The advert (three minutes and 10 seconds long) is fronted by Alesha Dixon who has never had a weight problem in her life, but wrote the song for the advert. The cost of the New Year’s Day ad alone is estimated to be £15 million – to make the advert and to air it.

I open my book “The Obesity Epidemic: What caused it? How can we stop it?” with the following passage:

“In a study of formerly obese people, researchers at the University of Florida found that virtually all said that they would rather be blind, deaf or have a leg amputated than be obese again (Ref 1). That is the extent of our desire to be slim and yet two thirds of people in the UK, USA and Australia are overweight and one quarter obese. Why?”

People do so desperately want to be slim and I would encourage people to try anything (safe and healthy) that will work. However, the evidence does not support the claim that calorie deficit diets work. Indeed we have known the following since Stunkard and Hume quantified the failure rate in 1959:

“Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it.” Stunkard and McLaren-Hume’s own statistical study showed that only 12% of obese patients lost 20 pounds, despite having stones to lose, only one person in 100 lost 40 pounds and, two years later, only 2% of patients had maintained a 20 pound weight loss. This is where the often quoted “98% of diets fail” derives from. (Ref 2)

The Mail article about the New Year’s Day advert ends with this sentence: “The company launched its ProPoints weight-loss plan last year and in just 12 months its one million members in the UK have lost more than 11million pounds between them.” The maths is easy – one million members losing c. 11 million pounds between them means an average 11 pounds per member – in one year.

The famous calorie formula (which I show to be wrong at every level here and here) claims that, if we create a deficit of 1,000 calories a day (which is approximately the goal with Weight Watchers) we should lose 2lbs per week (7*1,000 = 2*3,500). And – that should be fat lost alone. More should be lost on top in water and, sadly, lean tissue/muscle. Hence, the precise weight loss for every single person, who stuck to weight watchers for the year before this advert, should be 104lbs in fat and approximately 15% more in water/lean tissue – i.e. 120lbs in weight. The actual weight loss was 11lbs per person – less than one tenth of what ‘should’ have happened.

This 11lb number keeps popping up. In a study funded by Weight Watchers and conducted (appallingly in my view) by a government body – The Medical Research Council (MRC) – it was found (for a fee of “almost £1 million” Ref 3) that dieters doing Weight Watchers lost an average of 11lbs in a year. (The link to the blog gives full details of this study and links to the original data from the MRC study).

When I wrote to seven UK government and obesity organisations (National Institute of Clinical Excellence (NICE), National Health Service, Department of Health, National Obesity Forum, Association for the Study of Obesity, British Dietetic Association and Dieticians in Obesity Management) asking from whence the calorie formula came (the 3,500 theory) and asking for proof that it was true, the only study that was sent back to me was this one:

The NICE document Management of obesity: Full Guidance, December 2006 was offered as proof of the formula. Table 15.14 in this document contains results of one study of 12 people, given a deficit of 600 calories a day, where the outcome was “a change of approximately -5 kg (95% CI -5.86kg to -4.75kg, range -0.40 kg to -7.80 kg) compared with usual care at 12 months. Median weight change across all studies was approximately -4.6 kg (range -0.60 kg to -7.20 kg) for a 600 kcal deficit diet or low-fat diet and +0.60 kg (range +2.40 kg to -1.30kg) for usual care”.

So, let me understand this, the people on the 600 calorie-a-day deficit (the NICE recommendation) were 5 kilograms (11 pounds) lighter than those not doing this “at 12 months.” Applying the basic maths formula, these 12 people should each have lost 600*365/3,500 = 62.57 pounds of fat. Not an ounce (of fat) more or less. AND, there should have been no range of results – everyone should have lost exactly the same (that’s what happens with a mathematical formula). The least anyone lost (let’s put it all into pounds) was 0.8 pounds and the most anyone lost was 17.2 pounds. Even the highest weight loss was 45 pounds lower than it should have been. This is also all about fat – we haven’t even started looking at muscle or water loss. This is also a study of 12 people. There are 1.5 billion overweight people in the world and we can’t prove a formula using 12 of them.

The other bit that the advert won’t tell you is the well documented regain with calorie deficit diets – the 98% failure rate – known about for at least 50 years. In the Weight Watchers funded study – the press release omitted to mention that regain was starting to show at approximately 9 months (see slide 8).

There is an excellent and exceptionally useful review presented in the Journal of the American Dietetic Association (2007). (Ref 4)  Marion Franz and seven colleagues performed a systematic review of 80 weight loss studies, grouped into eight different categories, including only those trials with a one-year follow-up. The studies were all from the period January 1997 and September 2004. 26,455 participants were enrolled in the studies. At the one-year follow-up, the attrition rate was 29% across the studies. Overall attrition was 31% at study end regardless of follow-up timing. The graph of results is shown in this thread in our club here. Notice, again, the regain at 6-9 months in all calorie deficit methods (the post explains the anomaly for the now withdrawn Sibutramine – the dark brown line).

Hence the evidence confirms that you are most likely to lose less than a tenth of what you expect – less than a pound a month over time, not 2lbs a week. You are also highly likely to start regaining at around six months. My book “Stop Counting Calories & Start Losing Weight” explains why.

If you have been doing calorie deficit diets (Weight Watchers, Slimming World, Rosemary Conley etc) for some time and are either a) not at your natural weight or b) one of the ‘lucky’ 2%, but finding you have to starve and obsess about food to stay there – you need to try something different. There is a way to lose weight and keep it off, without cravings or hunger and without feeling deprived. It is super healthy – focused on giving you optimum nutrition and no empty calories/processed food. You will understand why you have craved food in the past and how to ensure that you never do so again.

If you’ve been doing calorie deficit diets for some time and are not where you want to be and are planning to continue – you are mad! The definition of madness is doing the same thing again and expecting a different result. Come and see what the people losing weight and keeping it off are doing – it’s called The Harcombe Diet. Oh, and by the way, you have a good chance of losing 11lb in the first week or two and going on to lose a lot more and keeping it off.

References:

Ref 1: Colleen S.W. Rand and Alex M. C. Macgregor, “Successful weight loss following obesity surgery and the perceived liability of morbid obesity”, International Journal of Obesity, (1991). (The study results are presented in the summary of this book).

Ref 2: Stunkard A. and M. McLaren-Hume, “The results of treatment for obesity: a review of the literature and report of a series”, Archives of Internal Medicine, (1959).

Ref 3: http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/article359154.ece The Sunday Times 1 August 2010.

