Here’s the maths!

One fairly small (5 inch diameter) Duchy Original Christmas pudding contains 2,839 calories (313 per 100g)

We live 27 miles from Bristol. This site tells me that a 110lb person would use up 1,482 calories in 9 hours walking 27 miles at 3 miles per hour. Hence I have to walk there and back to ‘use up’ over 2,800 calories.

However – and this is something I only realised writing this blog that all calories burned calculators include the Basal Metabolic Rate. Hence, I would need to allow for what I would have been doing had I not been walking to Bristol and deduct this – because, by walking, I have only burned additional calories. If I had been writing for 9 hours instead, I would have used 808 calories, so, walking to Bristol would use 2,000 calories.

Just as well that none of this calorie stuff amounts to very much. If you want to be fit – be active; if you want to be slim – don’t eat Christmas Pudding!

A recent (the first ever) audit on patient deaths from diabetes notes that approximately 70-75,000 diabetic patients die each year and it is estimated that approximately one third of these deaths could be avoided with better care of their condition.

This post is about the different types of diabetes, insulin non-production, insulin sensitivity, fat storage, insulin and obesity. It covers the issues related to diabetes, insulin and obesity and is intended to provide an understanding for why people are not keen to take medication for diabetes and why we could far better manage diabetes and avoid much of the incidence of diabetes if only we would return people to eating the real food that we ate before we had epidemics of obesity and diabetes – animals, vegetables and fruits in season, nuts & seeds where available. No cereals, no ready meals, no fortified margarines – none of the heinous products making us fat and sick.

Diabetes Type 1 & 2

Rosalyn Yalow and Solomon Berson are credited with having taken Sir Harold Himsworth’s distinction between what we now know as type 1 and type 2 diabetes (Ref 1), and demonstrating that type 1 diabetes was an insulin-deficient state, whereas patients with type 2 diabetes had substantial amounts of insulin in the blood and could be classified as insulin resistant (Ref 2). Type 1 diabetes can therefore be simplistically described as the type where the pancreas does not release insulin at all. In type 2 diabetes the pancreas is effectively releasing too much insulin and yet this still fails to regulate blood glucose levels normally, as cells have become resistant to insulin. This is a critical distinction and helps to explain why this Yalow and Berson study remains one of the most cited articles from the Journal of Clinical Investigation.

It follows that type 1 diabetes requires the administration of insulin and type 2 diabetes can be managed through medication to help optimise the insulin available and to help overcome insulin resistance. Both types of diabetes, I would argue, could be far better managed through diet, and I actually fail to see how type 2 diabetes can manifest itself in the absence of carbohydrate. Obesity in diabetics would be far less common if we adopted the low-carbohydrate principles from the nineteenth century, before the discovery of insulin in 1921, openly shared by William Banting in 1869 (Ref 3).

Insulin, obesity & diabetes

In their 1965 article (Ref 4), Yalow and Berson teamed up with Seymour Glick and Jesse Roth to review the relationship between insulin, obesity and diabetes. They opened with “Here we summarize several well established observations: A relatively high percentage of adult-onset diabetics (Ref 5) are obese and were so long before the onset of clinical diabetes. Diabetes occurs far more frequently in obese than in nonobese subjects. Obese patients without diabetes exhibit impaired glucose tolerance with abnormally high frequency.” With no claims of causation in any direction, the authors are merely observing associations between diabetes, obesity and insulin resistance. At the end of a rigorous study of blood glucose levels and insulin responsiveness in all permutations of lean and obese, diabetic and non diabetic people, their conclusion was as follows: “Thus, there is some degree of insulin insensitivity in obesity without diabetes and a greater degree of insensitivity in diabetes without obesity. When the two conditions coexist, insensitivity is greatest and results in the highest insulin concentrations if pancreatic reserve is adequate.”

This confirms that obese people are more likely to have type 2 diabetes and, even if not diabetic, they are more likely to display insulin sensitivity. Those who are both diabetic and obese are likely to be the most insulin resistant of all. The causation is likely circular, as obesity increases the person’s chance of developing type 2 diabetes and the accompanying insulin resistance makes obesity more likely. The subject of fat storage is very interesting to compare in type 1 and type 2 diabetes.

Type 1 diabetes

The first life event to trigger my interest in the subject of weight, insulin and carbohydrates was my brother developing type 1 diabetes when he was aged 15 and I was 13. As is classic in the onset of the condition, he lost approximately 20 pounds in a similar number of days (the condition took an inexplicably long time to diagnose, given the classic nature of the symptoms). His ‘energy in’ had undoubtedly increased – as he was sending me to the corner shop to buy litre after litre of sugary fizzy drinks. His ‘energy out’ undoubtedly decreased, as he seemed unable to move from his armchair. Having shared this story a number of times – the most common response is curiosity about any possible violation of the laws of thermodynamics – how could energy in go up and energy out go down and a human lose so much weight?

When type 1 diabetes occurs, sugar is lost in the urine. Indeed, diabetes means ‘sweet urine’ in Greek and diabetes is diagnosed by testing for sugar in the urine. At the 2010 Wales obesity conference Dr. Jeffrey Stephens a diabetologist, estimated that glycosuria (literally weeing out sugar in the urine) may account for 500 calories a day. That still doesn’t allow the first law of thermodynamics alone to explain the notorious weight loss in the sudden onset of type 1 diabetes. We seem more interested in calorie reconciliation than thinking about possible implications for obesity. I was always more interested in what this told us about the role of insulin in weight and weight loss.

What we observe, at the onset of type 1 diabetes, is, essentially, a human body incapable of storing fat in the absence of insulin. As soon as the condition is diagnosed we (unforgivably in my view) advise the person to eat carbohydrate at every meal and administer insulin regularly and the ability to store fat resumes. Invariably the person then struggles to avoid obesity for the rest of their life.

Type 2 diabetes

Conversely, just as onset type 1 diabetics, before diagnosis, are unable to store fat, type 2 diabetics are masters at this. Pre-diabetic individuals are often efficient ‘fat storing machines’ while insulin resistance is developing and before they are officially diagnosed with type 2 diabetes. Whereas the onset of type 1 is sudden and dramatic, type 2 diabetes can emerge over time and remain undiagnosed for months, even years. Any insulin resistant type 2, diagnosed or otherwise, would be well advised to avoid carbohydrates, as this is the one macronutrient that they cannot handle. Instead, we advise all citizens, diabetic or non-diabetic, to base their meals on starchy foods and to eat little and often and we maintain an excellent fat storage environment in so doing.

Insulin, fat storage & getting fat

Edgar Gordon wrote in the Journal of the American Medical Association (JAMA) 1963 “It may be stated categorically that the storage of fat and therefore the production and maintenance of obesity cannot take place unless glucose is being metabolized. Since glucose cannot be used by most tissues without the presence of insulin, it also may be stated categorically that obesity is impossible in the absence of adequate tissue concentrations of insulin. Thus an abundant supply of carbohydrate food exerts a powerful influence in directing the stream of glucose metabolism into lipogenesis, whereas a relatively low carbohydrate intake tends to minimize the storage of fat.” (Ref 6)

There are enough journal articles and medical references connecting insulin and weight to keep an obesity researcher engaged for years on this subject alone. The conclusion of all references, however, is that insulin leads to weight gain (and, therefore, by inference, that carbohydrate leads to weight gain). Nothing illustrates this better than medical journal forums seeking ways to encourage diabetics (especially young females) to take their insulin, because the doctors know that the diabetics know that insulin makes them fat.

The audit recently undertaken confirmed that the most at risk group was women aged 15 to 34 with diabetes. They were nine times more likely to die than non-diabetics of the same age. That’s because they know that insulin makes them fat and young women, particularly, don’t want to be fat. The solution is to lessen the intake of the macro nutrient that requires insulin to be administered – carbohydrates – but we do not advise this. Instead – we tell diabetics that this is a role model for healthy eating. It is, in fact, a recipe for making more diabetics and making current diabetics fat and sick.

