• Resolving confusion with dietary advice

    Resolving confusion with dietary advice

    Last Monday’s note was about a press release: “Eat Fat, Cut The Carbs and Avoid Snacking To Reverse Obesity and Type 2 Diabetes.” The story gained much coverage. It was Monday’s front page on The Express and The Mirror. Sky News led with the story and many TV and radio stations covered it during the day. Dr Aseem Malhotra did most of the interviews, I did BBC London, BBC Wales, BBC Tees, LBC, BBC Three Counties radio, Talk Radio Europe and the Mark Forrest show (which covers about 40 local radio stations each evening).

    The most common question that I was asked during interviews was this: “Isn’t it confusing for people? One minute they’re told fat is bad, then it’s good, what are they supposed to believe?”

    My answer was as follows: “It shouldn’t be confusing at all. The consistent message should be ‘eat real food'. The only debate should be – what should that real food be?”

    Why the confusion?

    There is confusion and I lay the blame firmly with Public Health authorities for this. On Monday, the opposition that Aseem, Sam Feltham, Dr Trudi Deakin, Dr David Unwin and I were facing was from public health representatives. The fake food industry executives must have been sat back in their plush offices wondering how on earth they managed to get dieticians and public health officials working as their unpaid spokespeople. (Not so unpaid if you know the conflicts in place).

    The fake food industry’s role is to promote their product and maximise returns for employees and shareholders. I don’t blame Coca-Cola for trying to get a red can of cola on the government role model healthy eating plate, which they managed to achieve from 1994-2016. I blame successive governments for allowing it to happen.

    Public Health England, Wales and Scotland are supposed to be giving optimal dietary advice to citizens. In the absence of official dietary advice, there would be no confusion. It is our governments telling people to eat margarine, not butter. Our governments are saying have (sugary) cereal for breakfast, not ham and eggs. Our governments have reiterated the message “eat carbs/fear fat.”

    Step 1: Eat real food

    The message from real foodies is consistent: “Eat real food.” Sometimes interviewers ask what that is. I say “oranges grow on trees; cartons of orange juice don’t. Fish swim in the sea; fish fingers don’t. Cows graze in the field; peperami sticks don’t.” Five year olds can understand such examples – it’s that simple.

    “Eat real food” can also be summarised as: meat, eggs and dairy – ideally from pasture living animals; fish; nuts and seeds; vegetables and fruit in season. That’s the basis. There is debate as to whether or not any grains qualify as real food. The argument goes that grains came with agriculture, which occurred approximately 10,000 years ago. That may sound like a long time, but it’s the blink of an eye in terms of evolution.

    Eye opening books like Wheat Belly (Dr William Davis) and Grain Brain (Dr David Perlmutter) explain why modern wheat (which is the grain that virtually all real foodies DIScourage consumption of) is a world apart from the wheat of biblical times, let alone that of ten millennia ago. Many real foodies consider grains such as brown rice, oats and quinoa as suitable for most people – especially non-diabetic and non-obese people. However, I think that the best way to answer the grain question is to move on to “What should that real food be?”

    Step 2: What should that real food be?

    Yes, eating is tasty and enjoyable and sociable and has other positive attributes. However, we must remember that we eat to survive and thrive as animals. To survive and thrive we need complete protein, essential fats, 13 vitamins and approximately 16 minerals. When step 1 is “eat real food” and step 2 is “what should that real food be?” the answer falls out from analysing which foods contain the nutrients that we need as humans.

    In the age of the internet and data, facts about the nutritional content of foods are easier to find than ever. My favourite site is nutrition data. Below is a selection of six foods:

    - Liver – the most nutritious food on the planet (I am open to someone finding a more nutritious food than offal, but no one has yet);

    - Sardines – oily fish are wonderful for the difficult-to-get bone nutrients of calcium, phosphorus and vitamin D;

    - Eggs – milk has similar nutrients to eggs – both are vital for vegetarians to optimise nutrient intake;

    - Broccoli – any green vegetable is excellent for vitamin C and good as a general plant nutrient all-rounder (however – do take a look at the vitamin C in liver vs. an apple – not many people know that!); *

    - Then we have two as comparators – a common fruit (apple) and the single substance that British (and American) people eat the most of: flour. I have chosen whole wheat flour, even though only a fraction of flour consumed is whole wheat, just to be as fair as possible in nutrient comparisons.

    This is the comparison table for vitamins (the highest in each row is in bold):


    This is the comparison table for some minerals (the highest in each row is in bold):


    Whole-wheat flour is best for B1 by weight comparison. However, it also ‘wins’ on calories, so you’d consume almost three times as many calories to get the same B1 as you would from liver. Whole-wheat flour also does well for a few minerals, by weight again. However, add in another real food favourite: cocoa powder (think dark chocolate) and the minerals per 100g for cocoa powder are: magnesium (499 mg); phosphorus (734 mg); copper (3.8 mg); iron (13.9 mg); manganese (3.8 mg); and zinc (6.8 mg). Cocoa powder beats (equals in the case of manganese) whole wheat flour by weight and has two thirds of the calories.

    The three main findings are:

    1) ** Much to my distress, as a vegetarian from approximately 1990 to 2nd April 2010, the nutrients that humans need are largely, and in some cases exclusively, found in animal foods. The day I realised that I needed to eat 39 eggs or approximately 200 g of sardines to get 15 mcg of vitamin D daily was the day I ended being a vegetarian.

    2) ** Notwithstanding the fact that the recommended nutrient intakes are estimates, rather than evidence based, they are difficult to obtain daily unless careful choices are made. (Calcium, magnesium, zinc, vitamin D and vitamin E are the most difficult to get).

    3)*** Setting macronutrient targets is really unhelpful. If we eat food to obtain the vital micronutrients, the macronutrients will be what they will be (take care of the pennies and the pounds/dollars look after themselves). If we eat food to try to meet some made-up macronutrient composition, (our current targets are 30% fat/15% protein/55% carbohydrate) the micronutrients are likely impossible to consume. It is an inescapable fact that processed carbohydrates have little or no natural nutrition and even nature’s carbohydrates are comprehensively beaten by nature’s fats and proteins. Telling people to avoid fat is the same as telling us to avoid nutrition.

    Our parents and grandparents were brought up on relatively cheap, highly nutritious, foods like liver, eggs and sardines. Cod liver oil was commonly administered by previous generations. When you see the vitamin A*and D content of the latter, our elders were very sensible. We shun such foods nowadays and should not.

    Finally, we've pulled together a little medley of radio interviews from last week and published it in the club. You can listen to it here.

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