The first major study to look at all-cause mortality and cardiovascular disease and nutrition across all 5 continents of the world may have arrived just in time. The study findings have just been published in one of the world’s leading scientific and medical journals, The Lancet and were presented yesterday at the European Cardiology Society conference in Barcelona.
With this study now published, it’s going to be very difficult for governments to continue to tell us to get most of our energy from carbohydrates when there’s now clear evidence that that advice is killing us. The new study out of McMaster University, Canada, gives credence to those of us, including cardiologists, who have long advocated lower carb and higher fat diets. And if that wasn’t enough, it shows that raw and cooked vegetables aren’t equivalent, a difference that’s never distinguished in government guidelines.
In the Acknowledgments section of the paper, the study is claimed to be investigator-initiated and over 50 sources including the Population Health Research Institute (PHRI) at McMaster University, the Heart and Stroke Foundation of Ontario and Canada, the Canadian Institutes of Health Research, “and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi-Aventis [France and Canada], Boehringer Ingelheim [Germany and Canada], Servier, and GlaxoSmithKline), and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries.”
The sheer diversity and number of the funding sources, the fact that Big Pharma grants were ‘unrestricted’ and that it was investigator-initiated reduces the risk of vested interest bias or conflicts of interest. The study does however have weaknesses, among the most evident being the reliance on self-reported intake data from questionnaires which tend to vary in accuracy.
Since it’s now almost universally accepted that what we eat and what lifestyles we choose are for most of us the single most important determinants of our health, we have to take government advice seriously. That’s because so many people rely on it, from health professionals through to consumers. It’s of course not as simple as that, as layered on top of what governments tell us are a complex of other factors, linked to preferences or addictions, and a minefield of interacting social, cultural and economic determinants.
The low fat farce
Governments, along with Big Food, have for over 3 decades been locked into the notion that low fat diets are healthy, despite an absence of ‘gold standard’ evidence from randomised controlled trials.
The Lancet study blows this into the long grass. The study, referred to as the Prospective Urban Rural Epidemiology (PURE) study is one of a series. The present one looked at reported dietary intakes, via questionnaires, of 135,335 individuals, across 18 countries (reflecting low, middle and high incomes) on all 5 continents, over a 10-year period. Follow-up continues and will result in further publications.
The researchers found that people between the ages of 35 and 70 on low fat/high carb diets had an increased risk of early death compared with those on a lower carb/higher fat diet. This emphasises that government advice over recent decades to switch out saturated fats and replace them with carbs has been killing people. Interestingly, the apparent protective effect of higher fat intakes occurred whatever the type of fat, whether saturated, monounsaturated or polyunsaturated.
Dietary fat intakes amounting to around 35% of total energy intake had a drug-busting 23% lower all-cause mortality risk. By contrast, diets high in carbs (60% of total energy intake), around the amount consumed when following government guidelines like the UK’s Eatwell or US Myplate guidance, were associated with a higher risk of death.
How long can health authorities and governments hold out before updating their advice on optimal fat/carb intakes?
Optimal veg and fruit intakes
The current PURE study also found that an intake of veg, fruit and legumes of 3-4 servings a day, equating to 375-500 grams, was associated with a lower total mortality and non-cardiovascular mortality.
The researchers found no evidence of benefit for consumption above this level, possibly because it was offset by excessive carbohydrate intake. The authors commented that in some developing countries where vegetables and fruit are expensive, recommending say 3 instead of 5 servings daily, around 400 grams, might be more achievable.
Lead author, Dr Mahshid Dehghan, said in a podcast accessible from The Lancet website that In higher income countries the study findings shouldn’t be looked on as a suggestion to eat less veg, legumes or fruit.
Another important finding was that the study showed that consumption of raw vegetable sources was more protective against cardiovascular diseases than cooked veg. We have long known that many phytochemicals, vitamins and other nutrients are heat sensitive and may be damaged by heat, and we also know that certain forms of cooking can introduce new, harmful chemicals and byproducts, especially when starches, sugars, fats and proteins are subjected to high temperatures. These range from carcinogenic heterocyclic amines (HCAs) formed in high temperature cooked meats, to advanced glycation end products (AGEs) that contribute to inflammation and oxidative stress in the body.
Astonishingly, government guidelines simply don’t distinguish between cooked and uncooked foods despite a wealth of evidence showing many are as different as chalk and cheese, including the latest from this PURE study.
Recently, we’ve raised the question with governments in the European Union over whether they can move to force manufacturers of processed meats to include cancer risk warnings. This would reflect the 2015 classification by the International Agency for Research on Cancer (itself an organ of the World Health Organization) of processed meats as proven human carcinogens. Governments might be aware of this, but the majority of the public isn’t and this type of nitrite-preserved processed meat is fast becoming a staple of kids and adults alike.
