Public Health England (PHE) has just launched the latest version of the Eatwell Guide (1). In the related PR the following points were made:
- There is greater prominence for fruit, vegetables and starchy carbohydrates, preferably wholegrain, in the new guide. PHE recommends consuming 30 grams of fibre a day, the same as eating 5 portions of fruit and vegetables, 2 whole-wheat cereal biscuits, 2 thick slices of wholemeal bread and 1 large baked potato with the skin on. Currently people only consume around 19 grams of fibre per day, less than 2 thirds the recommendation.
- Adults should have less than 6 grams of salt and 20 grams of saturated fat for women or 30 grams for men a day.
- SACN recommends that the dietary reference value for total carbohydrate should be maintained at a population average of approximately 50% of dietary energy. Carbohydrates are a good source of energy and SACN recommends that we should continue to base our diets on them. Their report concludes that total carbohydrate intakes at the current recommended levels show no association with the incidence of cardiovascular disease, type 2 diabetes, glycaemia or colo-rectal cancer.
According to Dr Alison Tedstone, chief nutritionist at PHE:
“The evidence shows that we should continue to base our meals on starchy carbohydrates, especially wholegrain, and eat at least 5 portions of a variety of fruit and vegetables each day.
“On the whole, cutting back on foods and drinks that are high in saturated fat, salt, sugar and calories would improve our diets, helping to reduce obesity and the risk of serious illnesses such as heart disease and some cancers. A smoothie, together with fruit juice, now only counts as 1 of your 5 A Day and should be drunk with a meal as it’s high in sugar.”
Dr Lisa Jackson said:
- “As a GP it is important that I have engaging and meaningful resources like the Eatwell Guide to support my patients to eat more healthily. I encourage professionals helping people to follow a healthy, balanced diet to use the new Eatwell Guide which will help reduce their risk of developing long term illnesses such as heart disease, Type 2 diabetes and some cancers.”
So although the dangers of sugar have clearly been recognised, essentially we are being bombarded with the same old rubbish that got us into the mess in the first place. An excellent detailed critique of the Guide has been done by Zoe Harcombe which explains in detail why there are fundamental flaws in the justification of the dietary advice (2).
Lots of carbs
It really is unbelievable that the official advice from PHE continues to emphasise the importance of having such a high proportion of the diet as carbohydrates. Obviously the authorities are relying very heavily on the recommendations made by the SACN group which produced a report on carbohydrates which was released in July 2015 (3). The big problem with this report is that it restricted its deliberations to those research studies which it considered relevant. There was a total failure to address current public health concerns. It is my contention that Type 2 Diabetes (T2D) is one of the best indicators…essentially it is the tip of the iceberg because those with T2D have a greatly increased risk of developing most of the serious chronic diseases/conditions including heart disease, Alzheimer’s Disease (AD) and cancer. In the past 15 years the incidence has doubled and all the projections accept that it will continue to increase. It is glaringly obvious that the present strategies are not working. So from a policy perspective it is paramount to focus on this issue.
There is now no doubt that insulin resistance is the key concept to our understanding of T2D and the many other forms of ill-health that are associated with it. This was conceived by Gerald Reaven as long ago as 1988 (4). It is caused by continued high levels of insulin in the blood. This because the insulin is needed to control excess glucose in the blood, which in turn is caused by a habitual diet which is high in sugar and carbohydrates. When this happens the various organs in the body develop insulin resistance and as a consequence the pancreas has to produce even more insulin to achieve the same effect. Ultimately there is catastrophic failure because the pancreas is unable to meet the demand for insulin. It is at this point that the blood glucose is out of control with the result that the level in the blood starts to increase. This is full-blown T2D.
The main carbohydrate in foods is starch which is broken down to glucose. It is present in bread, flour, potatoes, pasta and rice. Hence it follows that the obvious answer is to limit the intake of carbohydrates as well as sugar. There is no disputing the logic of these conclusions. We do not need complicated scientific trials to prove this. Nevertheless there is research which produces the expected results (5) not to mention the numerous individuals who have found out for themselves that their T2D can be effectively controlled by a diet which has a low content of sugar and carbohydrates. Invariably these people have replaced the carbohydrates with fat, which includes many sources of saturated fats (SFAs) such as meat, dairy and coconut oil.
In the light of this knowledge, it is completely irresponsible for government and the health professions to recommend such high intakes of carbohydrates. It really is not rocket science to accept that the key to an effective policy on T2D must focus on the factors which contribute to the development of insulin resistance. Therefore instead of recommending a high intake of carbohydrates, the emphasis should be to reduce the consumption. It is somewhat disingenuous that the official view is caused by insufficient insulin production (6) but of course this suits the pharmaceutical industry very nicely. A policy based on changing the diet means that the demand for drugs would be reduced drastically.
The fundamental reason for the advice to consume plenty of carbohydrates originates with the vilification of the SFAs, which takes us back to the cholesterol fiasco. We now know that most this is nonsense. In particular we know that those who have cholesterol levels which comply with the guidelines actually have the highest death rates (7).
The present policy is an absolute scandal which appears to be in the best interests of the drug companies very much at the expense of the personal health. If we are to make any kind of progress it is imperative that more and more people understand what is actually happening so that they can exert pressure for a fundamentally different approach that will result in improved standards of public health.
- G Reaven (1988) Diabetes 37 (12) pp 1595-1607