An extremely valuable contribution to our understanding of contemporary nutrition has just been released. This is a review of research which has been conducted by a team from the Credit Suisse Bank. The primary purpose is to understand the basic concepts which should be used to devise a diet consistent with good health. In my opinion, the work is objective and extremely competent. Hence the conclusions should be regarded as reliable.
There can be no disagreement that there are fundamental problems with the quality of the diet in many countries as demonstrated by the high incidence of obesity and type 2 diabetes (T2D). However there is debate about the relative importance of the different fats and carbohydrates. This blog will highlight the key points in the report:
- Natural fat consumption is lower than “ideal” and if anything could increase safely well beyond current levels.
- Although saturated fat (SFA) was blamed for being the main cause behind an epidemic of heart attacks this cannot be substantiated because consumption declined between 1930 and 1960. Smoking and alcohol were far more likely factors behind the heart attack epidemic.
- SFA has not been a driver of obesity: fat does not make you fat. The most likely causes are carbohydrates and the solvent-extracted vegetable oils (canola, corn oil, soybean oil, sunflower oil, cottonseed oil). Globally consumption per capita of these oils increased by 214% between 1961 and 2011 and 169% in the U.S. Carbohydrates and vegetable oils accounted for over 90% of the increase in calorie intake in this period.
- Total blood cholesterol (TC) and LDL cholesterol (the “bad” one)—are poor indicators of CVD risk. In women in particular, TC has zero predictive value if we look at all causes of death. Low blood cholesterol in men could be as bad as very high cholesterol. The best indicators are the size of LDL particles and the ratio of TG (triglycerides) to HDL (the “good” one). A VAP test to check your pattern A/B costs less than $100 in the USA, yet few know of its existence.
- The intake of foods rich in SFA (butter, palm and coconut oil and lard) poses no risk to health and particularly to the heart. SFA should be regarded as a healthy source of energy and it has a positive effect on the pattern A/B.
- Transfats have negative health effects.
- Most research on consistently shows benefits from additional intake of omega-3 fatty acids. Additional intake of 1 gram per day of omega-3 reduces the risk of CVD death by 5-30%. It has also been shown to be beneficial in lowering the risk of mental illnesses such as Alzheimer’s Disease or dementia.
- An analysis based on a group of 22 European countries shows that there is a positive correlation between the increase in omega-6 intake and the level of CVD deaths.
- Two surveys of doctors, nutritionist and consumers revealed that all three groups had only superficial knowledge of the potential benefits or risks of increased fat consumption. Their views are influenced significantly more by public health bodies or by WHO and AHA rather than by the results of research. With respect to cholesterol, 40% of nutritionists and 70% of the general practitioners surveyed still believe that eating cholesterol-rich foods is bad for your heart.
- Consumers have a positive perception of fish, nuts, chicken, eggs, yogurt and milk as sources of fat and a negative view of beef, pork, cheese, margarine and butter. They are neutral to positive on vegetable oils in general, but olive oil commands a very positive “healthy” image.
- Health care officials and government bodies have been consistently behind developments on the research front. Research showed that transfats were quite unhealthy as early as 1993, yet a full ban of transfats in the U.S. will only happen in 2018. In Europe only Switzerland and Denmark have so far banned them. The stance of most officials and influential organizations such as WHO or AHA is now well behind research in two main areas: SFA and polyunsaturated omega-6 fats.
- Carbohydrates are one if not the major cause behind the fast growth of metabolic syndrome cases in the U.S.—4% a year—which includes T2D and obesity.
The research team analysed the changes which changes in consumption which occurred in the USA between 1971-75 and 2009-10 during which time the percentage of obese males rose from 12.1% to 35.5%. Over this period, total fat consumption increased just 2%, SFA declined by 7% and protein increased just 7%. By contrast, carbohydrate consumption increased by 30%. The corresponding changes in specific foods is also relevant. Red meat consumption declined by 24%, butter and lard by 39% and eggs by 21%, and dairy rose by just 5%. Conversely, the consumption of vegetable oils (rich in omega-6) soared by 89%, chicken by 139% (which contains saturated fat and omega-6 in almost equal quantities), maize by 100% (rich in omega-6) and sugar by 25%.This led to the conclusion that:
“It seems clear that saturated and monounsaturated fats have very little to do with the soaring levels of obesity among the U.S. population but that carbohydrates and/or polyunsaturated fats (mostly omega-6) have a lot to account for and are also the two main factors behind the overall increase in calorie intake. Excessive consumption of carbohydrates and omega-6 have been shown to trigger insulin resistance through an inflammatory response. Note that obesity is not just an isolated “illness.” Most obese people have a higher probability of experiencing cardiovascular problems, diabetes, and other metabolic illnesses. In retrospect, it would be easy to conclude that in the U.S. the stance of many health officials and medical researchers against saturated fat—and the concomitant switch into carbohydrates and potentially omega-6—created a health disaster of major proportions.”
