I’ve just finished watching this terrific programme on BBC2 (Thursday 14th June 2012). It will be on iplayer for just a week from now here. Full marks to the presenter, Jacques Peretti for getting together such greats as Robert Lustig, Gary Taubes, David Kessler, Philip James and for honouring John Yudkin posthumously.
The programme opened with some facts about overweight and obesity:
– “More people are overweight than undernourished.”
– “Two thirds of British adults are overweight and one in four of us is obese.”
– “The average person in Britain is nearly three stone heavier than they were 50 years ago.”
Professor Jimmy Bell starts off by doing an MRI to look at the fat inside Jacques Peretti’s body. It is discovered that Peretti has very low levels of subcutaneous fat, but high levels of visceral fat. Four to five litres of internal fat in fact. Bell says that he would expect internal fat to be less than two litres. Peretti blogs here about having discovered he is someone who meets the expression TOFI – thin on the outside, fat on the inside.
Peretti says “These hidden fat deposits put me at risk of diabetes and cardiobadscuar disease.” Bell says “Long term this could be quite troublesome for your health.” My first challenge of the programme would come here – does obesity (internal or visible) cause diabetes and/or heart disease or is it the modern processed food that we are consuming causing all conditions – obesity and diabetes and heart disease? We need to take extreme care when making assumptions about causation.
“Britain has got fat in just 40 years – why?” asks Peretti and then travels to America in search of the answer.
During the Nixon years, housewives were protesting at soaring costs of food. Nixon needed farmer support to be re-elected. A man called Earl Butz was appointed secretary for Agriculture in 1971. He was described as “A friend of the farmers”. Butz’ vision was mass production/cheap food on an unprecedented scale. “Get big or get out” was his motto. Peretti proffered: “This surge in farm production would ultimately lead to a surge in obesity”
“Fence row to fence row farming” was the new agricultural order. As grain production became so high that grain surpluses were commonplace, Butz championed a process that would utilise cheap grain and the massive grain surplus resulting from this mass production policy. High Fructose Corn Syrup (HFCS) was the (literally) golden product – a brand new industrial sweetener.
Peretti gave some Superbowl facts. This is the second biggest American feast after Thanksgiving. In one day Americans consume 14,000 tonnes of tortilla chips, 4,000 tonne of guacamole and one and a quarter billion chicken wings. There’s a great visual about 15 minutes into the programme where Peretti unwraps a burger and chips and shows that the beef in the burger has been fed on corn, the bread has been made with corn syrup, the fries fried in corn oil, the ketchup made with corn syrup and the soda made with corn syrup. Butz’s corn syrup has made it into everything. Peretti notes that the largest single source of calories in the American diet is soft drinks. In 1984 Coca-cola and Pepsi replaced sugar with corn syrup.
Hank Cardello, Marketing Director for Coca-cola between 1982-1984 was interviewed and talked about the switch from sugar to corn syrup, which needed to happen without compromising taste. Corn syrup was a third cheaper than sugar, so the economics were compelling. The cola companies were able to sell more and make more money.
Cardello explained that The Centres for Disease Control (CDC) in Atlanta didn’t start mapping out obesity until 1985 – so this change went under the radar. Peretti continues: “In two decades, consumption of soft drinks increased from 350 cans a year to 600.”
Enter Robert Lustig: “HFCS has a sweetness index of 120. So it’s actually sweeter than sucrose. They should be able to use less, but they use more. The sweeter they make it, the more we buy.”
One of the best bits of the programme comes next. Peretti interviews Susan Neely, from the American Beverage Association. Peretti asks the simple question: “Do you think that soft drinks contribute to obesity?”
Neely replies: “No I do not.”
Neely follows this with: “The evidence says that obesity is caused by people consuming too many calories and not getting enough exercise to balance it out. Our soft drinks are a source of calories so if you’re consuming too many calories and watching too much television, you may have a problem”. She then uses the analogy – it’s like saying because you go in the ocean, you’re going to get bitten by a shark. Lots of people go in the ocean and don’t get bitten by a shark. (Hello – but if you get bitten by a shark, you’re in big trouble!)
Neely closes with “I don’t know that I’ve seen any study that shows causality.”
