 
# Olive oil can tap dance

by Zoë Harcombe
Olive Oil Can Tap Dance

Copyright © Zoë Harcombe 2013

Published by Columbus Publishing Ltd at Smashwords 2013

Epub edition

www.columbuspublishing.co.uk

ISBN 978-1-907797-40-8

Zoë Harcombe has asserted her right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise without the prior permission of the author. This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each person you share it with. If you are reading this book and did not purchase it, or it was not purchased for your use only, then you should return it and purchase your own copy. Thank you for respecting the hard work of this author.

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Brand and product names are trademarks or registered trademarks of their respective owners.

All links to external sources were correct at the time of writing each post. Some may have changed since

The information provided in this book should not be construed as personal medical advice or instruction. No action should be taken based solely on the contents of this book.

Readers should consult appropriate health professionals on any matter relating to their health and well being.

The information and opinions provided here are believed to be accurate and sound and are based on the best judgments of the author, but readers who fail to consult appropriate health authorities assume the risk of any injuries. Neither the author nor the publisher can be held responsible or liable for any loss or claim arising from the use, or misuse, of the content of this book.

# Table of Contents

Introduction

How medical studies are manipulated

Kellogg's Coco Pops Advert

Kellogg's Special K Mini Breaks

Olive Oil can Tap Dance!

The calorie myth & eating 36,000 calories a day

Weight Watchers works – according to a study funded by Weight Watchers

Statins with your burger? Better add a pregnancy test too

"Surgery is better than dieting, says conflicted doctor"

One in ten adults dangerously obese...

Weight Watchers ProPoints plan – what's it all about?

Cholesterol & heart disease – there is a relationship, but it's not what you think

The White Paper on Public Health (Andrew Lansley)

UK Women are the "World's Worst Dieters"

Red meat & cancer & very bad journalism

Five-a-day – is it enough?!

Bariatric Surgery: What's it all about?

MyPlate – the new American USDA food pyramid

Who's teaching our children about 'nutrition'?

The Vegetarian Myth – Lierre Keith

Red meat & diabetes?

Nutrition – where will a student be taught the truth?

# Introduction

Probably my best blogging experience was waking up on the morning of March 14th 2012 to find that one of my heroes had commented on one of my blog posts overnight. The comment was "Hi Zoe My simple comment: nice job. Thanks gt." gt stood for Gary Taubes! I had posted a blog the day before entitled "Red meat & mortality & the usual bad science" and I'd had one of those 'viral' moments when it seemed I'd been one of the first to cover a breaking story and my analysis was widely shared.

That's what makes blogging so rewarding. We all have things that we want to say and we all want to counter bad science when we see it. The internet generally and blogging particularly have given the little person a voice (and I am little!) We don't just have to take things 'put out there' any more - we can answer back and then other people can share what we do, so that we can punch above our weight.

I started blogging in 2007, but it tended to be brief comments about something in the media, which needed addressing. I started blogging in earnest - or should that be in anger?! - in 2010 and I found myself putting serious time and effort into tracking down conflicts of interest, locating medical journal articles to dissect the original data, finding links that would help other people researching each topic and so on.

Over the next three years, I came to see the same tricks over and over again - manipulating 'research' to make a desired point. As Einstein famously said - "If you know what you're looking for it isn't research." The tricks played in presenting data in a misleading way are summarised in the opening chapter - this is not on open view anywhere on my sites. I hope that you enjoy it and I hope that it helps you to dissect studies in the way that I enjoy doing.

This book is a collection of my blog posts on www.zoeharcombe.com from February 2010 to September 2011. There are 20 in total - comprising approximately 40,000 words. They are on open view on my blog, but we have pulled together this book so that you can read them at your convenience off-line. This is the first of a series of books collating my blog posts in this way - look out for the others.

This first collection of blogs includes a classic post on the true relationship between cholesterol and heart disease. Conditions from diabetes to cancer are covered. We look at bariatric surgery and conflicts of interest. Kellogg's get a bashing and Weight Watchers doesn't fare much better. But then nor does the English health minister. Is the USA dietary advice any better? Does the calorie formula hold? What's the deal with five-a-day? And who's indoctrinating our children - and nutritional students? If you want to win an argument with a vegetarian - it's all in this book.

Thank you for reading this and for not simply accepting the nonsense that is spouted by our governments and their advisors. I hope one day that they will be sued for what they have done to their fellow humans. Until then - bloggers will keep blogging.

# How medical studies are manipulated

This article was inspired by an article that appeared in the media on Monday 31st October 2011. (Link) The original journal article was actually accepted in July and published in August, so I'm not sure why it was suddenly 'hot news' on Halloween (Link). The Daily Mail article opened with: "A daily dose of drugs designed to lower cholesterol could also slash the risk of breast cancer recurring, say researchers. They found that women who had developed a breast tumour were nearly 30 per cent less likely to suffer a relapse if they took a type of statin called simvastatin."