By focussing on the fundamental changes in the food consumption patterns, the research team has been able to obtain insight into those factors which may have been contributing to the changes. Even more significant, it is shows conclusively that the SFA could not possibly have any involvement in the development of obesity and related health problems. This approach contrasts favourably with that of many academic researchers who restrict themselves to investigations of doubtful validity while ignoring what is happening in the real world.
This is illustrated very neatly in this report with an evaluation of an epidemiological work on omega-6s. A meta-analysis reached the conclusion that replacing 5% of SFA with polyunsaturated fats lowered coronary events by 13%. But there was no breakdown of the relative proportions of omega-3s and omega-6s. Because omega-6s cause inflammation and omega-3s are anti-inflammatory, this information is essential if any sound conclusion is to be drawn. Furthermore there was no information on the content of transfats present in the SFA. In the absence of this information it was totally impossible to reach a definitive conclusion. The fact that the research team identified these weaknesses certainly inspires confidence in the quality of the investigation.
Based on the results, forecasts are made about how demands for various foods and ingredients are likely to change in the future which include:
- Fat consumption per capita is expected to grow from the 26% of total energy intake registered globally in 2011 to close to 31% by 2030.
- Carbohydrates will decline from 60% of global energy intake in 2011 to 55% by 2030. This substantial decline is likely to happen because of that the rising awareness of the link between excess carbohydrate consumption (and particularly sugar) and T2D, cardiovascular issues and mental illnesses.
- SFA is likely to experience the fastest growth, rising from 9.4% in 2011 to 12.7% of daily energy intake by 2030, monounsaturated will increase from 10.2% to 12.2%. On the other hand omega-6s are expected to decline slightly from 6% to 5.4% and omega-3s to grow from 0.50% to 0.55%.
- Meat consumption is expected to grow 23% over the next fifteen years. The perception of red meat is likely to improve with the acceptance of SFA as healthy rather than harmful.
- The two leading processed oils: rapeseed and soybean oil should decline somewhat. Palm oil should gradually improve its image and see the benefits of a trend towards “natural” oils and should grow by 10%. There is also a good future for olive oil and coconut oil.
- The growth in the demand for fish and nuts should be maintained.
- Eggs should do particularly well as the more people understand that the cholesterol theory has been discredited. By 2030, it is predicted that everyone will be consuming about 5 eggs per week.
- Demand for butter and cheese should continue to grow at a fast pace, in line with growth rates in the last 3-5 years. Milk and milk-related products should grow by 50% or 2.5% a year. Butter should continue to replace margarine and benefit from the full ban on transfats.
Publication of this report represents a significant step forward in progress towards a total re-evaluation of the current official dietary recommendations in most countries. As it clearly recognises, the guidelines developed in the USA during the 1970s have proved to be an unmitigated disaster. Awareness that changes are required is growing but there is inertia within governments to take the necessary policy initiatives. The fact that these issues are now being considered seriously by the business/financial interests will certainly help to drive things forward. While the implications in the marketplace for some products are poor there are others which will provide opportunities that can be exploited by progressive entrepreneurs. There are indications that this is already happening in Sweden where there has been a shortage of butter reported (2).
I am delighted that the conclusions here are in total agreement with several of my earlier blogs on topics including:
- Cholesterol (3)
- Saturated fat(4)
A very welcome report which is further ammunition for those of us who to are keen to get these concepts widely accepted.
- Credit Suisse Research (2015) “Eat: The New Health Paradigm” https://doc.research-and-analytics.csfb.com/docView?language=ENG&source=ulg&format=PDF&document_id=1053247551&serialid=MFT6JQWS%2b4FvvuMDBUQ7v9g4cGa84%2fgpv8mURvaRWdQ%3d