Would that change if it had a cancer warning on it? We think so.
It’s refreshing that that as more evidence is released, there is ever more scientific support for our own Food4Health guidelines that we believe properly reflect the available scientific and clinical evidence.
Join our campaign
In the coming weeks, we’ll be unfolding a campaign targeting a number of governments with a view to making significant adjustments to their guidelines. Among the hit list of changes to dietary guidelines we will be pushing for are the following:
Removal of any recommendation to consume low fat foods
Removal of any recommendation to limit saturated fats
Total carbohydrate consumption should not exceed 50% of energy intake
Recommending at least 3 portions a day of fresh uncooked and unprocessed vegetables or fruit
Minimise consumption of refined carbohydrates (e.g. sugar, white bread, white pasta, pizza bases)
Minimise consumption of savoury snacks
Minimise consumption of charred or high temperature cooked meats
Minimise consumption of processed meats containing nitrite preservatives
We’ll keep you posted on progress of the campaign. In the meantime, if you want generalised dietary guidance, whether for adults or children, that’s based on solid scientific and clinical evidence, please refer to the ANH Food4Health guidelines.
Given that your government won’t be telling your friends and contacts about their defective advice, do them a favour and forward this widely.
Written by
BadHare
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What a very interesting article BadHare , it's what most of us on here have known for a while but to see it out there in print is refreshing. I will share your link on my Facebook account so that it's 'out there'.
It's a very good website and I can see this is where you got the leaflets about what food we should be eating, you posted that a couple of weeks ago or so and I printed the leaflets off.
Its a interesting article, but before taking it too seriously it's worth reading some other responses to that PURE study, such as this one on the NHS website:
I won't cut and paste huge chunks of those links, as anyone interested can easily view them but part of the conclusion from the NHS article reads:
"The results of the study have been presented in the media as if they overturn all current dietary guidelines. In the UK at least, that is completely misleading. The study results support the UK guidelines, having found that people who get around 50% of their calories from carbohydrates and 35% from fat, as recommended by Public Health England, were likely to live the longest."
and the final takeaway from Harvard:
"The main messages for nutritional advice have not changed: follow a healthy dietary pattern that includes abundant amounts of vegetables, fruits, whole grains, legumes, and nuts; moderate amounts of reduced-fat dairy products and seafood; and lower amounts of processed and red meat, sugar-sweetened foods and beverages, and refined grains. Such a dietary pattern does not need to limit total fat intake but the main types of fat should be unsaturated fats from plant sources rather than animal fat."
Thanks benwl . The latter comments a bit vague when there's a huge difference between plant sources if fat in avocados to processed margarine, & low fat dairy often contains unhealthy thickening agents & artificial sweeteners. Obesity, diabetes, etc, are on the rise, so I'm sure the NHS advice isn't so good. My GPs recommendation for people to avoid HC/LF diets has avoided or reduced the medication level of people at that practice, compared with the standard NHS advice dished out elsewhere.
I think that statement about plant sources needs to be read in the context of the whole article and it's critique of the PURE study.
As I'm sure you know, correlation does not equal causation, so to conclude that the NHS's advice is not good just because people are still getting fat and obese is misguided. Its more likely that people are simply not following that advice, or not following it well. And it certainly doesn't follow that the advice should just be reversed.
It's great that your GP is able to get people healthier with nutritional advice, but again it would be premature to conclude that means the NHS advice is wrong. Your GP may be more interested in nutrition than others, and be willing to spend time encouraging patients.
In other words its not actual content of the advice that makes the difference, it's the way that it's presented by an informed and interested doctor rather than just being "dished out".
It's also quite possible that the benefits seen are due to weight loss and increase in activity. Being overweight is a risk factor for so many health problems that getting it down gives benefits - and any diet with a element of calorie restriction would probably do that.
I heard an old dear on the bus telling her friend about unprocessed HF/LC diet, that her GP recommends. Most doctors are generally not interested in nutrition, & few healthcare professionals are trained or have time to discuss nutrition, beyond dishing out pamphlets, so you may be right. I've had an assortment of leaflets handed to me by other health professionals, & am able to follow up the information with successful interpretation, whereas some people aren't. That the NHS doesn't differentiate sufficiently with advice regarding which foods are better or worse than others can be misinterpreted by folks who don't know better, not just with regard to weight loss.
I agree with you regarding misinterpretation, and i kind of agree with you on the NHS advice, but i also disagree.