The weight gain resulting from insulin is so well known that, as far back as 1925, Wilhelm Falta began using insulin to treat underweight adults and anorexia (Ref 7). The weight loss at the onset of type 1 diabetes is equally long known and remarkable. The non diabetic person can produce the same fattening effect of administering insulin by eating carbohydrates frequently and causing the pancreas to release insulin. The impact of insulin on weight is irrefutable and substantial, as we will also see in the next section on medication.

Diabetes & medication

The large-scale studies, such as the diabetes control and complications trial (DCCT) in patients with type 1 diabetes and the United Kingdom prospective diabetes study (UKPDS) in patients with type 2 diabetes, have quantified the weight gain resulting from the administration of insulin. The DCCT was a prospective trial involving 1,441 patients with type 1 diabetes randomised to either an intensive (three to four insulin injections/day or insulin pump) or conventional (one to two insulin injections/day) treatment protocol (Ref 8). At the nine year follow up, approximately 30% of men and 35% of women, receiving the intensive insulin dosage, were five points higher on their BMI scale. Men and women on the more conventional dose still gained weight, but far less. The study quantified the average (mean) weight gain as 4.75 kilograms greater for the three to four injections a day group.

The UKPDS study had 3,867 participants, newly diagnosed with type 2 diabetes (Ref 9). They were randomly assigned to either an ‘intervention’ group, with insulin or alternate drug treatment, or to a ‘managed through diet’ group. Weight gain over the 10 year study was a mean of 6.5 kilograms. Weight gain was significantly higher in the insulin/drug group (mean 2.9 kilograms) than in the diet group. Furthermore, of the drug treatment options, patients assigned insulin had a greater gain in weight (4.0 kilograms) than those given chlorpropamide (2.6 kilograms) or glibenclamide (1.7 kilograms). (The latter two named drugs are from the family of medication called sulphonylurea. They act to stimulate the release of insulin from the beta cells in the pancreas, thus trying to optimise any insulin that can be ‘squeezed out’ from the body more naturally than insulin administration).

The Glasgow report (Ref 10) presented numerous other studies confirming the same observed weight gain with the administration of either insulin or sulphonylureas. The latter produced lower weight gain than insulin, but gain none the less.

The weight gain with insulin is immediate and sustained, as the Yki-Jarvinen 1992 study showed, with a mean gain of 1.8 kilograms to 2.9 kilograms in 12 weeks with two injections and multiple injections respectively. Similarly the Yki-Jarvinen 1997 study, carried out over a one year period, showed a mean weight gain of 5.1 kilograms with 2-4 injections per day. All of these studies were done for management of type 2 diabetes, not type 1.

The people taking sulphonylureas fared better than those taking insulin, but still recorded notable weight gain. The largest weight gain, over a one year period, for a sulphonylurea, was a mean of 3.6 kilograms recorded by Marbury (1999) for glipizide (Ref 11).

Conclusion

The BBC article linked to in the opening line says of diabetes: “It means their bodies cannot use glucose properly. If they do not manage it, they can develop potentially fatal complications like heart or kidney failure.” This is a useful, if simplistic, description of both types of diabetic – “their bodies cannot use glucose properly.”

Q) So, how does the body get exposed to glucose? A) From our public health dietary advice:

- “Base your meals on starchy foods” (glucose);

- “Eat five-a-day” (glucose and fructose);

- Eat less fat” (which means that carbohydrate as a proportion, if not absolute amount, in the diet must increase – more glucose).

Insulin makes us fat. Glucose demands that insulin be released, so glucose makes us fat. Carbohydrates break down into glucose (and fructose) – fructose goes straight to the liver to be turned into fat and glucose stimulates and insulin response to make us fat. Medication for dealing with the complications of not being able to “use glucose properly” makes us fat. What doesn’t make us fat is the real food that the government tells us to eat less of – meat, fish, eggs and dairy products.

I hope that the government realises the consequences of their dietary advice before we make any more diabetics, let alone record the deaths of those we have already made.

References

Ref 1 : Sir Harold Himsworth, “Diabetes mellitus: its differentiation into insulin-sensitive and insulin-insensitive types”, The Lancet, (1936).

Ref 2: Rosalyn Yalow, Solomon Berson, “Immunoassay of endogenous plasma insulin in man”, Journal of Clinical Investigation, (1960).

Ref 3: William Banting, “Letter on Corpulence addressed to the public”, (1869).

Ref 4: Yalow R.S., Glick S.M., Roth J., Berson S.A.,“Plasma insulin and growth hormone levels in obesity and diabetes”, Annals of the New York Academy of Sciences, (1965).

Ref 5: “Adult onset” was the common terminology used for type 2 diabetes at the time of the 1965 article. Type 1 diabetes similarly used to be called juvenile diabetes, as it manifested itself in children, adolescents or young adults. Type 1 and 2 are the favoured terms nowadays, not least because we are observing new cases of type 1 diabetes in middle aged people and, extremely worryingly, type 2 diabetes in children. The vast majority, 90-95%, of diabetics have type 2 diabetes.

Ref 6:  Edgar Gordon, “A new concept in the treatment of obesity”, The Journal of the American Medical Association, (1963).

Ref 7: Wilhem Falta, Endocrine diseases including their diagnosis and treatment, (1923).

Ref 8: DCCT Research Group, “Influence of intensive diabetes treatment on bodyweight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial”, Diabetes Care, (2001).

Ref 9: UKPDS Group, “Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes”, The Lancet, (1998).

Ref 10: W.S. Leslie, C.R. Hankey and M.E.J. Lean, “Weight gain as an adverse effect of some commonly prescribed drugs: a systematic review” QJM, (June 2007).

Ref 11: Marbury T., Huang W.C., Strange P., Lebovitz H., “Repaglinide versus glyburide: a one-year comparison trial”, Diabetes Research and Clinical Practice, (1999).

We need to remember that the UK health service was devolved in 1999, with England, Scotland, Wales and Northern Ireland managed separately from this point forth. Hence, this Department of Health announcement was for England only.

On 15 March 2011, the Department of Health issued a press release on what they call “The responsibility deal.” The government believes that  partnering with the food and drink industry “can be the most effective way of tackling some public health objectives.” The purpose of the food and drink industry is to sell as much food and drink as possible. The government believes that we need to be consuming less food and drink to lose weight. How these aims can be compatible, therefore, baffles me.

The pledges announced in the March press release include:

- Calories on menus from September this year;
– Reducing salt in food so people eat 1g less per day by the end of 2012;
– Removal of artificial trans-fats by the end of this year;
– Achieving clear unit labelling on more than 80 per cent of alcohol by 2013;
– Increasing physical activity through the workplace; and
– Improving workplace health.

We know that putting “Smoking kills” and “Smoking will harm your unborn child” on cigarette packets makes no difference, so why would putting a calorie number on food make any difference? It won’t and we know already that it won’t – here is an article about a study done in the British Medical Journal to prove this.

The October ‘new’ news

Health secretary, Andrew Lansley, and England’s Chief Medical Officer, Professor Dame Sally Davies, launched the ‘new’ proposals, but there really was only one thing new:

1) Davies called for everyone to be more  honest about their eating and drinking habits – so, not only are we greedy and lazy, we are now liars too!

2) We have been told to “slash” five billion calories a day. If the population of England approximates to 50 million people, that’s 100 fewer calories per person per day. No knowledge whatsoever of the difference between calories has been demonstrated with this headline grabbing number.