Ref 4: Marion J. Franz, Jeffrey J. VanWormer, A. Lauren Crain, Jackie L. Boucher, Trina Histon, William Caplan, Jill Bowman, Nicolas Pronk. “Weight Loss Outcomes: A Systematic Review and Meta-Analysis of Weight Loss Clinical Trials with a Minimum 1-Year Follow-Up”, Journal of the American Dietetic Association, (2007).

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).

Such a progressive move by Denmark has been followed by the astonishingly regressive move – adopted in October 2011 – to tax foods containing a certain level of saturated fat. The magic number has randomly been set at 2.3% – foods above this level of saturated fat (by weight) will be taxed at the rate of 16 Danish Kroner per kilogram of saturated fat.

Time Magazine helpfully gave us some examples of what this will mean for standard food items: On October 1st “The average price of a half-pound package of butter increased by 2.5 krone (or 45 U.S. cents). A pound of cheese rose from 34.5 krone ($6) to 36 krone ($6.50). And don’t even think about lard. In a single day, the cost of a half-pound block of pork fat skyrocketed from 12 krone ($2.15) to 16 krone ($2.85) — a 35% increase.”

What are fats?

Fats, commonly known as lipids, consist of a wide group of organic substances that are not soluble in water. In simple terms, fats are chains of carbon atoms (chemical symbol C) with hydrogen atoms attached (chemical symbol H) and they have a COOH group at one end (carbon, oxygen, oxygen and hydrogen). There are two groups of fats in which we have a nutritional interest – saturated and unsaturated. Within the unsaturated category, there are two further types – monounsaturated and polyunsaturated fats.

Saturated fats are the most stable fats (this is merely a statement about chemical structure). They have all available carbon bonds filled with (i.e. saturated with) hydrogen. Saturated fats are solid at room temperature. Interestingly, when our glycogen (storage form of glucose) capacity is full, the liver turns the excess glucose (from carbohydrates) into fat in the liver and it turns it into saturated fat. If saturated fat is bad for us, this could be the first example of the human body, in normal circumstances, trying to kill itself. Breast milk is also high in saturated fat, so did evolution also design us to kill our offspring? I have my own views on this; I’ll let you develop yours.

Unsaturated fats, quite simply, have pairs of hydrogen atoms missing. Monounsaturated fats have one double bond in the form of two carbon atoms ‘double-bonded’ to each other and, therefore, lack two hydrogen atoms. Mono means one and hence, with monounsaturated fat, there is one double bond. Monounsaturated fats tend to be liquid at room temperature (but solid at fridge temperature) and are the next most stable fat. The best known monounsaturated fat is oleic acid, the main component of olive oil. Oleic acid is also found in the oils from almonds, pecans, cashews, peanuts and avocados.

On the web site “margarine.org.uk” (described on the site as “the mouthpiece of the margarine and spreads industry”), unsaturated fats are described as follows: “In unsaturated fats, some of the carbon atoms are joined to others by a double bond and, therefore, could accept more hydrogen atoms.”[i] They could accept more hydrogen atoms. Isn’t that just a wonderful way of saying they are missing some hydrogen atoms (and are therefore less stable)?

Normally poly means many, but, in the case of polyunsaturated fat, it can mean only two. Polyunsaturated fats have two or more pairs of double bonds and, therefore, lack four or more hydrogen atoms. Polyunsaturated fats are liquid at room and fridge temperature. The two polyunsaturated fats found most frequently in our food are double unsaturated linoleic acid, with two double bonds, also called omega-6; and triple unsaturated alpha-linolenic acid, with three double bonds, also called omega-3. (The omega number indicates the position of the first double bond. If the double bond is three carbon atoms along from the right hand end, this is an omega-3 fat. If it is six carbon atoms from the right hand end, this is an omega-6 fat. The logic comes from the Greek alphabet, which goes from Alpha to Omega – like we go from A to Z). Omega-3 and omega-6 fats are called “Essential Fatty Acids” because the body cannot make them, so it is essential that they are consumed.

It is not widely known that all fats and oils, whether of vegetable or animal origin, are a combination of saturated, monounsaturated and polyunsaturated fat. Coconut oil has the highest saturated fat content of all foods at 92% saturated, 6% monounsaturated and 2% polyunsaturated. Lard is 41% saturated, 47% monounsaturated and 12% polyunsaturated. Olive oil is 14% saturated fat, 75% monounsaturated and 11% polyunsaturated. The above are 100% fats, so we can usefully compare their composition as percentages. Butter has a significant water content and a trace of protein, so 100 grams of butter has 51 grams of saturated fat, 21 grams of monounsaturated fat and 3 grams of polyunsaturated fat.[ii]

We simply cannot eat “saturated fat” – no such food exists in isolation in nature. A healthy human, who only eats real food as provided by nature can only reduce intake of saturated fat by reducing intake of all fats. An unhealthy human, who eats things that man makes, can reduce saturated fat intake and have this artificially ‘replaced’ by man-mad Franken-fats and/or carbohydrates – both substantially worse for us than nature’s real fats.

The role of Fat

Fat is utterly vital for human health – dietary fats serve four key purposes:

1)  They provide the essential fatty acids (EFA’s);

2)  They are the carriers of the fat soluble vitamins A, D, E and K;

3)  They supply the most concentrated form of energy in our diets;

4)  They help make our diets palatable. Food with little or no fat can be quite tasteless and sometimes difficult to digest.

Fats are crucial for every aspect of our wellbeing as they form the membrane (protective wall) that surrounds every cell in our bodies. Excluding water, our brains are approximately 60% fat (lipids in fact, including cholesterol).[iii] Fats also play a crucial role in cushioning vital organs, as some people have tragically found out when fat (and lean tissue) has been lost suddenly on a very low calorie diet. Put simply, with the right fats and enough of them our cells are strong, without them they are weak and prone to attack.

Let us look at these four key roles in more detail.

1)  Starting with the EFA’s, good sources of the essential fats are as follows: omega-6 is provided by meat, eggs, avocado, nuts, whole grains and seeds and their oils (sunflower seeds, rapeseeds and pumpkin seeds as common examples). Omega-3 is found in meat, fish and fish oils – salmon, halibut, shark and swordfish being particularly valuable sources.

Omega-6 deficiency may cause: growth retardation; eczema-like skin conditions; behavioural disturbances; arthritis-like conditions; liver and kidney degeneration; excessive water loss through the skin accompanied by thirst; drying up of glands; susceptibility to infections; wounds fail to heal; sterility in males; miscarriage in females; heart and circulatory problems; dry skin and hair; dry eyes and hair loss.

Omega-3 deficiency may cause: growth retardation; dry skin; behavioural disturbances, tingling sensations in arms and legs; weakness; impairment of vision and learning ability; high blood pressure; sticky platelets; tissue inflammation; mental deterioration and low metabolic rate.