Normally, I can see through 'research' in a few seconds and at least know the game that has been played straight away. I must admit that this one baffled me. Every common sense bone in one's body says – the opposite would be the case. Healthy cells need cholesterol, cancerous cells need even more cholesterol – how can there even be an association between taking statins and cancer reoccurrence? I circulated the original study and the Daily Mail report amongst The International Network of Cholesterol Sceptics (thincs.org) and got the response within an hour or so. It made me think that it would be beneficial to document all the tricks being played on us – not just on Halloween, but every day of the year.

Before we look at the tricks, let's just remind ourselves of the two main types of study:

Types of studies

There are two main types of studies – a) epidemiological and b) clinical trials.

a) An epidemiological study is one that looks at populations. This kind of study gathers data on different groups of people and then tries to look for patterns and differences between those populations. The populations can be small (a few people) or entire countries. Epidemiological studies can only suggest association, but they may throw up interesting observations that will help to focus further research.

The Seven Countries Study was an epidemiological study. Such studies don't have to be done on a whole country basis and indeed are often more helpful when done on a section of a population basis. Hence, the Seven Countries Study included people from the countries Finland (2), Greece (2), Holland (1), Italy (3), Japan (2), USA (1) and Yugoslavia (5). There were 16 regions studied within these countries (the number of regions studied in each country is in brackets). We call a population being studied in an epidemiological study a "cohort". So there were 16 cohorts in the Seven Countries Study.

Epidemiology is a useful and interesting science, but not an end in itself. It should suggest connections to be investigated further, but not make assertions about causation. You can see that it has the potential to be abused and misinterpreted all the time. As examples, we can observe that approximately 64% of Greek men smoke and 36.7% of UK men smoke. (Link) We could observe in parallel that the national debt of Greece is higher than the national debt of the UK. We would be unlikely to try to connect these two pieces of information (unless we tried to argue that Greece was less productive as a nation because of cigarette breaks!) However, if we observed in comparison data that Greek death rates were substantially higher than those in the UK, we could suspect that smoking has something to do with dying and investigate this further.

b) Clinical trials are studies where a specific intervention is made to test a hypothesis. Usually there is one group of people called the control group and one group of people called the intervention group. The control group either has nothing done to it, or is given a placebo (dummy medication in effect), so that they don't know that they are NOT being treated. The intervention group is 'treated'. In rare studies, there are more than two groups. As an example – one group may have no change in diet, group two may have fish oil added to their diet and group three may have olive oil added to their diet. This would be done to see if either fish oil or olive oil is better than no oil. The more of the following components that a clinical trial has, the better it is considered to be:

– Large numbers of people. Broadly speaking, the larger the study the better. If we compare two people and discover something, the chance of this being coincidental is quite high. If we observe a pattern in 100,000 people, this is more significant (statistically, as well as logically).

– Randomly assigned people. Clinical trials should NOT be able to select which people go in which group otherwise bias could be introduced.

– 'Blind' people. This means that people don't know whether they are in the control group or the intervention group. It requires that (if the trial is about a new drug), both groups take a drug that looks the same, but one group is taking the actual drug and the other is taking a dummy pill. This overcomes the well known placebo effect – that people feel better just because they are being treated. Both groups should have similar placebo effects and then any real effects should be comparable. (You can see that it would be virtually impossible to have a 'blind' diet trial).

– Double blind. This means that both the participants and the researchers don't know who is taking which drug. A clinical trial sets out to test a hypothesis. Human nature says that we will look for what we are expecting. Hence if we think that a drug will lower blood pressure and we get what looks to be a surprise reading, we may try to dismiss it, exclude it or explain it away if the reading seems contrary to what we are expecting. If we don't know if the reading for person 123 is someone on the drug or the placebo, we are less able to bias the results.

– Only one thing should change. This is the most difficult one to achieve. The perfect trial would have group A given a drug and group B given a dummy and absolutely nothing else would change whatsoever – no change in diet, location, job, stress, happiness, marital status, family circumstance etc. Clearly this is impossible to achieve. The size of the study is assumed to help compensate for this. In a large study, with people randomly assigned, it is as likely that there were similar lifestyle changes in both groups, such that any impact of the drug should still stand out above this. However, many, if not most, of the studies that you will see are done on very small numbers.

As an example, the June 2011 headlines, that low calorie diets could 'cure' diabetes came from a study of just 11 people (Link) This study illustrates another way in which a 'clinical trial' experiment can be done. An intervention can be done with one group of people and the rest of the population (in this article – the two and a half million other diabetics) can be considered the control group.

That's the basis structure of studies being undertaken in universities, hospitals, research centres and Research & Development (R&D) labs world-wide, right now. Here are the ways in which the studies can be manipulated:

1) The funding of the study.

This is the starting point and one of the most significant opportunities for bias. Studies are expensive. Drug studies are phenomenally expensive. Surgical studies even more expensive again. Someone has to fund these. The most likely funder is the pharmaceutical company. As a general rule, only those who stand to gain are going to spend a lot of money on research. Drug companies are in fact obliged to do clinical trials, before a drug can be approved and therefore have to fund these. Drug companies are also able to analyse the results and be involved at every stage of the process. As we will see in the following points, there are many ways in which data can be manipulated, exaggerated and/or excluded, which may be unethical, but sadly not illegal.