A guinea pig called Ken (a human really!) is then shown being fed shakes to trace where the sugars, including corn syrup, are metabolised and then converted into fat. About half way through the programme we see something I never thought I’d see on TV – fructose on trial! Fructose is singled out by Dr Jean-Marc Schwarz (the scientist doing this experiment) as being a key component in both sugar and HFCS (sugar is 50 50 glucose and fructose; high fructose corn syrup varies but the most common combination is 55% fructose and 45% glucose). A factoid is slipped in – “90lbs of added sugars a year are consumed by Americans”. Fructose is named as a factor for fat in the blood and therefore a problem for heart disease, fatty liver and diabetes. (The reference to blood fats is referring to Very Low Density Lipoproteins – VLDL. I also cover this in my book “The Obesity Epidemic” with reference to the study by Elizabeth Parks entitled “Effect of dietary carbohydrate on triglyceride metabolism in humans”. The study concluded: “When the content of dietary carbohydrate is elevated above the level typically consumed (>55% of energy), blood concentrations of triglycerides rise. This phenomenon, known as carbohydrate-induced hypertriglyceridemia, is paradoxical because the increase in dietary carbohydrate usually comes at the expense of dietary fat. Thus, when the content of the carbohydrate in the diet is increased, fat in the diet is reduced, but the content of fat (triglycerides) in the blood rises.” (“Effect of dietary carbohydrate on triglyceride metabolism in humans”, The Journal of Nutrition, (2001).) Please note that we are advised by dieticians and public health advisors to consume 55-60% of our intake in the form of carbohydrate. Hence this is not above a level typically consumed.
Lustig is back talking about the impact of fructose on leptin – our appetite regulating hormone. He explains how sugars – fructose particularity – can lead to obesity, disease and addiction through disruption of the hormone leptin and its signalling process.
Back to the UK and Peretti asks “How did we get fat in Britain?” The answer put forward is “snacking”.
In the 1970s we didn’t snack. Then the marketing departments did their best to change this. Milky Way was advertised as “The sweet you can eat between meals” and snacking is now worth £6 billion a year. Remember “A finger of fudge is just enough to give your kids a treat”?
“Britain’s calorie intake went up” says Peretti. This is my second challenge – the evidence does not support this. Indeed the Food Standards Agency stated: “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.” The Ministry of Agriculture Fisheries & Food (MAFF) National Food Survey tells us that the average Brit was eating 2,290 calories per person per day in 1975 and, by 1999, this had fallen to 1,690 calories per person per day. Obesity increased almost ten fold during this time.
Terry Jones, is then interviewed from the Food & Drink Federation: “We lead busy lives, we have to graze from time to time. The food industry has provided nutritious products that match those busy lifestyles.” I would suggest that taking out the word nutritious would be closer to the truth.
Professor Philip James makes his first appearance “The industry love snacking – a huge burgeoning part of their profit.” The message is clear – ‘food’ manufacturers are not responding to a need – but driving it.
After talking to Paul Simons, an advertising consultant, Peretti reiterates “Calories went up massively” I reiterate – the evidence does not support this.
We then get the story that I present in my book and Taubes presents in his and Tom Naughton has done presentations about – the fat vs sugar debate. Peretti guides us through the story: In the 1970’s, heart disease was the issue and the question was – what caused heart disease? Sugar or fat? Lustig is back again (we can never get too much Lustig!). Lustig explained that Keys developed the K Ration (convenient supplies for the military) – he believed sugar was energy. In 1952 Keys did a sabbatical in England and saw an epidemic of heart disease and correlated it with the great British diet. He said that saturated fat had to be the culprit. He spent the next 50 years trying to prove himself right.
Lustig’s explanation continues: In Britain one lone voice contested what Keys was saying – John Yudkin – Pure White & Deadly (Reference to the 1972 classic). Lustig describes Yudkin as “a prophet”. I agree! “If you read Pure White & Deadly, it’s all there.”
The obesity crisis we face today is in part due to our ignoring the warnings provided by Yudkin. The industry provided more and more sweet foods. We move on to Dr Tony Goldstone next, who is looking at brain activity when people are shown high calorie foods. We can see brain activity related to choices, motivation, drives etc – “the food industry spends a lot of time developing products that we will be motivated to eat and eat again.” “The brain activity is the holy grail for the food industry trying to get us to eat more and scientists trying to understand obesity.”
The experiment on brain activity was done on “Samantha”, who is waiting for a bariatric operation -“I do try to keep to me fruit!” says Samantha. Bless her – she should listen to Robert Lustig’s expertise on fructose and try to avoid it!