Both lists present a compelling case for ensuring adequate consumption of essential fats.

2)  Moving on to the four fat soluble vitamins – A, D, E and K. (We can become blasé about the role of vitamins and minerals in the body. It may be interesting to read the following lists with the mindset – would you personally like to have any, or all, of the following functions impaired and can you be sure that you eat the foods necessary to deliver these vital nutrients?)

-    Vitamin A has many functions within the body. It is needed for our sight, cell function, skin, bones, growth, reproduction, blood formation and to fight infection. Vitamin A is particularly important for pregnant women and growing children. Deficiency in vitamin A can lead to: sight conditions generally and night blindness particularly; growth and reproductive impairment; increased susceptibility to infections; and rough, dry, scaly skin. Retinol is the pure form of vitamin A – the form used most easily and readily by the body. This makes for a memorable connection between retinol, the retina of the eye and the role vitamin A plays in sight.

There is much debate as to whether plants can provide adequate vitamin A, or whether it needs to be consumed in an animal product. We can say the following with certainty: a) only animal products contain retinol; b) plant sources of vitamin A come in the form of carotene, which requires conversion within the body into retinol; c) even with Beta-carotene, the carotene most easily converted into retinol, there is substantial loss such that the conversion ratio is at best 6:1 (“The accepted 6:1 equivalency of beta-carotene to preformed vitamin A must be challenged and re-examined in the context of dietary plants”);[iv] d) not every person is capable of converting carotene to retinol “Diabetics and those with poor thyroid function cannot make the conversion. Children make the conversion very poorly and infants not at all”[v] and e) carotenes are converted by the action of bile salts and very little bile reaches the intestine when a meal is low in fat. Our grandparents put butter on their vegetables for good reason. We can confidently assert, therefore, that animal food generally, and liver particularly, are the best sources of vitamin A.

-    Vitamin D is critical for the absorption of calcium and phosphorus. Vitamin D is increasingly being studied in nutritional journals and its possible role in cancer prevention is being explored. Deficiency in vitamin D can lead to tooth decay, muscular weakness and a softening of the bones (rickets), which can cause bone fractures or poor healing of fractures.

Vitamin D is found naturally in oily fish (for example herring, halibut, catfish, salmon, mackerel and sardines) and unnaturally in fortified breakfast cereals. Vegetarians would need to eat 26 medium eggs each day (1,634 calories) to get 10 micrograms of vitamin D – considered an “adequate intake”. 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 10 micrograms 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.

-    Vitamin E is a generic term for a family of fat soluble vitamins active throughout the body. We are learning more about the different forms of vitamin E and more of them are being found to have unique functions. The key role of vitamin E is as an antioxidant. The oxygen that we need to breathe can make molecules overly reactive and this can damage cell structure. This imbalanced situation involving oxygen is called oxidative stress. Vitamin E helps prevent oxidative stress by working together with a group of nutrients (including vitamins B3, C and selenium) to prevent oxygen molecules from becoming too reactive. Vitamin E protects the skin (cells) in much the same way as it protects other cells. We hear little about the possible heart protection role of vitamin E, yet it acts as an anti-blood clotting agent and it maintains healthy blood vessels.

Deficiency in vitamin E can lead to dry skin, poor muscular and circulatory function, damage to red blood cells and blood vessels and an inability of the white blood cells to resist infection.

Vitamin E is found naturally in seeds, nuts and oils that derive from these. Hence, we don’t need to eat animal foods to obtain vitamin E, but we do need to consume fats. Sunflower seeds are one of the best sources of vitamin E and they have 51 grams of fat per 100 grams of product.

-    Vitamin K has a number of important functions, such as its role in blood clotting and wound healing. Vitamin K is very important for the health of our gut and it is being destroyed with the high modern consumption of anti-biotics, leaving humans prone to imbalance in the gut flora and concomitant illness. Deficiency in vitamin K complicates blood clotting and can manifest itself in nose bleeds, bleeding gums, heavy menstruation or even blood in the urine or stools. A propensity to bruise can also be a sign of vitamin K deficiency.

Vitamin K comes in two forms: K1 and K2. K1 is found in plants, green leafy vegetables particularly, and is also called phylloquinone. Vitamin K2 is found in animal foods. K2 is also known as menaquinone and comes in different forms – MK-4 through to MK-10 (the ‘MK’ comes from a phonetic abbreviation of MenaKwinone). Meat is a primary source of MK-4. Eggs and calcium rich hard cheese are particularly good sources of MK-7, 8 and 9. The Rotterdam Study[vi] concluded: “Intake of menaquinone was inversely related to all-cause mortality and severe aortic calcification. Phylloquinone intake was not related to any of the outcomes. These findings suggest that an adequate intake of menaquinone could be important for CHD prevention.” I share this as another example of the animal form of fat soluble vitamins being the most useful – in the context of current public health advice steering us away from these nutritious foods.

3)  The fact that fat supplies the most concentrated form of energy in our diets is used against this macronutrient in today’s modern, obese environment. It is argued in our calorie obsessed world that we should avoid fat because of its calorie content. There are two ironies here:

a) Man would not be here today without the energy supplied by fat (predominantly from animals, but also from nuts) during evolution and particularly during the ice age and in regions of the earth where vegetation was not available. At 80-90% water and containing only approximately four calories per gram, humans would simply not have been able to get enough vegetation to survive. (If any ancient berry approximated to, say, a wild strawberry in nutritional content, Neanderthals would have needed over three kilograms of berries to provide 1,000 calories).

b)  The second irony is that fat cannot make us fat – only carbohydrate can do this. The glycerol backbone, which turns fat particles into a triglyceride (the form in which adipose tissue is stored), is produced in the presence of glucose and insulin – the environment created following the consumption of carbohydrate.

4) In this carbohydrate consuming/calorie avoiding world, we have lost the awareness of the palatability and unique satiety of fat. 100 grams of a well known brand of cereal, marketed to slimmers, contains rice, wheat (whole wheat, wheat flour), sugar, wheat gluten, defatted wheat germ, dried skimmed milk, salt, barley malt flavouring, and a number of added vitamins to give the product nutritional value. This brand has 76 grams of carbohydrate and 379 calories per 100 grams of product. Most people could eat 100 grams of this with relative ease. (I work with people who commonly binge on cereal). Try to eat 300 grams of “pork chop, boneless, raw lean and fat” – calculated by the USDA database as having slightly fewer calories than the cereal and no carbohydrate content. It will be substantially more filling, and therefore more difficult, to eat the meat than the cereal.