3) Astonishingly – this was the only new bit – the Scientific Advisory Committee on Nutrition (SACN) – advised that the recommended daily calorie intakes for both men and women should be raised. We are told to eat less, but our intake guidelines should go up? Davies tried to explain this by saying – our daily intake should be raised but we are still eating more than this, so we still need to cut back. This is confusing at best and ludicrous at worst. I do not think that we should be raising calorie recommendations in the midst of an obesity epidemic. Not because the obesity epidemic is about calories (because it isn’t), but because it sends the wrong message. If health were going to suffer by not raising these calorie limits then raise them – but at a completely different time, so as not to confuse the public. However, I am far from convinced that anyone’s health would suffer if we did not raise calorie limits – health is about what we eat and the vital nutrients that we consume – not the amount of petrol we put in our tank. Putting petrol in a diesel car is the worst thing we can do to a vehicle. Putting sugar, transfats and empty calories in a human body is equally harmful.

The calorie intakes, just for the record, have been increased from 2,550 to 2,605 for men and a whopping 1,940 to 2,079 for women.

The chair of the SACN working group, Alan Jackson, has declared interests in Nutricia (a specialised unit of Danone food company) and Baxter Healthcare (see page 32). The full list of members of the energy requirements sub committee is on p19 of that link. Ian Macdonald has declared interests with Mars Inc, Mars Europe, Unilever, Nestle and Coca-Cola – just what we want on a Scientific Advisory Committee on Nutrition! Andrew Prentice, also on the group, ‘only’ has connections to Tanita Scales and Danone. His wife, however, (see p34) has the most extraordinary list of declared interests: Beveridge Institute for Health and Wellness, Diabetes UK, Institute of Brewers & Distillers, Milk Development Council, Optimal Performance Ltd, The Rank Prize Funds, Tanita UK Ltd, World Cancer Research Ltd, Weight Watchers UK Ltd, B Kassardjian Fund – Zurich, Dee Caffari Ltd, Mars, BBC, Rosemary Conley Diet & Fitness Club, National Trust, Coca Cola, Outsights, Nestle, Emap, Kelloggs, Almond Board California, Nunwood Consulting, Pepsico, GlaxoSmithKline, British Institute of Sport, The Pelican Buying Co, National Institute of Nutrition and J Sainsbury. Go girl!

The bottom line

The bottom line is that the English government thinks that people just need to eat less and do more and they will lose weight. As I detail at length in my book The Obesity Epidemic this has been Plan A for more than three decades and we have continued to get more and more obese. We have known since Benedict’s 1917 study that eating less leads to short term weight loss and then regain to beyond the starting weight. This was confirmed in the definitive eat less experiment – the Minnesota Starvation Experiment - initial weight loss, followed by regain plus 10%. At least 9 out of 10, if not 19 out of 20, of the personal consultations that I do start with the explanation “I didn’t really have a weight problem until I went on my first diet. I lost weight, regained and more. I went on another diet, lost weight, regained and more.” When they say ‘diet’, my clients mean a calorie deficit diet – the eat less/do more that the government thinks will get us out of this mess.

Here’s an interesting statistic for you:

The MAFF (Ministry of Agriculture Fisheries & Food) National Food Survey tells us that we were eating 2,290 calories per person per day in 1975 and, by 1999, this had fallen to 1,690 calories per person per day. If we apply the 3,500 calorie formula (notwithstanding that this formula is also wrong, but it’s the one that government and all calorie advisors rely upon), to the change in annual average calorie intake, all other things being equal, we should have lost an average of 62.6 pounds per person during this period. Instead obesity rose nearly ten fold during this time.[i]

The DEFRA (Department for Environment, Food & Rural Affairs) report notes the continual decline in calorie intake. The Family Food Survey for 2001-02 comments on the short term: “Energy content of the household food supply has decreased considerably over the last 5 years.” The Family Food Survey for 2002-03 notes the same trend over the longer term: “Average energy intake per person in the UK is unchanged in 2002-03 compared with the previous year, although it has been declining since 1964.”[ii]

The Food Standards Agency (FSA) web site also acknowledges the above conundrum, “Since the 60s we’ve been consuming fewer calories from household food (this doesn’t include eating out). However, there are an increasing number of people who are overweight or obese. The reasons for this are not clear.”[iii]

We need to eat better, not less. We need to return to eating real food, not the empty calories dominating the eatbadly plate. We need to eat naturally produced meat, fish, eggs, dairy products, vegetables and salads to ensure that our bodies can use the calories that we eat for our basal metabolic needs. We absolutely cannot afford to eat the empty sugar and flour calories, which we are eating.

World Health Organisation data tells us that the average UK citizen consumes 38 kilograms of sugar per year.[iv] Statistics from the Flour Advisory Bureau note that UK per capita flour consumption reached 74 kilograms in 2008/9.[v] 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?

What the government should have done

I set out in Chapter 16 of The Obesity Epidemic what should be done to reverse the obesity epidemic. Here are the headlines:

1) Tear down the eatbadly plate from every surgery, hospital and school in the country and never allow it to be shown again. Tell people to eat real food from now on and nothing but real food. If nature provides it – eat it; if food manufacturers provide it – don’t. That’s the only healthy eating food message that the government needs to have  to start to reverse the obesity epidemic.

2) Ban trans fats. In the unlikely event that we were bold enough to ban sugar, trans fats and sweeteners, this one step would be sufficient to reverse the obesity epidemic (whether such bans are necessary is a matter for debate). Trans fats should be singled out for an immediate ban (as has happened in Denmark and Switzerland). The National Heart Forum summed up their position on trans fats in the opening to their paper calling for a ban on these substances: “Industrially produced Trans fats (IPTFAs) are harmful to health, they have no nutritional benefits and there is no known safe level of consumption.”[vi]

3) Fiscal policy (taxation). I cannot conceive of any government having the courage to ban sugar, trans fats and sweeteners. Hence, if we lack the leadership qualities to ban nutritionally void substances, the minimum that we need is a deterring and punitive tax on each of them. We need to be very specific about the targets. In May 2009 Dr. Tim Lobstein called for a ‘fat tax’,[vii] while talking about junk food and pizza. The reiteration of the notion that ‘fat is bad’ is incessant. We must stop this forthwith. Here is a blog on the October 2011 Denmark fat tax and how misguided this is. The target of fiscal measures needs to be processed foods and no real food should ever be demonised again. Again, although this step may not be necessary, it would be sufficient and we are almost expecting the impossible from our populations to tell them to avoid processed food while the food manufacturers are simultaneously promoting BOGOF’s (Buy One, Get One Free) on biscuits, cakes, confectionery and all the things that we need help to resist. David Kessler’s book, The end of overeating, gives full details of what humans are up against in terms of food industry tactics.[viii]

Taxation would merely be a return to previous public policy, albeit from centuries ago. Adam’s Smith’s The Wealth of Nations (1776) noted “Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.” Just under one hundred years later, the sugar tax was repealed. If sugar is not banned, the tax needs to be reinstated.

The objective of such taxation should primarily be to reduce consumption, but any revenue generated can have an added benefit of subsidising real food and/or the health services that are impacted by such consumption. Using sugar as an example, I would put a minimum 100% (double the price of the product) tax on any product containing non naturally occurring sugar (any added ‘ose’).[1] This would immediately discourage food manufacturers from adding sugar, completely unnecessarily, to ham, cottage cheese, tins of chick peas, kidney beans and other healthy products. I would put at least a 200% tax on any product where all sugars added together are the majority of the composition of the product. For any product (e.g. children’s sweets) where the entire product is essentially sugars (with a bit of crushed animal innards, gelatine, for bonding), we should multiply the current price by four or five fold. The proceeds from taxes on sugar, trans fats and sweeteners should subsidise real food for people who are currently least able to afford it. We cannot hope to solve an obesity epidemic when we can buy ten doughnuts or one cucumber for the same price.