The NHS has an unenviable job of making and promoting health advice to the whole population (all 60 million of us), morally that advice should be based on the best available science (with all the usual caveats about how that is obtained and decided), as you said it needs to address issues of misinterpretation, but it also needs to be easy to understand and follow. There's a real danger that if the advice is seen as too complicated people don't even try to follow it. It also needs to be accessible by people on lower incomes and in disadvantaged areas.
I just had another look at the NHS eatwell plate and at a broad level it seems ok. I think it's very easy for people like you and me who have educated themselves about this (even though we might disagree on things) to approach advice like that at a microscopic level and spot all the details we don't like.
For example i just read on eatwell that:
"Starchy food should make up just over a third of the food we eat. Choose higher-fibre, wholegrain varieties, such as wholewheat pasta and brown rice, or simply leave skins on potatoes. There are also higher-fibre versions of white bread and pasta."
I'd be much happier if they just said don't eat white rice, white pasta, white bread, and suggested other sources of plant starch than potatoes etc. but I see this as a detail, an important one certainly, but not evidence that the whole thing is flawed.
One final point about public heath messages in general. When you dealing with a population of 60m like in the UK, virtually anything you can do to improve the heath of the population in aggregate affects huge numbers of people, and potentially saves the NHS money. There's people like us who make sure they take their tumeric with pepper and fat to maximize benefit, but there are huge numbers of people that don't eat any vegetables or get any exercise. These are the primary audience of simple messages like stop smoking, eat 5 a day, and walk 10k steps.
It's hard having a one size fits all. My concern, as well as people not understanding, is that the advice re eating bad stuff such as margarine & artificial sweeteners are still promoted as good swaps.
It's sad that people don't understand what's good for us, as well as how to prepare simple healthy meals, & the allure of easy but unhealthy cheap food is so widely promoted. You're right re trying to advise 6 million people, & the lack of Big Brother government in not being specific re eating wholefoods is people getting vague information that's open to interpretation,
I remain alarmed at the difference between school cookery lessons that I took, where we learned a different cooking method every week & had to learn basic nutrition, has been replaced with learning microwave cooking & designing processed food packaging ~ the latter being taught as the government controlled curriculum.
It's a pity fruit, veg & wholefoods don't get the same tax breaks as the multinational "food" companies get from selling so much junk.
I agree with what you have said here BadHare as I watched Sugar Free Farm a couple of years ago with Ann Widdecombe as one of the celebrities taking part and the bit where she used low fat spread on her bread etc. She was told that butter in small quantities was better and she didn't believe that until they asked her to make the margarine, she duly did that and was disgusted with the manufactured ingredients that were used for the margarine. After the experiment she said she was never going to eat low fat margarine again.
I was told not to eat margarine by a reflexologist in 1993, & the same advice that moderate amounts of natural butter is better.
A relative who ate margarine, artificial cream & milk substitutes, rather than natural dairy had cancer twice with a stoke inbetween, before she was 50. I think the artificial diet contibuted to her morbid obesity, as did her sugar substitute drinks.
I've never been told not to eat it but I haven't had margarine for a few years now and would never ever go back to the stuff. I recently purchased some lactose free spread as my daughter is lactose intolerant, I made a cake for her with it at Christmas, but the one I bought had 62% of butter, 24% of Rapeseed Oil, water, 1.2% salt, Lactic Culture, Vitamins A and D and Lactase Enzyme. This was the only lactose free product I could find that replaced butter.
I had a look at all the other spreads that didn't have lactose in them and they contained so much rubbish in them i.e. Palm Oil that I refused to buy them.
Really feel for your family member, how awful. It was drummed into us for years that low fat was good for us and we are now realising that it isn't good.
I no longer drink diet or any other squash as my drinks are either water or coffee. I very occasionally will have a Diet Coke when I'm out but as I don't go out very often this is very rare.
Recently I have cut so much rubbish out of my diet. I made flapjacks today which are made using dates, oats, butter, coconut and honey. I no longer use honey for these and the last batch I made I used Organic Rice Malt Syrup and it made delicious flapjacks. I have used a small amount of Maple Syrup and Coconut Syrup today (the Coconut Syrup is made extracting the liquid from the leaves of the Coconut and nothing else).
I am very aware of what I eat these days and actually don't want to eat rubbish any longer which is really good.
Alicia
BadHare
Thank you for posting this
This can lead to discussions
A few conclusions i make:
1) Take home cooked foods
2) Avoid packaged foods
3) Avoid Refined carbs
4) Avoid the modern processed seed oils & try to have minimal traditional oil / fat type
5) Just avoid or at least minimze sugar sweetened beverages
6) Dont fear healthy fat. We can have some fair amount of Good Fats which offers fat soluble vitamins like A,D,E & K2
Communities like HE does encourage Healthy eating & with Zest initiating the posting of Today's meals in pic form... This should be it... Sticking to good home made foods.
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