David Kessler – former FDA Commissioner 1990-1997 had to appear on such a programme as this. He talks about food as the most socially acceptable fix in our society. Peretti and Kessler drive around anywhere in America and see outlet after outlet for fast food and drink. Kessler introduced the concept of hedonic response – Kessler believes that the industry is trying to process food to elicit a hedonic response. He sees the combination of sugar and processed food as dangerous, deliberate and fattening. Kessler believes that for some people their brains are being hijacked in effect – the emotional neural circuits are being activated. The same circuits that are involved in addiction. Peretti says that the mere idea of food addiction is highly controversial.
Back to Susan Neely for her view on food addiction (i.e. there’s no such thing). “We like to eat things that taste good. There’s a big difference between liking something and being addicted to it.”
In my books, Why do you overeat? When all you want is to be slim and Stop Counting Calories & Start Losing Weight, I present four stages of food addiction:
1) We want a particular food e.g. chocolate
2) We want more of that food – one bar of chocolate is no longer enough, we want two and then three, daily
3) We feel bad when we don’t have the food – we literally get withdrawal symptoms in the absence of our fix
4) We suffer consequences – only these tend to drive people to seek help. The food addict gets fat or diabetic and only then has the motivation to overcome their addiction to their specific fix.
I absolutely believe in food addiction and I’ve yet to meet anyone addicted to salmon and green beans.
Back to America again and Peretti is to be applauded for including the story about George McGovern – who was given the task of setting the first dietary guidelines for Americans. Nick Mottern was hired by the committee to write a report on the matter. He gathered half a dozen nutritionists in the country. The report recommended moderate reductions in fat, salt and sugar but when it hit the press the food industry was incensed. Mottern – “I don’t think the government anticipated the kick back.” Mottern had a copy of an incredible document from The Sugar Association Inc. : One section said: “For 2 years now the sugar industry has had to live with 2 myths: 1) that consumption is increasing annually; and secondly that consumption of sugar is directly responsible for death dealing maladies.”
In the media coverage following the report – sugar was barely mentioned. Reducing fat, as advocated by Ancel Keys was the concession that the food industry was prepared to make. Gary Taubes explains why: The instruction “people should eat less fat” gave the ‘food’ industry the invitation to produce low fat products. Then we’ll have junk foods that claim to be healthy – and that’s exactly what happened. Low fat became an industry – “It was genius”.
Dr Alice Pegg – a food scientist explains one of the challenges of the food industry. Fat stays in the mouth. This is because it doesn’t mix with water and wash away in the mouth. You have to completely reformulate food to replace the taste of fat. Many manufacturers replaced fat with sugar. Lustig again. Kids won’t drink skim milk, but put chocolate in it and then they will. SnackWells – low fat biscuits – flew off the shelves in America. Low fat doesn’t mean it’s not fattening!
Lustig again: “By the time anyone thought to to ask if it was a good idea to replace fat with sugar it was too late. ” If fat is the cause, it’s a good thing to do. If sugar is the cause, it’s a disastrous thing to do. ” I detail in The Obesity Epidemic how our consumption of fat has plummeted:
“The data in the National Food Survey 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 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.” Meanwhile our consumption of cereals, cereal products, processed potatoes, ice cream, confectionery and so on – processed foods and primarily sugars and carbohydrates – has increased substantially.
Time for just one more story in the programme: In 2003, Britain and America were assembling forces to invade Iraq. Other US politicians had other battles to fight. In Geneva, the World Health Organsiation (WHO) was about to issue a report to set worldwide limits on the sugar in our diet. Marion Nestle was interviewed at this point to explain that the sugar industry mobilized its forces. The Sugar Association wrote to the WHO – threatening $406 million dollars of US funding would be withdrawn if this sugar limit went ahead. The US health secretary even flew to Geneva to put the sugar industry’s case to the WHO. The WHO never did make that recommendation. Geneva shows the power of the ‘food’ industry. The global body for health cannot come out and declare that we should consume less sugar.
Terry Jones is nicely timed to reappear at this juncture: “The food industry takes its responsibility very seriously. Playing our full part in public health.” etc Puh-Lease! As Peretti says “While obesity has boomed, so have profits”.
Obesity is costing the NHS over £4 billion a year. Maybe only when the costs to the NHS exceed the profits made from fake food will we wake up and smell the fries and milkshakes!