Other fiscal measures should be considered. Corporation tax can be raised on companies that make processed food and lowered, or eliminated, on companies that provide completely unadulterated natural food. The local butcher must become the provider of choice for meat, not McDonald’s. Today, I can buy one pound (454 grams) of grass fed steak for the same price as a regular cheeseburger and medium fries and mayo chicken and a McFlurry original and a medium drink and a double cheeseburger.[ix] This is not conducive to healthy eating – particularly in the sections of our population who can least afford, and most need, real food. Kessler details some of the most contemptuous examples of fast food: “One of the signature hamburgers at Hardee’s is called the Monster Thickburger, which famously contains 1,420 calories and 108 grams of fat.” “Yet even that pales in comparison to a slice of Claim Jumper’s Chocolate Motherlode Cake … 2,150 calories a slice”. (Note the use of the word ‘mother’ to imply approval). Such inhumanity to man should be met with an “Inhumanity Tax”. It’s not far away from manslaughter, if you are familiar with the legal definition.

If this sounds extreme, how does “90% of today’s children being overweight or obese by 2050” sound?[x] And, why would this be considered extreme? I am merely suggesting that we return to eating what we used to eat before we got too obese to function as human beings.

England has one of the worst obesity epidemics in the world. Thanks to the conflict of interest and ignorance of the English government, they now have one of the worst obesity strategies in the world. Relying on the profit motivated organisations that want us to eat ‘fake’ food instead of real food, to lead a return to the real food that would signal their demise, is naive at best and fatal at worst.

[1] As an example, fructose in a whole apple is fine, as this is the form in which nature intended us to eat fructose. Fructose added to sweeten other products is not necessary.

[i] I calculated this mathematically year on year and analysed the average calorie intake for 1975 and then that for 1976 and used the 3,500 calorie formula to work out what the average person should have gained/lost between these two years and repeated this for each year between 1975 and 1999 to calculate the overall number of pounds that should have been lost on average. The overall number was calculated cumulatively, as some years people should have gained weight and most should have produced weight loss – all according to the calorie theory.

[ii] http://www.defra.gov.uk/evidence/statistics/foodfarm/food/familyfood/index.htm

[iii] http://www.eatwell.gov.uk/healthydiet/seasonsandcelebrations/howweusedtoeat/ changingtastes/

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

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

[vi] http://www.heartforum.org.uk/Policy_Consultations_2093.aspx

[vii] http://www.medindia.net/news/British-Expert-Calls-for-Fat-Tax-on-Unhealthy-Foods-to-Save-Children-51144-1.htm

[viii] David Kessler, The end of overeating, published by Rodale, (2009).

[ix] Rump steak was £14 per kilo (£6.36 per pound) and McDonald’s had the first five items listed for 99p and the double cheeseburger listed at £1.29 (June 2010). http://www.mcdonalds.co.uk/food/saver-menu/saver-menu.mcdj?dnPos=0

[x] One of the forecasts of the Foresight Report: “Tackling Obesities: Future Choices” (October 2007).

And you can download the presentation slides here

Nutrition is a fascinating topic. There is little more important to human health than what and how we eat.  Modern epidemics of obesity and ill health are capturing media headlines and the attention of curious minds alike. This is a subject about which many people want to know more. However…

When I am asked to recommend a course on nutrition I can’t. I am not aware of a single programme being offered anywhere in the world, which is evidence based and which presents facts, rather than the current myths presented as facts. That doesn’t mean that there isn’t one, but I don’t know of one and I would be surprised if there were one given the extent of the misinformation being perpetuated by the vast majority of people working in this field.

What do you want to learn?

My starting advice to someone interested in studying nutrition would be to be specific about what you want to know. The British Dietetic Association curriculum for training as a dietician is detailed here. If this is your first higher qualification, the background in basic sciences and biology may be useful to you. For those who already have a degree and/or studied science to a reasonable level at school, reading a cell biology, physiology and biochemistry textbook will deliver the required background.

My passion is obesity. There is more than enough to study on this topic to do nothing else for the rest of one’s life. Hence I am not interested in (using the attached curriculum by way of example) immunology, microbiology, (food hygiene), clinical medicine, pharmacology, sociology and social policy, communication and educational methods and definitely not interested in ‘food’ science. Nature provides food – that’s the only food I want to understand. I’m not particularly interested in dietetics for the prevention of general disease (besides the fact that eating real food will achieve this naturally) and I’m only interested in public health to the extent of how we managed to get ourselves in the midst of an obesity epidemic.

Becoming a dietician

When I set out to study nutrition more formally, I investigated training as a dietitian. I rejected the prospect very quickly on two grounds:

i) With 1.5 billion overweight people in the world, this is more than a big enough arena in which to specialise. As detailed above, I have no interest in the vast majority of the dietician curriculum and have no time to ‘waste’ on such topics when I could be spending that time reading obesity journals.

ii) Upon investigation of the weight management part of the course, I discovered that the first lesson is the calorie formula. I would be told that energy in equalled energy out and that to lose one pound of fat a deficit of 3,500 calories must be created.

Thus the one part of the course that I would be interested in, would be of no use to me. Presumably I would need to reproduce answers that I know not to be true to pass, or fail as a result of giving my honest answer. A quick analysis of the 58 page curriculum document confirms that I made the right decision: the word weight does not appear once; the word obesity does not appear once; the word calorie does not appear once and the word diet only appears six times and in a very general context of the word diet e.g. UK diet or diet and lifestyle.

A third reason became apparent when I was researching for my book The Obesity Epidemic: What caused it? How can we stop it? Conflict of interest…

Here are the sponsors of The American Dietetic Association. Here are the program partners of the Dieticians Association of Australia. Here are the major partners of the Dieticians Association of Australia. Here are the associate partners. I detail in my book, The Obesity Epidemic, how unwilling the British Dietetic Association is to disclose its conflicts of interest. After a number of email exchanges, a BDA spokeswoman confirmed “we have been delighted to work with the Sugar Bureau…” The chief executive’s foreword (Andy Burman) in the 2008-09 annual report of the BDA notes “We now have our first national partners with Danone and Abbott and we hope to announce new partners over the coming year or so.” There is reference to a “Bird’s Eye” education award, but no mention of other partners or sponsors. The accounts for 2009 showed a turnover of £2,359,013 with no details of the source for this revenue. The notes to the accounts, which could add detail to this number, are for the eyes of BDA members only. A press release, dated 1 March 2007 entitled Kellogg’s: commitment to health and wellbeing, informed me that Kellogg’s had been the lead sponsor for the British Dietetic Association’s annual obesity intervention campaign since 2002 (and may still be).

Here are the members of the British Nutrition Foundation. Here are the sustaining members of the British Nutrition Foundation.

It is a complete disgrace that our nutritional ‘education’ has been infiltrated in this way. The partner that most disturbs me is Abbott Nutrition. This company makes an infant formula called Similac. The feeding guidelines on the Similac web site range from 1-2 weeks to 9-12 months, so this is clearly a product designed for babies. The can of baby formula, of the part that is not water, contained 43% corn syrup solids and 10.3% sucrose. “It’s a baby milkshake,” said a horrified Robert Lustig in the video “Sugar: The Bitter Truth“. I wanted to analyse a product for myself, so I chose Similac Isomil Advance, Soy Formula and the composition of this was 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. 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.

It is clearly in the interests of ‘food’ companies to partner with those giving us dietary advice – and to start as close to birth as possible. Does the public know that our advice is so conflicted? How can we “Trust a dietician to know about nutrition” (their slogan) when this conflict of interest exists?

Nutritional ‘education’

That’s the conflict inherent in our nutritional training, what about the content of programmes?

I only know one way to learn and that is to “get the facts”. I am a thinker, not a feeler. If I am told something I need it to be evidence based. I want to know the source of everything – where did that come from? when did this become known and so on. This stood me in good stead studying economics (maths, statistics options) at Cambridge. Applying the same rigour to the subject of nutrition was the most shocking thing I have ever done.

During the three years of full time research for The Obesity Epidemic, the following nutritional beliefs did not hold up to scrutiny. Please note – these points are only in the part of nutrition related to dietary advice and weight loss. There may be many more errors in the teaching of nutrition outside my areas of interest.