What Denmark now needs to tax

So, Denmark has started down the road of destroying human health. People who eat real food will be penalised for all fat consumption, as they cannot reduce saturated fat consumption in isolation. People who eat fake food will be able to increase their consumption of man-made, bleached, deodorised and emulsified alternatives to real fats and/or their consumption of fattening carbohydrates.

However, I wonder if Denmark knows which foods contain more than 2.3% saturated fat?

From the extremely useful United States Department of Agriculture -all-foods database, we can find the following:

Meat

- Beef, Porterhouse steak, raw, trimmed to 1/8″ fat (USDA reference = URMIS 2145) will be taxed; Beef, Sirloin, lean only (URMIS 2244) won’t be. Hence humans will be encouraged to eat an unnaturally high ratio of protein to fat – taxing (excuse the pun) the liver and our vitamin A requirement further.

- Pork chop, boneless, raw, lean and fat escapes tax with 1.5% saturated fat. However, Pork, fresh, loin, top loin (chops), boneless, separable lean and fat, raw [America's cut chops, Pork top loin chops, Strip loin chops, URMIS #3369] will be taxed at 2.5% saturated fat. Again – the fact that pork has far more unsaturated than saturated fat seems to have escaped the wisdom of Danish-powers-that-be. Somewhat amusingly, the notoriously ‘low fat’ meat, favoured by fat phobics, venison, will be taxed: Venison, game meat, deer, ground, raw has 3.4 grams of saturated fat per 100 grams of product. Interestingly, venison is the only meat thus far that I have been able to find with more saturated than unsaturated fat. Not that one fat is better or worse than the other – all real fats are vital – but just to dispel nonsense that we have been told.

Fish

- Fish – that ‘heart healthy’ oily fish, which we are encouraged to eat – will likely be taxed. The less nutritious white fish likely won’t be. Mackerel has almost twice the saturated fat of our boneless pork chop above. Again – the polyunsaturated fat ‘darling’ of dietitians will suffer for being in the same food as something with more than 2.3% saturated fat content. Damn nature for putting all the fats in all the foods!

Eggs

- Eggs, although only one third saturated fat and with the main fat being that so-called super fat “mono-unsaturated” – will be taxed. That’s a tax on a product containing omega-3 and omega-6, complete protein and a phenomenal range of vitamins and minerals – the closest a vegetarian will get to a super-food.

Dairy products

- Cheese, with the vital vitamins A and D (the UK currently gets approximately 50% of the minimum vitamin A requirement and barely 25% of the paltry vitamin D requirement) and an abundance of the crucial minerals calcium and phosphorus, as well as zinc, will be taxed heavily. That’s osteoporosis set to continue its relentless rise and rickets in children set to continue.

- Milk – if you want the fat-free nonsense, with the delivery mechanism for the fat soluble vitamins removed – no tax. If you want the ‘full fat’ version (still only c. 3-4% total fat) the saturated fat content could get close. Those dairy farmers had better to be able to measure this one to the gram or ml – it’s going to be touch and go!

Nuts, Seeds & Fruit

- Sunflower seeds will be taxed, at 4.5 grams of saturated fat per 100 grams of seeds. The 18.5 grams of monounsaturated fat and the 23.1 grams of polyunsaturated fat in sunflower seeds get ‘taxed’ indirectly by association. At a whopping 33mg of vitamin E per 100 grams of product, sunflower seeds are unbeatable for vitamin E. This is the body’s natural anti-oxidant, so we are taxing a unique natural anti-oxidant that would help with heart and blood health.

- Any nuts – prepare to pay highly for the natural fats and terrific amounts of nutrients in nature’s gold nuggets in a shell.

- Avocado just escapes at 2.1% saturated fat. Olives are also dangerously close at 2% saturated fat.

Real fats

Butter is not the only real fat that will be taxed. That ‘superfood’ of the Mediterranean diet, olive oil, is 14% saturated fat – 9 times that of our boneless pork chop. That will get a hefty fine on its claimed healthful benefits. Sunflower oil ditto. Lard, mostly unsaturated fat (60% infact – not many people know that) will also get clouted, despite this being (like butter) one of the most stable, and therefore safe, fats to cook with.

I think that’s covered real foods – meat, fish, eggs, dairy products, nuts, seeds & fruit and real fats. Vegetables and sugary fruits are the only real foods to escape this Danish madness. I have deliberately not mentioned any manufactured foods because I couldn’t care less about any of them. Tax them out of reach. Heck – ban the horrors – but don’t attack nature’s real foods when the real culprits are those made by man.

A final thought

My passion is obesity. All I care about is how we can reverse this horrific epidemic that we inflicted on our fellow humans. I am convinced that our change in dietary advice (USA 1977 and UK 1983) was responsible for the concomitant obesity epidemic.

I open my book The Obesity Epidemic: What caused it? How can we stop it? with the following quote from the UK document (Proposals for nutritional guidelines for Health Education in Britain (1983))

“The previous nutritional advice in the UK to limit the intake of all carbohydrates as a means of weight control now runs counter to current thinking and contrary to the present proposals for a nutrition education policy for the population as a whole… The problem then becomes one of achieving both a reduction in fat intake to 30% of total energy and a fall in saturated fatty acid intake to 10%.”

And so started the obesity epidemic…

The data in the UK National Food Survey is extremely comprehensive, to the point of including detail on both macro and micronutrients. The information on macronutrients says that we consumed 51.7 grams per person per day of saturated fat in 1975 and 28.1 grams in 1999. The food examples in the data tables support this – all fat, butter, meat, whole milk and eggs – real foods and sources of saturated fat – are down. Dramatically in some cases – we eat half the number of eggs that we used to and one fifth of the butter and whole milk.

During the time, in which we all but halved saturated fat intake in the UK, obesity increased from 2.7% for men and women in 1972 to 22.6% for men and 25.8% for women in 1999.

Fat doesn’t make us fat – only carbs can do that. Theoretically, biochemically and empirically, the evidence is irrefutable. Although not to the Danes apparently. They have shown themselves to be a few rashers short of a packet.

[i] http://www.margarine.org.uk/whatisfat-types.html#unsaturated

[ii] United States Department of Agriculture nutritional database. www.nutritiondata.com

[iii] McIlwain, H. and Bachelard, H.S., Biochemistry and the Central Nervous System, Edinburgh: Churchill Livingstone, (1985). Estimates the composition of the brain to be (approximately) 78% water, 10-12% lipids, 8% protein, 2% soluble organic substances, 1% carbohydrate and 1% inorganic salts.

[iv] Solomons, N. W. and J. Bulux. “Plant sources of provitamin A and human nutriture.” Nutrition Review, July 1993.

