{"id":6376,"date":"2017-10-16T10:45:32","date_gmt":"2017-10-16T09:45:32","guid":{"rendered":"https:\/\/www.zoeharcombe.com\/?p=6376"},"modified":"2018-01-13T15:13:20","modified_gmt":"2018-01-13T15:13:20","slug":"belgian-dietary-guidelines","status":"publish","type":"post","link":"https:\/\/www.zoeharcombe.com\/2017\/10\/belgian-dietary-guidelines\/","title":{"rendered":"Belgian Dietary Guidelines"},"content":{"rendered":"
On October 9th 2017, Professor Tim Noakes tweeted about a new food pyramid in Belgium asking \u201cWonder what anyone hopes this will achieve? On basis of what evidence? Will outcomes be measured?\u201d<\/em><\/p>\n The pyramid was published on September 19th by an organisation called the Flemish Institute for Healthy Life<\/a>. What is this organisation? Is this new official Belgian policy? What does the pyramid advise? Is the advice good? Let\u2019s take a look…<\/p>\n The Flemish Institute for Healthy Life<\/strong><\/p>\n The Flemish Institute for Healthy Life describes itself as \u201ca government-recognized center of expertise.<\/em>\u201d The organisation dates back to September 1991 when it was The Flemish Institute for Health Promotion (VIG). There have been a number of changes in name and focus. In 2009, the organisation became the Flemish Institute for Health Promotion and Disease Prevention (VIGeZ). In 2017, VIGeZ\u00a0changed its name again to become The Flemish Institute for Healthy Life.<\/p>\n I contacted the organisation to ask 1) Is the Is the Flemish Institute for Healthy Life a government organisation? and 2) Is this pyramid now official Belgian policy?<\/p>\n I received a very prompt and helpful reply: 1) \u201cWe are a non-profit organization and official partner of the Flemish government for nutrition and health promotion (funding comes mainly from the Flemish governmen<\/em>t)\u201d; and 2) \u201cThis is indeed the official food guide for Flanders (Dutch speaking part of Belgium)<\/em>.\u201d<\/p>\n This is not<\/em> new health policy for the whole of Belgium therefore \u2013 just for Flanders, which is one of three regions in Belgium. The Food and Agricultural Organization of the United Nations (FAO) reports the Belgian and Flemish guidelines on this site<\/a>. The Flemish pyramid needs to be updated by the FAO in the light of these new guidelines. I am not aware that any changes have been made to the food pyramid for the French community.<\/p>\n A brief history of Flemish dietary guidelines<\/strong> <\/a><\/p>\n <\/p>\n In Flanders, the first diagram for dietary advice was developed in 1967. It was known as the four leaf clover and it had four sections \u2013 equal in size: i) Dairy \u2013 milk, cheese, yogurt; ii) Meat, fish, eggs, nuts; iii) Vegetables and fruit; and iv) Starchy foods \u2013 bread, pasta, rice, potatoes. This was commendable, real food, advice.<\/p>\n <\/p>\n The four leaf clover was replaced in 1997 with a classic food pyramid, with starchy (fattening) foods as the base of the food pyramid, then fruit and vegetables, then dairy, meat, fish and eggs squashed up in the narrow part of the diagram. The portions were quite staggering: the cereals equivalent of 5-12 slices of brown bread and 3-5 cooked pieces of potato were recommended daily:<\/p>\n <\/p>\n In the year 2000, so-called \u201ccalcium-enriched soy products\u201d were added to the food pyramid. In 2004, a layer of activity was added at the bottom to make the diagram \u201cThe Active Food Pyramid.\u201d These two amends are reflected in the following diagram:<\/p>\n <\/p>\n The 2017 pyramid<\/strong><\/p>\n The context for the latest diagram was given as \u201cThe general public is constantly bombarded with information about health. Think about the internet and (social) media where there\u2019s advice from self-declared experts and experienced professionals, and irresponsible statements made by the media based on unreliable studies<\/em>.\u201d In this context, The Flemish Institute for Healthy Life wanted to create a model, which communicated clear and accessible messages to the general public, as well as to health professionals. Given the context, one would also hope that this new pyramid would be evidence-based and backed up by reliable studies…<\/p>\n The pyramid is intended for the general public from the age of one year! (That\u2019s the lowest age I\u2019ve ever seen adult guidelines apply). The pyramid shape was recognised by 73% of Flemish people, in a 2013 survey, so the creators of the new model wanted to retain the shape. The pyramid was inverted because (as explained by its creators) a pyramid is read from top to bottom and so the most important foods should be at the top.<\/p>\n A panel, with representatives from health sciences, universities and other health organisations, put together the new pyramid. There were no declared conflicts of interest and none seemed obvious from the names of the people and organisations. Hence, unlike the English \u2018eatwell\u2019 plate (adopted by the rest of the UK), which was assembled by the who\u2019s who of the fake food industry<\/a>, this pyramid appears to be conflict free.