Starting at the very beginning – dieticians state that “energy in = energy out.” “You can’t change the laws of the universe”, they say. But there is no law of the universe that says  “energy in = energy out.” I detail in The Obesity Epidemic exactly what the laws of thermodynamics say and which law we have misunderstood and which law we have ignored.

We are then told that 1lb = 3,500 calories. It doesn’t.

We are told that we will lose 1lb if we create a deficit of 3,500 calories. We won’t.

We are told that 98% of diets fail (true for calorie deficit diets) but are continually told to “eat less/do more” despite this.

Five-a-day is a marketing myth. Eight-a-day (drinking) is similarly fabricated. Alcohol guidelines are numbers “picked from the air.”Fruit is essentially sugar (fructose/glucose – aka sucrose) with vitamin C and not much else by way of nutrition. Offal, red meat and butter, the foods most often condemned by diet advisors, are nutritionally exemplary.

Saturated fat is life vital. Mother Nature is not trying to kill us.Cholesterol is life vital. Our own body (which makes our cholesterol) is not trying to kill us. The formula for cholesterol is C₂₇H₄₆O. There is no good or bad version.Grazing (don’t); fibre (pointless); sedentary behaviour (how humans were designed to be) – there’s so much that we have got terribly wrong.

As Kaayla Daniel said at the 2011 Weston Price Conference – “If you’re told it’s bad, it’s good and if you’re told it’s good, it’s bad – work on that basis and you can’t go far wrong!”

Check out this free ebook or any of these presentations: Calories, Energy Balance, Thermodynamics and Weight Loss; Ten diet myths; The Obesity Epidemic to find out more.

Conclusion

I cannot recommend any dietetic or nutrition course because I know of none that will teach the truth about everything from thermodynamics to the role of insulin in fat storage. My genuine recommendation is that you need to study via amazon (Sean Croxton, Underground Wellness, concluded the same) and medical journal web sites.

Read Mary Enig and Sally Fallon Morell on fats; Uffe Ravnskov, Duane Graveline and Dr Malcolm Kendrick on cholesterol and the lipid hypothesis; The Diet Delusion (Gary Taubes); critical reviews of all of these and weigh the evidence for yourself. There will be many more non- conventional wisdom works for different areas of interest. The seminal journals to be read include Benedict (1917); Newburgh & Johnson (1930); Hugo Rony (1940); The Minnesota Starvation Experiment/The Biology of Human Starvation (1950); Stunkard & McLaren-Hume (1959). The Seven Countries Study (1970); The COMA report (1984). There are 400 references here for convenience – the books and journal articles are recommended.

When I started to question the origin of the calorie theory (1lb = 3,500 calories, so to lose 1lb you need to create a deficit of 3,500 calories), I asked the Department of Health, the National Health Service, the National Obesity Forum, The National Institute for Clinical Excellence, the Association for the Study of Obesity, Dieticians in Obesity Management and the British Dietetic Association. None could source the calorie theory. None could prove it.

The British Dietetic Association reply was: “Unfortunately we do not hold information on the topic that you have requested.” It was suggested that I contact a dietitian. I happened to be with several dietitians at an obesity conference later that month (June 2009), so I asked fellow delegates and no one knew where the 3,500 formula came from. No one knew where the ‘eatwell’ plate proportions came from. One dietitian said to me “You’ve made us think how much we were just ‘told’ during our training, with no explanation. A group of us over there don’t even know where the five-a-day comes from.”

I rest my case!

Why do we say “eat less/do more”? Does it work? What do the laws of thermodynamics actually say? (because it isn’t “eat less/do more”)

Why do we say “to lose 1lb of fat, we need to create a deficit of 3,500 calories”? Is any part of this equation correct? Do the 7 leading public health authorities in the UK know why they say this? Does anyone?

What is human fat tissue? How do we lose it? i.e. how do we lose weight? (because it isn’t “eat less/do more”)

And much more.

Hope you enjoy it!
Very best wishes – Zoe

Or you can listen to the talk and download it for listening later…

Or you can listen to the talk and download it for listening later…

And you can download the presentation slides here

This article, therefore, is a summary of what we all may like to know about bariatric surgery: What exactly is it? How is it supposed to work? What are the risks/side effects? Is there an alternative that we haven’t considered? Not least if this seems a bit scary and extreme.

What is Bariatric Surgery?

Bariatric surgery is the collective term given to a number of different procedures all designed to ‘interfere’ with a person’s digestive system.

The main different types are:

1) A Gastric Bypass (also called the Roux en Y Gastric Bypass procedure). This operation was first done in 1967 in the USA. In 2008 there were 200,000 such procedures done in the USA. It was originally always done as an open operation (cutting the stomach open) and sometimes still is done in this way. More commonly nowadays, however, it is done “laparoscopically”. This means it is a less invasive operation – small cuts are made (usually 0.5-1.5cm) and then the surgeons can use cameras to pin point the area they want to work on without having to open up the whole stomach area. This reduces time spent in hospital to 2-3 days and there is a shorter recovery time also. Most people still need 2-3 weeks off work and can’t drive for a couple of weeks.

Gastric Bypass is a very accurate name for what is happening here – the stomach is literally bypassed – so that food doesn’t go where it used to go – and where it should go. All you need to know, from a nutrition and health perspective, is that the majority of nutrients (vitamins and minerals, vital for life and human health) are absorbed in the small intestine. In the pictures above, you can see that the small intestine is bypassed and nutrients can not, therefore, be absorbed properly. This surgical procedure is irreversible.

2) A Gastric Band is less invasive than Gastric Bypass surgery. This is done through key hole surgery, with four small incisions. An adjustable band is placed around the top of the stomach, as shown in the diagram, and it can be adjusted after the procedure. The operation is done under general anaesthetic, taking about an hour and the person can be released in 24 hours and be back to normal activities within a week or two. Unlike gastric bypass surgery, banding is reversible although this is not advised as weight gain is likely to occur.

Anne Diamond and more recently Vanessa Feltz have had Gastric Band surgery. Sharon Osbourne is probably the most well known example of a reversal of this procedure. Sharon had a Gastric Band fitted in 1999 and then had it removed in 2006. Sharon’s reason for having it removed was “I keep wanting to eat more and more….I’m a pig”! She was being physically sick every time she ‘overate’ (probably normal amounts for someone without a gastric band) and this can’t be pleasant. No matter how much we want to be slim – Sharon obviously found that some things are just so intolerable and uncomfortable that she made a decision that may seem unimaginable to some of us.

3) A Gastric Balloon is a soft silicone ‘balloon’ that is inserted into the stomach ‘deflated’. The c. 20 minute operation doesn’t need a general anaesthetic, mild sedation (whatever that is) is induced instead. The balloon is inserted through the mouth and guided down to the stomach where it is then inflated until it takes up a big part of the stomach area. The balloon needs to be removed after 6 months because of the risk of erosion from stomach acid. The removal takes about the same time – 20 minutes – and, again, can be done under mild sedation.The idea is then that the person has had 6 months to improve their ‘eating behaviour’ and doesn’t need a band. Yeah, right!

Often a balloon is used to try to help someone lose some weight before they then have a band or a bypass. This may happen with someone who is dangerously obese and the surgeons don’t want to risk a general anaesthetic until the person has lost some weight.

There are other procedures, which fall under the collective term ‘bariatric surgery’:

- A Sleeve Gastectomy removes 85% of the stomach. Effectively a new ‘sleeve’ or tiny stomach is created. It is alleged that this enables some of the nutrients to be absorbed, because a stomach of sorts is still there. However, the key thing to find out is what they plan to do with your small intestine. The small intestine is actually more than 6 metres long and this is where the majority of nutrients are absorbed. I’d want to know what they were planning to do with my 6 metres! This is obviously irreversible.