[v] Sally Fallon and Mary G. Enig, “Vitamin A”, (March 2002).

[vi] Geleijnse JM, Vermeer C, Grobbee DE, Schurgers LJ, Knapen MH, van der Meer IM, Hofman A, Witteman JC, “Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study”, The Journal of Nutrition, (November 2004).

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!

Let’s start with the positive:

1) It’s much easier to understand that the current American Food Pyramid (2005):

This was so complicated (and seemingly needed to be individually tailored), that many people just carried on using the old American Food Pyramid (below – introduced 1992), which directed Americans to have: 6-11 grain portions a day; 2-4 fruit portions; 3-5 vegetable portions; 2-3 dairy servings and 2-3 meat/egg/fish/bean/nuts/egg servings per day. Hence Americans could have 26 portions of food a day – all having an impact on blood glucose levels. And we wonder why America led the world in getting fat and sick.

MyPlate is served with some advice, as a side dish

Here is the accompanying dietary advice in black; my comments in red alongside:

Balancing Calories
●     Enjoy your food, but eat less. (Less than what? An anorexic? Less than you are eating now? Less than you need for health?)
●     Avoid oversized portions. (Requires too much judgement to be useful advice – what is oversized to you may not be to me or vice versa. Plus – it is very difficult to ‘overeat’ real food – organic meat/fish/eggs/veg – it is very easy to ‘overeat’ processed food. Hence nature sorts out portion sizes for us)

Foods to Increase
●     Make half your plate fruits and vegetables. (i.e. Fructose & glucose & glucose).
●     Make at least half your grains whole grains. (there is debate on this in the informed nutritional world – whole grains have more nutrients than white grains (still far fewer than quality meat/fish/eggs), but white grains are less abrasive than whole grains and therefore less likely to cause irritable bowel syndrome or bowel cancer. It’s all glucose to the body either way).
●     Switch to fat-free or low-fat (1%) milk. (The UK is deficient in vitamins A, D, E and our government doesn’t bother recording vitamin K in the National Food Survey, but no doubt we are deficient in all four fat soluble vitamins. I doubt that the USA is any better, so we would be well advised to consume real fats in real food – like milk from ruminants freely living on grass. Nature sensibly puts real fat with real fat soluble vitamins in real food. Man stupidly takes them out).

Foods to Reduce
●     Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers. (Don’t eat anything processed).
●     Drink water instead of sugary drinks.  (Good advice. Better still “Don’t drink anything processed”).

So the new MyPlate is simpler, but does this make it any better… Here are my key concerns for America’s national (public) health and for the nutritional advice in this new model…

Three national health concerns about MyPlate

1) This will do nothing to solve the obesity epidemic.

I have written 135,000 words on The Obesity Epidemic: What caused it? How can we stop it? In a nutshell we changed our diet advice (America in 1977-1980 and the UK followed suit in 1980-1983) and obesity has increased 10 fold since in the UK; America started from a slightly higher base, so has ‘only’ increased by a few multiples and not 10! We changed our advice away from “Farinaceous and vegetable foods are fattening, and saccharine matters are especially so” (Tanner, The Practice of Medicine, 1869) to “Base your meals on starchy foods.” This has had catastrophic consequences for human weight and health and cataclysmic benefit for the food, drink and drug industries, which profit from us being fat and sick.

MyPlate will do nothing to change this. It is still telling humans to “Base your meals on starchy foods” instead of realising, as we did for the 3.5 million years before the last 30 years of ‘conventional wisdom’, that carbs are uniquely fattening (and unnecessary for human health). Grains are just glucose, fruit is fructose and glucose (a particularly uniquely fattening combination – the same as sucrose – table sugar), vegetable are glucose (potatoes and starchy vegetables especially so) and dairy (processed yoghurts) and protein foods (beans etc) chosen can also have a carbohydrate content.

2) This will do nothing to solve the nutritional crisis.

We seem to have forgotten why we eat. We eat because there are 13 vitamins and c.16 minerals vital for human existence, let alone health and well being. All the plates and pyramids are obsessed with macro nutrients (fat, protein, carbohydrate); they seem to have forgotten mico nutrients (vitamins & minerals) entirely. Remember that slogan “Take care of the pennies/cents and the pounds/dollars look after themselves”? This applies nicely to nutrition. “Take care of the vitamins and minerals and the fats, protein and carbs will look after themselves.”

Our dietary advice should start from – how do we get our vitamins and minerals (notwithstanding that the concepts of “Recommended Dietary Allowance” (RDA), let alone “Adequate Intake” (AI) are a joke – as Sally Fallon Morell says “Why am I only allowed a certain  level of nutrition?”!) I did just this in my book The Obesity Epidemic. I’ve put three examples (for omnivores, vegetarians and vegans) as an Appendix to this post.

MyPlate will do little to nothing to improve the health of the American nation. We should be telling people to base their meals on meat and eggs from animals freely grazing on grass; fish and vegetables/salads. Quality dairy (again – only products from grass living animals are worth consuming), nuts & seeds (in moderation if overweight) and local, seasonal fruits (in moderation if overweight) are useful additions to the meat/fish/egg/veg base. Almost half the plate is taken up by fruits and grains – high glucose/low nutrition relative to meat/fish & eggs. No attention is given to the quality of food (other than the emphasis on whole grains, which is debatable (see red notes above)). The importance of eating animals that have predigested cellulose for us (arguably their role in the circle of life, along with fertilising the soil without needing oil) is not addressed. The epidemic of (type 2) diabetes will continue unabated with this level of carbohydrate intake.

3) The food industry will still love this.

The food industry, in fact, wasted no time in saying how much they loved it. Kellogg’s and General Mills (sponsors of the American Dietetic Association) (ADA) will love that grain segment – that’s cereals for breakfast then. Unilever and CoroWise (more  ADA sponsors) should be happy – dietitians will be telling people to put hydrogentated spreads on their copious amounts of bread – certainly not that natural butter product. The dairy industry (another ADA sponsor) will be very happy – they’ve got their own little segment all to themselves. When chips and potatoes count as veg, the fast food companies will be happy (Aramark – the ‘dining away from home’ ADA sponsor – should be happy anyway). Plus, no one is really going to opt for water instead of phenomenally promoted Coca-cola & Pepsi (not least when these are also ADA sponsors and therefore able to convince dietitians of the marvel of calorie-free, aspartame-laden, fizzy concoctions).

Here’s how it works for the fast food industry: Burger (protein), bun (grains), fries (vegetables), tomato slice (fruit), lettuce leaf & gherkin (more vegetables), strawberry milk shake (more fruit & dairy) – the perfect meal!

