the plaque itself is not the root cause of problems. Plaque forms over damage to the arterial walls in much the same way that a scab forms over a cut on the skin. The original source of that damage is what we need to understand. Chief suspects should be smoking, sugar, stress, chemicals and apparently we now need to add egg yolks to this list!)

The above table has columns A to E categorised into these invented egg-yolk years. The plaque area rises from columns A to E. However the age of the participants at first visit also rises from A to E. The average age in column A is under 56; the average age in column E is 70. That’s a 14 year difference! Surely the single biggest determinant of plaque area?

Column E has 24% more incidence of diabetes than column A – could that impact plaque area? (Please note that the association between plaque area and diabetes does not follow a uniform relationship – Columns C and D buck the trend).

Column E has 20% higher smoking pack years  than column A – could that impact plaque area? (Please note that the association between plaque area and smoking pack years does not follow a uniform relationship – Column D bucks the trend).

The data – Plaque builds up with age

I look at the above table and conclude that the strongest relationship is between age and plaque – as one would expect.

If you consume a particular food regularly over more years you will amass more ‘food-years’. The authors could have picked broccoli and measured broccoli years and the top quintile group of 70 year olds would have had 14 years more broccoli consumption than the 56 year olds!

But when you are funded by drug companies, to continue the cholesterol/lipid hypothesis you’ll pick on a cholesterol rich food and not broccoli. Scroll down to “Conflict of interest” and you’ll see: “Dr Spence and Dr Davignon have received honoraria and speaker’s fees from several pharmaceutical companies manufacturing lipid-lowering drugs, and Dr Davignon has received support from Pfizer Canada for an annual atherosclerosis symposium; his research has been funded in part by Pfizer Canada, AstraZeneca Canada Inc and Merck Frosst Canada Ltd.“

The data – Eggs & cholesterol levels

The other thing I take from the table above is that egg consumption has bugger all to do with blood cholesterol levels – unless we want to note the inverse association. People eating an average 4.68 egg yolks per week have lower total cholesterol, lower triglycerides, higher HDL and lower LDL than people eating an average of 0.41 egg yolks per week. Omelette anyone?

However, this also doesn’t display a consistent relationship – total cholesterol is highest at the mid range of egg yolk consumption – an average of 2.3 per week. Triglycerides and LDL are also highest at the midpoint of egg yolk consumption – an average of 2.3 per week. (Not that I care about any ‘cholesterol levels’ – but just to comment on the data in the article from people who do care about ‘cholesterol levels’).

BMI, by the way, peaks at the midpoint of egg consumption and is lowest at the highest level of egg consumption. Low carbers know why.

In all of this please note that even the highest egg consumers are not eating even one egg a day. The very top egg consumers are consuming an average two thirds of an egg a day.

What plausible mechanism is there?

Any study not only has to show an association, it has to show that this association is plausible. I can observe that more people who wear blue socks have a larger plaque area than people who wear red socks. However this is a meaningless observation unless I can offer a rationale for why this might be.

For this study to suggest an association between egg yolks and carotid plaque (which is analogous for heart disease in effect in the article) there needs to be a plausible mechanism. Interestingly the study has ruled out cholesterol as a mechanism. Hence the conventional view that cholesterol is ‘clogging up arteries’ cannot be used because no association with cholesterol holds (the association is inverse, if anything).

So what is the mechanism by which egg yolks are supposed to build carotid plaque? We don’t know. The article is conspicuously silent on any possible pathway, let alone any plausible pathway.

Let’s see what happens when we eat to see how ludicrous this study really is…

One large egg yolk (c. 17g) has 9g water, 3g protein and 5g of fat – the majority of the fat is unsaturated with monounsaturated fat being the single largest fat in egg (and egg yolk). The protein is digested in the stomach – broken down  into amino acids. I’ve not yet seen any suggestion that protein clogs up arteries so let’s focus on the fat. (Plus – if the Canadians do come back and suggest that the protein element of egg yolks is an issue then we can talk about egg whites.)

The fat passes from our mouth very quickly into the pharynx (the part of the throat that goes from behind the nose to the start of the oesophagus) and then into the oesophagus (the muscular tube through which food travels from the mouth to the stomach). From there it goes into the stomach (the main area for food ‘short-term’ storage and digestion of protein and carbohydrate). Fat is not digested until it passes from the stomach into the small intestine (where almost all nutrients are absorbed) and, from there, it passes into the large intestine (the main function of which is to transport waste out of the body and to absorb water from the waste before it leaves). So, our egg yolk fat has quite a journey through our digestive system and we haven’t yet started to describe how it can go anywhere near our arteries.

Chylomicrons (the largest lipoproteins) are formed in the intestine, as a result of digestion, and chylomicrons are the transport mechanism for taking dietary fat (and cholesterol) from the digestive system into the blood stream and from there to the different parts of the body to do their vital work. As any young biology student will know, arteries pump blood around the body from the heart. There is no artery to take dietary fat away from the intestines.

The chain length of fatty acids determines how they are transported out of the digestive system. If a fatty acid has fewer than 12 carbon atoms, it will “probably travel through the portal vein that connects directly to the liver. If the fatty acid is a more typical long-chain variety, it must be reformed into a triglyceride and enter circulation via the lymphatic system.”[i]

The composition (by weight) of the most prevalent fatty acids in egg yolk is typically as follows:[ii]

Unsaturated fatty acids: Oleic acid, 47% (18 carbon atoms); Linoleic acid, 16% (18 carbon atoms); Palmitoleic acid, 5% (16 carbon atoms); Linolenic acid, 2% (18 carbon atoms) and

Saturated fatty acids: Palmitic acid, 23% (16 carbon atoms); Stearic acid, 4% (18 carbon atoms); Myristic acid, 1% (14 carbon atoms)

Egg yolks thus have no short chain fatty acids that may even head off in the portal vein to the liver (not that this should cause concern anyway). The longer chain fats (saturated and unsaturated) are packaged into chylomicrons, released into the lymphatic system and they glide from there into the blood stream to carry the vital nutrients around the body to do their vital work.

So, assuming that egg yolks have not been injected into our arteries, egg yolks have not gone into any arteries through any less invasive route. Egg yolks have gone on a normal digestive process journey, probably taking a few hours for fat, still without going into an artery. Yet, the world is now led to believe, thanks to the imagination of some Canadians, that eating egg yolks is going to clog up our arteries. I’d love to hear the process by which the authors think that the post digestion component parts of egg yolks leap out of chylomicrons, find their way into an artery and lay themselves down in the name of plaque. Or maybe they do inject egg yolks in Canada?!

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[i] Gordon Wardlaw, Anne Smith, Contemporary Nutrition, seventh edition, McGraw Hill (2009).

[ii] ] (National Research Council, 1976, Fat Content and Composition of Animal Products, Printing and Publishing Office, National Academy of Science, Washington, D.C., ISBN 0-309-02440-4; p. 203)

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