- A Duodenal Switch. I have absolutely no idea why someone would opt for this procedure. The full name is “Biliopancreatic diversion with sleeve gastretomy”. You’ve got the idea of the Sleeve Gastrectomy above – so this procedure involves having 85% of the stomach removed. Then you get clear direction on what is planned for your small intestine. The procedure makes a new pathway from the end of the new small stomach to the colon (also known as the large intestine). The colon is where food should end up after digestion and from there it is evacuated from the body as faeces. In this procedure, food bypasses the majority of the small intestine (the duodenum particularly), which limits the amount of food that can be absorbed.

- Stomach Stapling used to be quite common – this involves pretty much stapling the stomach (as if you were stapling paper, to give you the imagery) so that the stomach is made smaller. It is simply less favoured now and the bypass and band options are preferred instead, having similar and apparently safer outcomes to stapling. Staples had an unfortunate habit of becoming infected or tearing another part of the person’s inside and causing internal bleeding etc. I wouldn’t put a staple in my finger, so why would we think putting a few inside our body is a good idea?!

And those are pretty much the surgical options available under the term ‘bariatric surgery’.

How are they supposed to work?

1) A Gastric Bypass has a pretty direct way of making the person consume less food than is needed for energy and health (and that’s the right way to describe what’s happening – the individual will have insufficient energy and nutrition from food permanently after the operation). One of the private weight loss surgery information sites says “Over-eating causes abdominal discomfort and vomiting.” You may still feel like overeating (most likely you will), but, if you do so, you will regret it very quickly and violently.

Some people become scared to eat and this will be quite an effective way of losing weight, health and energy from that point onwards. For others, the temptation and cravings are too great and they do try to eat their craved foods and they will feel terrible very quickly. Many will put up with feeling so ill because of the power that their fix has over them.

2) A Gastric Band works literally by making the stomach so small that the person can hardly eat anything before they feel full (very temporarily). If they eat more than the tiny area above the band can hold they are likely to be sick and throw back up the food that they have tried to eat.

This is a pretty drastic way of trying to get people to eat less.

3) A Gastric Balloon is intended to work in a similar way to the Gastric Band – by making the stomach area smaller so that the person feels full sooner and stops eating. (Yeah, right, again!) The person will also feel sick and will actually vomit if they eat ‘too much’.

The literature for Gastric Bypasses and Bands admits that mal-absorption of vitamins and minerals is a problem (that’s a bit of an understatement) and that people need to take vitamin supplements and be regularly tested for anaemia and that iron, B12 and calcium deficiency are especially common. All fat soluble vitamins are likely to be compromised – vitamins A, D, E and K – just as they are when Orlistat/Alli/Xencial is taken in tablet form to try to stop fat being absorbed by the body. Messing around with the entire digestive system has a similar disruption to the body’s ability to be able to absorb fat.

The National Obesity Forum produced a booklet, written by Dr David Haslam, Colin Waine and Anthony R Leeds. At the end of the booklet, Haslam declared an interest as a consultant for Lighter Life and Leeds declared an interest as an employed medical director for the Cambridge Diet. The booklet was funded by the Cambridge Diet. This is a conflict of interest as liquid only diets are advised for a couple of weeks before surgery and many people will find they can only consume liquid diets for a period of time after the surgery.

The bit that is interesting to note in this booklet is the admission: “The risk of complications is dependent on the nature of the surgery and the degree of bypass… All are likely to develop vitamin B12 and iron deficiency. Many UK patients have low or deficient vitamin D status pre-operatively due to low exposure to sunlight, low dietary intake and effects of their previous experience of weight loss regimens. Vitamin D status and bone health therefore need to be watched. Serum trace elements such as Zinc, Selenium and Copper levels have been shown to fall in the majority of patients post-bariatric surgery.”(my emphasis)

There are so many interesting comments to make about just this short passage:

a) Note the admission that vitamin D intake in the UK is deficient and the admission that diet has played a part in this. What are the best sources of vitamin D? Eggs and dairy foods. So dieticians tell us to avoid eggs and have low fat dairy foods (when fat soluble vitamins, like vitamin D, need fat to accompany the vitamin or it is pretty useless);

b) Note that word “All” – I added the emphasis – not the authors. All bariatric surgery patients are likely to develop vitamin B12 and iron deficiency. What does that mean? Anaemic, extreme tiredness, pale skin, low energy, palpitations, breathlessness, pins & needles, confusion, depression, poor concentration and so on. And that’s just 1 vitamin and 1 mineral. There are 13 vitamins and c. 16 minerals that will be seriously affected by effectively removing the ability to absorb nutrients vital for life.

c) How would we like selenium deficiency? It can cause heart arrhythmias and loss of heart tissue, deterioration of muscle tissue, muscle pain and weakness etc. Or maybe zinc deficiency? Dandruff, eczema and hair loss if we’re lucky and inflammatory bowel disease, growth retardation, pre-eclampsia (serious complication in pregnancy) and loss of sex drive if we are not so lucky.

We talk and act as if vitamins and minerals are optional and it doesn’t matter if we take away the body’s ability to absorb them. Vitamin comes from the Latin word “vita” meaning life. They are literally life or death substances.

Risks and side effects:

What are the risks and side effects of the most common procedures: Gastric Bypass and Gastric Banding?

1) Nutritional deficiencies (and all the minor and serious and even life threatening conditions that come with deficiencies in any individual vitamin and mineral) are not risks – they are virtually guaranteed. The ‘prescription’ following gastric bypass is “lifelong vitamin supplementation required.”

2) The post-operative information, which can be found on private surgery web sites, has a number of FAQ’s. Here are a couple of the most Frequently Asked Questions:

Q Will I lose my hair after surgery?

A) Yes there is a possibility

Q) Will I have baggy skin or stretch marks?

A) Unfortunately you are likely to be left with a large amount of loose skin.

Q) Will I lose weight straight away?

A) Following a bypass you can expect to lose a stone a month for the first year. Following banding a loss of 3kg per month is normal. (My comment – this is hardly different to what calorie counting promises, but doesn’t deliver. Weight regain is documented to occur in 98% of cases following calorie deficit diets (Stunkard & McLaren-Hume 1959). Whether the person manages to eat less/do more through willpower, or because they have had surgery, matters little. The only difference being that the gastric options make it less possible for people to eat the fuel that they actually need – because they will be sick and/or ill if they do).

3) The ‘complications’ list for Gastric Bypass includes: infection (an estimated 1 in 20 patients); internal bleeding (an estimated 1 in 50 patients); leakage from stapled sites (one of the biggest causes of fatalities resulting from the surgery); blood clots; deep vein thrombosis (DVT); breathing difficulties; pain; vitamin and mineral deficiencies (they’re a given); heartburn and bowl obstruction. The private weight loss surgery sites themselves admit that about 1 in 50 patients need corrective surgery because something has gone wrong.

I’ve got a 1 in 14 million chance of winning the lottery and I still think it might happen – I’m not sure a 1 in 50 chance of internal bleeding is worth gambling on. The ‘complications’ list for Gastric Banding includes: band slipping/twisting and stomach obstruction; infection; erosion into stomach and injury to stomach and nearby organs.

4) There are then what the patient may consider to be complications: not being able to eat normally; serious bodily responses if they succumb to a binge (even a ‘small’ one); not being able to join in at family meal functions and celebrations; feeling hungry all the time; having to eat little and often and all the blood sugar swings that go with this; having little or no energy, as you can no longer put fuel in your petrol tank in effect; stomach pain and all the health complications that go with just not feeling well and nourished.

5) Life may never be the same again. When I first saw this headline I thought “there’s just no pleasing some people”. If you read the whole story and not just the headline, it is quite upsetting. Tim Daily can no longer eat any solid food. He is literally wasting away and is suffering from malnutrition and is now fed through a tube into what is left of his stomach. If he does eat any actual food the pain is so excruciating he needs to take morphine.