Anything that the food industry likes is a fail. The food industry would hate my advice – see below!

Three nutritional/technical concerns about MyPlate

1) The USDA appears not to know the difference between a food group and a macro nutrient!

There are 3 macro nutrients: fat, protein and carbs. There are essential fats (i.e. fats we must eat); there are essential proteins (i.e. amino acids we must eat); there are no essential carbs (i.e. there are no carbs that we must eat). Yes the brain does need glucose, but that doesn’t mean that we need to eat it. Indeed, anyone wanting to lose weight should relish in the fact that the brain needs glucose. Don’t eat it and then the body send out a signal to break down body fat to get glycerol/glucose. Result!

MyPlate has 4 food groups: vegetables, fruits, grains and dairy and one macro nutrient – protein! Protein is actually in everything. Literally everything from lettuce to apples to oats to beef. Hence MyPlate has protein in every segment. This is not necessarily a bad thing, but they still don’t know food groups from macro nutrients!

My food groups would be: meat; fish; eggs; dairy; vegetables & salads; nuts & seeds; fruits; beans & pulses and grains. That would make 9 in total. 5 of my food groups – meat; fish; eggs; nuts & seeds and beans & pulses – would end up in the one macro nutrient group on MyPlate – the protein segment. This should be the major part of the plate, not the minor part and the USDA should know a food group from a macro nutrient.

2) The USDA is as fat phobic as ever.

We changed our dietary advice c. 1980 (and started the obesity epidemic in so doing) because we developed this mad idea that fat is going to kill us. 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 saturated fats. These are not saturated fats – not primarily, not even secondarily. They are first processed foods, secondly major sources of carbohydrates and thirdly, almost all then have more unsaturated fat than saturated fat (not that any real fat is better or worse than any other, but these are not real fats, and they are not saturated fats). Don’t eat any of these heaps of junk because they are processed heaps of junk. However, real fats in real food are absolutely vital for human health and we are suffering epidemic levels of deficiencies, in vitamins A and D particularly, in the UK and the USA.

Where is the fat on MyPlate? Where is the quality offal and red meat? the mackerel? the sardines? the quality dairy foods? the real butter? the free range eggs? Where are the vital fats that we need? Emphasizing protein and carbs and not fat is seriously harmful to health. Fats are vital, carbs are not. Protein is vital, but consuming protein in an unnatural balance (without the fat that nature provides naturally alongside) is a rapid route to vitamin A depletion and  liver and other health damage. Ask bodybuilders!

3) MyPlate is a visual guide, which is easy to understand but then falls victim to “The law of unintended consequences”.

MyPlate is clearly intended to be volume guide “Make half your plate fruit and vegetables” is one of the instructions. The UK eatbadly plate may appear to be a visual “this is how your plate should look”, but, when I asked the UK Food Standards Agency where the proportions in their food groups came from (listed below), the answer was based on weight.

33% Starchy foods (bread, potatoes, pasta, cereals etc)
33% Fruit and vegetables
15% Non dairy protein (meat, fish, eggs, beans etc)
12% Milk and Dairy products  
8% Foods high in fat and sugar  (101% due to rounding)

I did another interesting experiment in The Obesity Epidemic: What caused it? How can we stop it? 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; non dairy protein would be 45 grams; there would be 36 grams of milk and dairy and 24 grams of foods high in fat and sugar.

Using a sample of foods from the USDA food database, I estimated the calorie averages for 100 grams of each of these food groups as 333, 42, 188, 183 and 595 respectively.  This would give the estimated calorie values (for each of these weights) of 333, 42, 85, 67 and 144 respectively. If these are then scaled up in proportion for a 2,000 calorie a day diet, the five groups end up with 992, 125, 255, 198 and 430 calories respectively. The numbers will vary for each person’s interpretation of the plate, but you can see how one third of intake in the form of starchy foods can represent half of calorie intake and another third from fruit and vegetables just 6% of energy. The supposedly smallest segment, being so energy dense, can form a perhaps unanticipated 21% of calorie intake.

The same will happen with MyPlate – potatoes and chips as ‘vegetables’ not withstanding, the energy intake (which is what the body registers) for vegetables will be small relative to, say, nutritionally inferior grains.

MyAdvice

This would be my advice by the way:

1) Eat food – we shouldn’t need to call it real food.

2) Eat that real food three times a day – unless you are a cow, or want to be the size of one, stop grazing!

3) If you need to manage your weight, manage your carb intake. Gaining weight is literally defined by the formation of triglyceride (body fat) and this is beautifully facilitated by eating carbs, which provide glucose for the glycerol part of the triglyceride structure and insulin to enable fat storage. Losing weight is literally defined as breaking down triglyceride (body fat) which can happen when the brain wants the glycerol part for glucose or the body wants the fat part for energy/repair. So, weight gain happens in the presence of carbohydrate/glucose/insulin and weight loss happens in the absence of carbohydrate/glucose/insulin.

MyPlate

MyPlate will encourage you to eat 70% of your food intake in a form that contains carbohydrate and allows you to eat 100% in this way. Nothing like what we have been eating for 3.5 million years and nothing like what we need to eat to end the epidemics of being fat and sick.

This is another tragic missed opportunity to do something about the weight and health of Americans. Follow MyAdvice and not MyPlate and you’ll buck the trend.

Appendix

In The Obesity Epidemic, for Appendix 3, I did an experiment where I tried to get the Recommended Daily Allowance (RDA) for 12 vitamins (information for B7, Biotin, was not available) and 8 minerals (calcium, magnesium, phosphorus, copper, iron, manganese, selenium and zinc). These were the nutrients for which the United States Department of Agriculture database had information and for which there was an RDA. Having said this, there were no RDA’s for vitamins B5, D and K or for the minerals calcium and manganese – an ‘Adequate Intake’ was recommended.

- Omnivores can get the RDA’s/AI’s from the following 5 foods: 100 grams of liver, 200 grams of sardines, 200 grams of whole milk, 100 grams of sunflower seeds and 200 grams of broccoli (1,300 calories). There will be infinite combinations of real foods that can provide the RDA’s/AI’s, but I started from the ones known to be highly nutritious.

- For vegetarians, the RDA’s/AI’s’s could be met with these five foods: 500 grams of whole milk, 450 grams of eggs (10 medium eggs), 300 grams of spinach, 250 grams of raw mushrooms grown in sunshine and 50 grams of sunflower seeds (1,360 calories). Dietary advisors applaud people for choosing a vegetarian diet, but then tell them to avoid eggs and to consume low-fat milk. It then becomes practically impossible for a vegetarian to meet even minimal nutritional requirements.