<\/p>\n The evidence relied upon for the Flanders pyramid was listed as: <\/a><\/p>\n <\/p>\n – International recommendations. The three countries listed as influences, were the Netherlands, America (Dietary Guidelines for Americans) and France.<\/p>\n – Supplementary scientific literature in relation to food, food groups and healthy eating. The document presenting the scientific literature is here<\/a>. It\u2019s in Dutch, which is double Dutch to me ha ha, but the references at the back are in English and I see quite a few references to Mozaffarian \u2013 funded by, and lover of, polyunsaturated fats. I certainly don\u2019t see any authors who have published evidence contrary to conventional dietary guidelines<\/a>. I also don\u2019t see any evidence for the plant-based pyramid e.g. \u201cA Meta-Analysis of Randomised Controlled Trials where beans and tofu replaced meat and dairy.\u201d<\/p>\n – Supplementary scientific literature in relation to sustainable eating. The document presenting the scientific literature is here<\/a>. Most of the references are in English and the belief system underpinning the reference choice is clear: \u201cA global assessment of the water footprint of farm animal products<\/em>\u201d and \u201cReplacement of meat and dairy by more sustainable protein sources<\/em>\u201d, as examples. Other references are about \u201cplant-based diets<\/em>\u201d, \u201canimal welfare<\/em>\u201d and \u201cmeat avoidance<\/em>\u201d. I saw none about how plant food can sustain top soil, without which the planet can no longer produce real food .<\/p>\n – Advice from \u201cThe Superior Health Council\u201d \u2013 described as an independent body for scientific advice.<\/p>\n The pyramid that was drawn up by the panel is pictured below:<\/p>\n <\/p>\n To spell out the visuals in the diagram:<\/p>\n – The top section advises the population of Flanders to eat MORE: carrots; broccoli; apples; pears; beans; tofu; oil (presumably vegetable oil); potatoes; pasta; rice; bread; and nuts.<\/p>\n – The next section (moving away from MORE toward LESS) includes: fish; yoghurt; milk; cheese; eggs; and chicken.<\/p>\n – The bottom section (LESS) has just two products \u2013 butter and red meat.<\/p>\n Off to the side of the triangle is the circle advising \u201cAS LITTLE AS POSSIBLE\u201d of: cake; biscuits; sweets; fizzy drinks; salami; bacon; salt; beer; wine; chips\/fries; pizza and crisps\/potato chips. I agree that some products in this red circle are best avoided, but others should be embraced. Salt is an essential nutrient. Curing (salami and bacon) has been a natural way of preserving meat for at least as far back as the Ancient Greek era (800-500 B.C.) and the PREDIMED study listed \u201cat least seven glasses of wine a week<\/em>\u201d as adherence to the recommended \u201cMediterranean Diet<\/a>\u201d.<\/p>\n The green to amber part of the pyramid fares little better in terms of evidence. If we go back to the basics of what human beings need to consume (beyond water) to survive, let alone thrive, the essential nutrients are: i) complete proteins; ii) essential fats (omega-3 and omega-6); iii) 13 vitamins (the fat soluble vitamins \u2013 A, D, E and K \u2013 and the 8 water soluble B vitamins and the water soluble vitamin C); and iv) a number of minerals. There is no requirement for carbohydrate to be consumed.<\/p>\n i) Carefully selected combinations of plant foods can provide complete protein, but the simplest and most reliable provider of complete protein is animal foods (meat, fish, eggs, dairy). ii) The essential fats are provided by any food that contains fat: meat; fish; eggs; dairy; nuts; seeds; olives; avocados; oils etc. For iii) vitamins and iv) a selection of essential minerals, I\u2019ve selected some samples from the United States Department of Agriculture (USDA) all foods database.<\/p>\n In the Table below, we have broccoli, apple, rice (brown \u2013 to be as favourable as possible) and olive oil. I\u2019ve compared vitamins (there are no data for B7\/biotin) and minerals for 100 grams of each of these foods with: chicken liver (there is no offal on the diagram); sirloin steak (in the LESS section); and sardines \u2013 below the starchy, carb foods section. (All foods are reported in the raw\/uncooked state).<\/p>\n I\u2019ve highlighted the \u2018winner\u2019 in each row, so that you can see at a glance which product is most nutrient dense. Olive oil wins on calories \u2013 probably not the one you want to win. Liver then cleans up on 7 of the 12 vitamins documented by the USDA database. Liver beats apples for vitamin C, but broccoli rightly wins vitamin C overall. Brown rice marginally beats liver for B1, but at three times the calorie intake. Olive oil is the best provider of vitamin E in the Table below, but, again, at nearly 900 calories for 14mg of this nutrient, you\u2019d be far better off getting the daily 15mg vitamin E requirement from 50g of sunflower seeds at fewer than 300 calories. Brown rice wins for manganese and magnesium. Far better to consume cocoa powder<\/a>, which would win for 7 out of 10 of the minerals listed.
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