This has literally ruined the man’s life and I suspect he will be dead in a few years from effective starvation. He has a one in four chance of death if he tries to have corrective surgery. That is one heck of a rock and a hard place and one heck of a ‘side effect’ .

6) Finally death itself. Some private web sites promoting bariatric surgery will admit that death rates for Gastric Bypass operations are 1 in 200. Try 1 in 50 said a CBS report into a Washington study. One of the most comprehensive reviews that I found was in the Journal of the American Medical Association (2005) – an extremely prestigious journal. This article found that, from a total of 16,155 patients who underwent bariatric procedures (mean age, 47.7 years; 75.8% women), the rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs. 1.5%, 4.8% vs. 2.1%, and 7.5% vs. 3.7% at 30 days, 90 days, and 1 year, respectively). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs. 1.7% at 30 days, 6.9% vs. 2.3% at 90 days, and 11.1% vs. 3.9% at 1 year). So, according to this study, up to 11% of patients for ’stomach’ surgery weight loss operations are dead within a year.

My view on bariatric surgery:

You can probably tell that I am not a fan and these are the main reasons why:

1) The most important one is that it is not necessary. I am shocked at the idea that we would rather remove 85% of someone’s stomach, than have people return to eating what we used to eat before we became so obese that we needed to invent bariatric surgery. There is another option, which can be used as a first resort as well as a last. It is healthy and is likely to lead to lost weight and gained health. However, I am considered radical for suggesting it. Surgeons who want to remove our digestive systems are welcomed onto the breakfast TV sofa and I am ostracised for daring to suggest that we just need to eat real food, as provided by nature. The excuse given will be that nature is ‘out to get us’ and put real, essential, fats in real meat, fish and eggs with the intention of killing us and so we must not eat what nature provides – we must eat what food manufacturers provide instead. You would not think that humans would be so stupid as to believe this, but, when PepsiCo alone is worth $44 billion and is larger than 60% of the countries of the world (comparing revenue with GDP) – there is no place for truth. There is no money to be made pushing Mother Nature’s natural products. The profit to be made by food & drink companies, pharmaceutical companies and/or bariatric surgeons is the real issue here.

The first/last resort should not be surgery. The first resort should be 1) eat real food 2) three times a day and 3) manage carb intake to manage weight. The last resort should be to take these 3 rules to the extreme of a virtually ‘zero’ carb diet. Then the body cannot store fat and it has to use its own fat for fuel. My recommendation would be the best of Harcombe/Atkins. “Only eat real food” (Harcombe) has to be the fundamental guiding principle for any healthy eating/weight loss plan and then the very low carb/ketosis principle of Atkins is a very useful one, which we have known about for over 150 years (since Banting et al).

Hence – the last resort should be to eat unlimited real meat and eggs from grass reared animals (nothing processed); real fish (meat, eggs and fish can be cooked in butter, lard or olive oil) and then 20 grams of carbohydrate a day. The carb intake can include dairy from grass reared animals, vegetables (not potatoes) and salads, but there will be no room for fruit, whole grains or large portions of dairy.

People would be better off using the carb allowance for green vegetables and salads (this would approximate to one coffee mug of green veg/salad at each of two main meals and the third meal would be carb free – (non-processed) bacon & eggs for example). This will just make meals feel more ‘normal’ and filling. There is no need to be hungry, no need to suffer ill health, vitamin or mineral deficiency, no need to be low energy (it may take a while for the body to get used to using fat for fuel and not carbohydrate) and there is no need to die from having your entire digestive system completely compromised. Surely that is a far better ‘last resort’?

2) Another issue I have with bariatric surgery is that it fundamentally believes in the ‘eat less’ principle (the person won’t be able to do more as they will have no energy). Everything we know about ‘eat less’ studies – the 80 studies from the outstanding review (Franz et al 2007) in that famous chart in the club ( http://www.theharcombedietclub.com/forum/showthread.php?1686-The-evidence-for-low-calorie-diets&highlight=franz) – says that the weight returns and the body will continually adjust to lower calorie intake. All the evidence for the past 100 years also supports this.

You will find many studies on line and I have come across clients who have had surgical procedures only to regain the weight. I give an example in “The Obesity Epidemic” book of a man I sat next to at dinner at an obesity conference. He had had a Gastric Bypass and had lost a reasonable amount of weight (never got a BMI below 30, so stayed technically obese). He was steadily regaining the weight when I met him.

One of the main reasons for this is that, after bariatric surgery, people are invariably only able to digest the things that we avoid. He could eat bread, potatoes and the pudding quite easily – he couldn’t digest the lamb and no doubt fish would also have been problematic. People who have had surgery will be living on carbs, little and often, continuously throughout the day and will be horribly hungry and their likelihood of developing type 2 diabetes must be high.

3) The third point that I would like to make about bariatric surgery (and many supporters of these operations make this point also) is that it does nothing to change the underlying problem that caused the obesity in the first place. It does not give people the understanding about food addiction and cravings that we have. It does not address the mind games and emotional connections with food that we have made. The poor person who has their stomach reduced to the size of an egg will still have all the food addiction and immense cravings that we all know only too well. Can you imagine having that incredible desire to eat and knowing that you would feel horribly physically ill if you gave in to it?

There is a term called ‘dumping’ used to describe a situation that people who have had bariatric surgery can experience. If you have ever fainted and had that most indescribably awful feeling when you come round (your blood sugar is on the floor; you feel sick/nauseous; hot and cold; you feel an urgent need to poo; you feel like you have died or wish you had – I faint at blood tests most times and I know this dreadful feeling only too well). If someone who has had bariatric surgery eats a small bar of confectionery they may well experience all of this and then some. That would terrify me on a daily basis.

Contrary to commonly held beliefs, people who have bariatric surgery rarely reach normal weight. They are lucky to even get into the overweight category and regain is likely.

The final point should not need stating, but clearly does, as the bariatric surgeons will be at pains to play this down. How can I support the mutilation of the human body? (the definition of mutilation is to deprive one of a limb or essential body part – I would consider my digestive system fairly essential). Do we have any idea of the long term effects of bariatric surgery? Dr Natasha Campbell McBride, a world authority on the gut, calls the gut “our second brain”. What would she say about effectively removing our second brain? If mutilation really were the last resort then maybe we would have no alternative but to consider this option – but we are far from at that point yet.

Here’s the link to the presentation at last.

The book is based on comments made by overweight kids and teenagers on two identical sites run by Dr Pretlow: www.weigh2rock.com and www.blubberbuster.com. The sites look fun and interactive and the comments in the book reflect the value that young people get from them. The book content is almost entirely provided by verbatim comments made by the people using these sites. Dr Pretlow provides a narrative and asks questions for which the comments provide answers e.g. What do overweight kids say about their parents? We then get many examples of responses, as a factual illustration of what kids say in answer to this question. The title of the book is a well chosen one.

I must admit that the unedited verbatim comments don’t make comfortable reading for anyone used to writing for a living. You can read pages before finding one comment that is even close to being spelled properly, let alone grammatically correct. I know young people use text speak, slang  and abbreviations, but saying “board” when they mean “bored” or “choose” when they mean “choice” makes one wonder if there will be any authors in the future!

If you can tolerate reading 300 pages of essentially ‘text messages’, the content will in turn make you laugh and then make you cry. More will make you cry and they should all make us, as adults, feel guilty. We have failed these children. We have put profits of the food industry ahead of the health of our next generation and we have created, as just one example, a 500lb “Fat boy 15″ who has to be home schooled as a result of his weight. We have cut him off from the world before he is even an adult himself. What is he then most likely to do to overcome loneliness and boredom? Eat.