- Vegans can’t get B12 naturally and they would need to eat 2.25 kilograms of (raw sunshine grown) mushrooms in a fat delivery mechanism (e.g. vegetable oil – unhealthy per se) to get the ‘adequate intake’ for vitamin D and an unusual food like oriental dried radishes to get their calcium – and to repeat this daily. For completeness, the five vegan foods would be 2.25 kilograms of mushrooms, 175 grams of porridge oats, 25 grams of sunflower seeds, 100 grams of oriental dried radishes and 300 grams of spinach (in more vegetable oil) and a vitamin B12 supplement. Without the calories in the vegetable oil, the vegan basket adds up to 1,644 calories – the highest of all three sample ways of getting our nutritional requirement.

Here’s the link to the presentation at last.

I discovered during the writing of my book “The Obesity Epidemic” that five-a-day was invented by a bunch (ha ha) of fruit & veg companies at a meeting with the American National Cancer Institute in 1991 (not 1998, as the article says). The American National Cancer Institute has since trademarked the term and the fruit & veg manufacturers, logistics and packaging companies hit the jackpot with this marketing slogan, as it is now ‘out there’ in c. 25 countries across 3 continents.

It was good to see Tim Lang, Professor of Food Policy at City University London confirming the lack of evidence in the article: “It was a political fudge,” Lang says, “there was very little evidence basis for it. They just chose a figure that was aspirational but not so high as to be perceived as impossible to reach.” Lang, it seems however, would be happy if the bar were set at 9-a-day – as it already is in Australia & Greece. However, as happens with non-evidenced bases messages that spread, Denmark advises 6-a-day, Ireland 4-a-day and I detail the whole range of variations on p204 of my book.

This article is not about the debate as to whether or not there was evidence before the creation of 5-a-day that 5-a-day would do anything to help cancer because there can be no debate. There was no evidence at the time that eating 5 portions of fruit & veg a day would help cancer – which was the only medical condition involved at the outset. There can be little debate that evidence has been found since – the EPIC (European Prospective Investigation into Cancer) concluded in April 2010 as follows. (Please note that this study was set up in 1991 – surely coincidence  ;-) ):

April 2010 – report from the EPIC study:

In April 2010 a study was published in the Journal of the National Cancer Institute written by Paolo Boffetta, as the lead of a large group of European researchers. The study sought to quantify if cancer risk were inversely associated with intake of fruit and vegetables. The article analysed data from the EPIC study, involving 142,605 men and 335,873 women for the period 1992-2000. This review of almost half a million people found that eating five portions of fruit and vegetables a day had little effect on cancer risk and the very small difference observed could be explained by other factors. The study also grouped participants into five categories from the lowest intake of fruits and vegetables (0 to 226 grams a day) to the highest intake (more than 647 grams a day). Significantly, the cancer risk did not vary between the five groups. The overall conclusion of the study was that:

“A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.”

The British arm of the EPIC study reported the same later on in 2010:

November/December 2010 – report from the EPIC study:

A report published in the British Journal of Cancer 30 November 2010, written by Professor Tim Key – UK leader for the EPIC study, concluded:

“The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established.”

This post is about the report which stimulated interest in The Independent article:

January 2011 – report from heart people at Oxford using the EPIC data:

The article refers to a report published in the European Heart Journal on 18 January 2011. It was covered in the press at the time, but The Independent picked up on it last week (16 March 2011).

Let’s just be clear at the outset what’s going on here. A huge, and no doubt hugely expensive, study has been done across Europe, involving half a million people, trying to establish even an association (not causation) between cancer and fruit & veg intake and the study has not been able to conclude this (and that alone says something, as most statistics can be manipulated, as we will see just below).

So, people studying heart disease have used the cancer study data to see if they can come up with an association (never, never leap to causation) between fruit & veg intake and heart disease. To be fair – the conclusion in the “abstract” (summary) of the report is as follows:

“Results from this large observational study suggest that a higher intake of fruits and vegetables is associated with a reduced risk of IHD mortality. Whether this association is causal and, if so, the biological mechanism(s) by which fruits and vegetables operate to lower IHD risks remains unclear.”
(NB ischaemic (ischaemia = reduced blood supply) heart disease = heart disease excluding strokes)

So, the researchers didn’t make the causation mistake in their summary. However, in the abstract, we have the following details about methods & results:

-    There were 1,636 deaths from IHD from  a study of 313,074 men and women from 8 European countries. That gives a death rate of 0.52% from IHD in nearly 10 years (the average years of follow-up was 8.4).

-    The journal says: “Participants consuming at least eight portions (80 g each) of fruits and vegetables a day had a 22% lower risk of fatal IHD [relative risk (RR) = 0.78, 95% confidence interval (CI): 0.65–0.95] compared with those consuming fewer than three portions a day. After calibration of fruit and vegetable intake to account for differences in dietary assessment between the participating centres, a one portion (80 g) increment in fruit and vegetable intake was associated with a 4% lower risk of fatal IHD (RR = 0.96, 95% CI: 0.92–1.00, P for trend = 0.033).”

So, in the method & results details, they do make the leap from association to risk – this is done all the time in studies and is bad science. They have effectively observed that there seems to be an association between people being in the bath and singing. They can no more say that being in the bath increases one’s risk of singing than they can say singing increases one’s risk of taking a bath. Or that either increases the risk of anything.

Note the second sentence – not the one that gave the 22% lower risk headline in The Independent article – that’s the memorable thing that sticks in the minds of the public and makes them rush out to add fruit & veg to their likely expanding waist lines. “After calibration of fruit and vegetable intake to account for differences in dietary assessment between the participating centres”… i.e. after adjusting for the fact that different centres were assessing intake differently, the difference is tiny (0.96 vs 0.92) – they surely cannot claim this as significant even for association, let alone causation.

Lies, Damned lies & Statistics

What newspapers want is the screaming headline “30,000 lives will be saved” (No lives will ever be saved, by the way – we’re all going to die. We may be able to delay likely time of death by a couple of months (see Dr M Kendrick’s brilliant analysis of the maximum possible impact of statins in “The Great Cholesterol Con“), but you’re going to die) or “22% lower risk of X”. This is wrong, misleading and, quite frankly, dishonest.

Forgive me for not paying the $40 to be able to view the full article for one day. I don’t know if the article would detail the categories of fruit & veg that the deaths were divided between and the numbers of people in each category, but I could guess “fewer than 3 portions”; “3-5″; “5-7″ and more than 8 and then let’s say it looked something like the following…

If you start from the assumption that people in each of 4 fruit & veg consumption groups were distributed evenly in terms of number of people and deaths, then 78,269 people would be in each group (total 313,074) and 409 deaths ‘should’ have occurred in each group (total 1,636) (notwithstanding that there are too numerous to cover reasons as to why deaths would not be distributed evenly – nothing to do with fruit & veg). For the deaths in the 8+ group to be 22% lower than the deaths in the fewer than 3 group, keeping the deaths in the 3-5 and 5-7 groups at 409, deaths in the 8+ group would be 369 and deaths in the fewer than 3 group 449. Hence 0.47% of the higher intake group would have died during the period reviewed and 0.57% of the lower intake group – not such an impactful headline when you state the facts.

But here’s the killer point – this is merely an observation. What lifestyle do you think people lead who are consuming more than 8 portions of fruit and veg per day? Do you think they put down their cigarettes, or recreational drugs, to free up a hand to eat an apple? Do you think they are sat on their fat and lazy backsides watching TV munching crudités? Or do you think people consuming 8 portions or more of fruit & veg a day are generally ‘healthy’ people – shunning processed food in favour of fresh, naturally active, not smoking, managing stress levels and so on. So this study might have observed that overall healthy people have fractionally lower heart disease than people who have less healthy lifestyles.

Hardly hold the front page now!

For a final couple of points:

1) We MUST start distinguishing between fruit and veg. Veg can be quite nutritious – especially the dark green leafy vegetables and especially when cooked in/eaten with butter to deliver the fat soluble nutrients within. Fruit is so different – high in fructose (and glucose) – which is the perfect fattening combination in the world of obesity (indeed fructose along has been called the fattening carbohydrate for some time – it just takes public health advisors a dangerously long time to catch up.) Low starch vegetables and salads definitely have a place in a healthy, enjoyable and varied diet. But, as Gary Taubes says, “If you are overweight, fruit is not your friend”, and that’s the world in which I work – obesity.

2) There are so many other far more important factors which could and should be looked at and yet no one is going to get funding for a study looking at the damage being done to human beings by the staggering British and American consumption of sugar and white flour. The Sugar Bureau and Flour Advisory bureau wouldn’t like it and our eatbadly plate (the UK role model of health eating) is, inexplicably, trying to drive precisely this food consumption – a la “base your meals on starchy foods”. Whatever you do, don’t eat meat, eggs and butter, which are stacked with vitamins and minerals, essential fats and essential proteins (there is no such thing as an essential carbohydrate – interesting).

What people are NOT eating is likely more important than what they are. People who DON’T eat sugar, flour and processed food are vastly more likely to be healthy than people who consume the 400 cals of sugar and 730 cals of flour that the average Brit (and American) eats per day. The Seven Countries Study made exactly this error – it concluded that America ate a lot of fat and Japan ate very little and this was why heart deaths were so different. Japan also ate no processed food whatsoever at the time (1956-1970) and the American coca-cola, burger, hot dog culture was well under way in the USA. It was not any real fat in real food that had anything to do with heart disease – it was any processed food (carbs or fats) that the Americans were eating.

If the idiot powers that be try to get people to eat 8-a-day, instead of the already fattening and unjustifiable 5-a-day, obesity will rise even faster and more certainly than it is now. People are trying to eat 5-a-day in addition to everything else they are eating.  People are also majoring on fruit, rather than veg (because it’s sweeter) and consuming fruit juice, dried fruit and other fattening things. Childhood obesity is being fuelled by trying to get 5 portions of fruit juice, dried fruit, sweetcorn on pizza etc into already fat little Johnny.

Or – as The Independent ‘helpfully’ illustrates how we can get our 8-a-day – sweet potatoes (actually higher in carb than normal potatoes), dried fruit, salty soup, sugary baked beans, banana milk shake – and you wonder why we have an obesity epidemic!

SPA Future Thinking, a market research firm did a “Question of Taste” survey. They surveyed 1,534 women around the world in the following countries: Brazil,  China,  France, Germany, UK and USA. Some of the key findings were:

1) Although most adults are on a diet (defined by some kind of restrained eating) for much of the time, 34% of British women had gained, rather than lost, weight over the previous year. This compared to 19% of German women who had gained over the previous year (that’s still a lot of people on the rise in the absence of many people losing).

2) 86% of British women had not lost weight since the previous year – this was the worst ‘dieting success statistic’. This is interesting because we have known for 50 years that sustained weight loss (on eat less/do more diets) has a 98% failure rate:

“Having reviewed the literature from the first half of the twentieth century and having done their own study Stunkard and McLaren-Hume (1959) concluded “Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it.”  Stunkard and McLaren-Hume’s own statistical study showed that only 12% of obese patients lost 20 pounds, despite having stones to lose, only one person in 100 lost 40 pounds and, two years later, only 2% of patients had maintained a 20 pound weight loss. This is where the often quoted “98% of diets fail” derives from.” (From The Obesity Epidemic: What caused it? How can we stop it?)

This statistic is astonishingly supportive of  Stunkard and McLaren-Hume’s finding. They found that only 12% of patients lost 20 pounds. This survey is saying only 14% lost anything at all.

3) Half of the British women surveyed said that they exercised for less than 3 hours a week.  Here’s the really interesting exercise bit, however – French and American women exercised the least – with almost a quarter doing less than half an hour per week. Using the most recent World Health Organisation estimated prevalence for female obesity per country, we find the following (the WHO takes women as aged 15+):

- Brazil 24.5%;

- China 3.6%;

- France 7.6%;

- Germany 22.1%

- UK 26.3% and

- USA 48.3%

So – the most obese and closest to the least obese exercise the least. The Daily Mail article quotes “diet experts” (not named) as saying “people are simply doing too little exercise.” On this evidence it doesn’t do the French any harm. Could it be that French women eat meat, fish, dairy and vegetables and very little refined carbohydrate and American people are told to base their meals on carbs?

4)  British women were only second in reliance upon convenience food – USA ‘won’ this category with 20% reliant on convenience food. The British figure was 13%. The other countries were in single figures – France and Germany at 6%.

If you want to be a successful dieting statistic this time next year, here are my top 3 tips:

1) Eat food – real food only and no processed food;

2) Eat three meals a day – stop snacking every couple of hours;

3) Manage your carbohydrate intake. Most people should be able to lose weight successfully with just tips 1&2. If you have weight to lose and are not losing by including ‘good’ carbs in your diet – these are the ones that need to go. Very carb sensitive people are becoming increasingly commonplace (hence the 171 million diabetics in the world – WHO data again) and they often need to cut back to naturally reared meat, fish, eggs, vegetables and salads to lose weight – no potatoes or grains or fruit or even dairy products in extreme cases.