The minimum that these kids feel is embarrassed – embarrassed to go out, to be themselves, to have slimmer friends, to do activities required of them at school – to even be alive. Some have considered suicide. Weight, fat, size and diets are totally dominating and ruining the lives of these young people. The exhaustion of trying yet another diet and the despair of failure is palpable. It really is heartbreaking. It also made me angry. We didn’t have an obesity epidemic until we changed our diet advice away from what we evolved to eat – meat, fish, eggs, dairy, nuts, seeds, vegetables, salads and local fruits – foods provided by nature – to grains, grains, more grains, breads, cereals, man-made spreads, low fat this, low fat that. The food industry profits have got as fat as our children. The joy of shareholders is equal and opposite to the despair of the consumers.

We have been watching Jamie’s Food Revolution on TV in the UK these past few months – it aired first in the USA. My heart sank when I saw the USDA custodian for the region, ‘Rhonda’, saying that kids must have two breads with every meal and I nearly threw something at the screen when she confirmed that fries counted as a portion of veg. Carbs are uniquely addictive and uniquely fattening – processed carbs especially. Why is the USDA not insisting that children eat the most nutritious foods at school lunch? Where is the campaign to get liver, sardines, eggs and real milk (not low fat rubbish) into the school meal plan? How long will it be before Dr Pretlow is reporting overweight kids as saying “my government made me fat”?

The most commonly asked question on www.weigh2rock.com and www.blubberbuster.com is, unsurprisingly, how do I lose weight? There are the usual platitudes about ‘eat less/do more’, which the site would do well to counter and provide evidence for the futility of this route. Since Benedict, 1917, through Keys, 1945, and Stunkard and McLaren-Hume, 1959, to the most recent definitive study that I have seen – Franz et al 2007, all evidence confirms that ‘eat less/do more’ does not achieve sustained weight loss. Stunkard & McLaren-Hume quantified the failure rate as 98% – a statistic we often hear today and may not know from whence it came. What can work is eating better, eating what we ate before we had an obesity epidemic, eating the food provided by nature that we have evolved to eat.

I was encouraged by the number of children who had worked out the right advice for themselves – cut out the junk and stop snacking were tips that will have a significant positive impact. There were also some excellent tips for dealing with cravings and the support that kids get from each other in the site will undoubtedly help.

Dr Pretlow addresses the very real issue of food addiction – a topic that has also been a key area of interest for me. I was very pleased to see Pretlow exploring ways in which kids could eliminate the foods to which they are addicted from their diet. 68% of the respondents to one survey reported feeling addicted to food and 66% feeling out of control with food. My only surprise was that these figures were not in the 90% range. People cannot be addicts in moderation. We should no more advise food addicts to eat sugary processed food in moderation than we should tell alcoholics to drink in moderation. We need to start treating food addiction for what it is – a serious addiction with serious consequences. The work that the sites do in this area is invaluable.

This is a unique and important book. I have not before seen so many comments from so many young people about so many different aspects of one issue – their weight. We adults need to take responsibility for the part we have played in making our children overweight – starting with dieticians, who are little more than sales reps for the food and drink industry and whose professional body is sponsored by a who’s who of the food industry.

Even in this area, the children have clear views as to who should help them. 74% want an advisor who was overweight, but isn’t now. Only 5% want an advisor who has never been overweight.  Whether we have been overweight or not, whether young people can relate to us or not, we can all play our part. We can read this book, hear what young people are saying and do anything and everything we can to stop this horrific (childhood) obesity epidemic. For my part that means campaigning for a return to real food and a condemnation of the processed food that made us fat and sick. What will your part be?

The sub heading is “Wake up call for 5m Britons as diabetes toll also soars.”

When will public health advisors realise that we started this obesity epidemic? When will public health advisors realise that we started this diabetes epidemic?

Since Australopithecus Lucy first walked upright, an estimated 3.5 million years ago, we have eaten food provided by mother nature. For much of that time our main energy intake has necessarily come from animals and their by products (during the ice age this is all that our ancestors would have had; during much of the rest of our evolution animals – especially their fat – would have provided our much needed calories. Nuts, when available, would have been very useful also).

Look at the evidence – in the UK obesity didn’t rise above 2% since time began until the 1970′s. Obesity rates for men and women in the UK were 2.7% in 1972. They had reached 25% by the end of the millennium. So what happened to cause such a catastrophic change in obesity rates? We changed our diet advice. The USA changed in 1977-1980 and the UK followed suit in 1983-84. Obesity has increased up to 10 fold since. You may think that is just a coincidence – I don’t.

We used to know that floury foods were fattening and sugary foods even more so. We now tell people to base their meals on starchy foods. The average Briton eats 400 calories a day of sugar – with no vitamins and minerals of any value whatsoever. The average Briton eats 730 calories a day of flour – with so little nutrition that it is invariably fortified. We are just doing what we have been told to do – basing our meals on starchy food; following the Eatbadly plate advice (I refuse to call it Eatwell because it’s not).

That sub heading – this is a wake up call for 5m Britons. Boy I hope that it isn’t! The only hope Britons have is if they have ignored the dietary advice of the past 25-30 years and they have carried on eating real food, as mum and granny told them to: liver, sardines, eggs, milk, vegetables with butter on etc. Those who are avoiding real food and eating processed food; those who are avoiding fat and eating fattening carbohydrate instead – these people will continue to get fatter and fatter until someone sues the government for making them fat and we realise the horrors of the ‘experiment’ we have done with the ‘developed world’ since the turn of the 1980′s.

Who stands to gain if you think eggs (one of the most nutritious foods on the planet) are bad for you? (Kellogg’s and other cereal manufacturers).

Who stands to gain if you think butter (another wonderfully nutritious food) is bad for you? (Unilever and other margarine and spread manufacturers).

Who stands to gain if you follow the mad advice to snack/eat little and often (the best way to store fat and stay fat) all day long? (Kellogg’s, United Biscuits, makers of snack foods).

Who sponsors the British Nutrition Foundation? Kellogg’s, Unilever, United Biscuits, makers of snack foods and many, many more.

Who stands to gain if you eat what nature has provided for you? No processed food or drink company that’s for sure. No drug company – because you will be healthy. You stand to gain and you need to take charge of your own health and not trust dietary advisors who are conflicted.

If you want to know the full story behind The Obesity Epidemic: What caused it? How can we stop it? – click here.

As for diabetes – diabetes is a condition characterised by the malfunction of the pancreas and blood sugar handling system. In simple terms, type 1 diabetes is characterised by the pancreas no longer producing insulin, so the person needs to administer insulin in some way (usually injection). Type 2 diabetes is often called “insulin resistance”. Some insulin is still produced by the pancreas, but rarely the right amount, as the body has become resistant to insulin and the cells don’t respond to insulin as they should. Both types of diabetes are all about carbohydrates – the macro nutrient we didn’t used to eat much of and are now told to base our meals on, to snack on, to (basically) eat all the time. Our bodies are literally saying “enough is enough”. I can’t cope with this high quantity or low quality of carbohydrate any more – “I, your pancreas, am packing up”. Hence we now have 171 million diabetics world wide – a figure set to rise to 366 million by 2030. 95% of diabetics are type 2 – all pretty much avoidable if we went back to eating food – real food – and not the processed junk that food processing companies make so much money from.

Then you have Simon O’Neill, from Diabetes UK, saying “we must keep up the mantra of five fruit and veg a day”! More conflict of interest. Five a day was invented by a bunch (ha ha) of fruit and veg companies in California in 1991. Dieticians, nutritionists and now a spokesperson from Diabetes UK are sales reps for the fruit and veg industry. Diabetics should be eating low carb veg (green leafy vegetables, peppers, salads etc) but being very cautious about baked potatoes and fruit – especially tropical fruits. It’s more carbohydrate – it turns into glucose and fructose in the body as if we had eaten sucrose (table sugar – which is one molecule of glucose and one of fructose).

If we are serious about sorting obesity AND diabetes at the same time, we must stop our current diet advice madness and stop telling people to eat carbs virtually every waking minute. Meat, fish, eggs, vegetables (not potatoes), salads and dairy products should be our staples and whole grains, baked potatoes and fruit only if we are slim and not diabetic.