Epidemiological studies are also extremely expensive and can be funded by governments, which may have a genuine interest in important discoveries. For example, if governments could prove that eating five portions of fruits and vegetables a day reduces the risk of cancer, they could consider the cost of promoting such a message (or even giving vouchers for produce) vs. the cost of treating cancer to their public health service. However, epidemiological studies are also run by humans and humans are prejudiced (this literally means to pre-judge) and they may be inclined to try to find what they think the study will show.

When Ancel Keys received government funding for the Seven Countries Study he was already convinced that fat and/or cholesterol were the cause of heart disease. When this is the preconceived view, it influences what one does and what one looks for, and sees, in data.

As a matter of interest, the EPIC study (the European Investigation into Cancer) has cohorts in Denmark, France, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden and the United Kingdom. The UK has cohorts based in Cambridge (Norwich) and Oxford. The Norwich cohort has 30,000 participants and this is funded by an MRC (Medical Research Council) Programme Grant and by additional grant funding from Cancer Research UK, the Stroke Association and the Food Standards Agency. So, it's an investigation into cancer, partly funded by Cancer Research UK – Cancer Research UK are not going to want to feel that their money has been wasted by the results being "consumption of five fruit and veg a day makes no difference." And yet, this was what the European study concluded in April 2010 and the UK study concluded in November 2010.

In November 2010, the UK part of the EPIC study published their findings in the British Journal of Cancer (Link). Professor Tim Key concluded that: "The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established."

If you can get to the source of the funding of any study, you will invariably find conflict of interest. One problem is that the funders are making it increasingly difficult to find that conflict. The article will either conveniently leave out the funding source or declarations of interest will be vague and difficult to find or third party bodies will be used to give implied legitimacy to the study. For example, the Weight Watchers study in July 2010 (Link) was ostensibly done by the government Medical Research Council. The Sunday Times needed to do very little digging before they discovered that Weight Watchers paid approximately £900,000 to the MRC to do a very specific study: The control group should go to their GP and get weight loss advice and nothing more. The intervention group should attend Weight Watchers for a year and then the study can achieve the desired headline "Weight Watchers works better than going to the GP" (Link).

If the study itself is not actually funded with conflict, look out for the conflicts of interest of the 'researchers'. Example 1, on 18 May 2010, Peta Bee reported in the UK Daily Mail "Giving up bread can make you fat: Gluten is good for you." The expert in this report was Dr. Emma Williams of the British Nutrition Foundation. Excellent job done there, keeping the many food industry sponsors of the BNF happy. (Link).

Example 2, on 18 January 2010, the headline news was "Ban butter to save thousands of lives says heart surgeon." Shyam Kolvekar called for a ban on butter and said people should switch to 'a healthy spread'. Mr Kolvekar's comments were issued by KTB, a public relations company that works for Unilever, the makers of Flora margarine. Felicity Lawrence, writing in The Guardian on 23 January 2010 noted that the surgeon's hospital, University College London Hospital (UCLH), had received a fee from KTB for filming Kolvekar performing heart surgery, as part of Unilever's campaign to highlight the dangers of eating too much saturated fat (Link).

2) The subjects of the study.

Roland Rat, or Mickey Mouse, rather than Fred Bloggs, or Jane Doe, is the subject of many studies. We clearly can't remove ovaries randomly in women, so we remove them in rats and see what happens. The study usually reports any findings reasonably accurately and notes findings in rats without suggesting that these findings will be replicated in humans. However, to make the headlines, the summary has to be human. One never sees the headline "rats exercise better after eating chocolate", but the headlines in August 2011 were "How chocolate can help your workout." (Link) Either the press release of the study, or the media story, will make the quantum leap from rats to humans. What happened to the rats may happen to humans, but we won't know unless we study humans.

Using this ovaries one as an interesting example... We can effectively study the same thing happening in humans without removing ovaries as an experiment. Some women do have ovaries removed as part of a hysterectomy or because of an ovarian cyst or other medical condition. We also see the mimicking of ovaries being removed when women reach menopause and eggs are no longer produced, as if the ovaries are no longer there. Having done the rat studies is then very useful because it helps us to observe similarities and to understand possible pathways. We observe rats with ovaries removed eating voraciously. Further studies can show hormonal changes that increase appetite hormones and impair metabolism hormones and we can then understand HOW the ovary changes are impacting weight. This does enable us to advise measures to counter the changes. Whereas we assume that people can largely trust appetite while eating real food/managed carbohydrate, post menopausal women may need to be aware that they may feel 'inappropriately' hungry much of the time and to develop strategies to overcome this.

One would need to be an expert in animal biology to know how comparable different animals are to humans. Here is an interesting general article about how useful animal studies are to tell us things about human health. (Link) We can easily research basics like – do rats have a pancreas? – which can tell us if they release insulin and may be of use in blood glucose studies. However, you don't need to research far to see that the rat may have a pancreas, but it may not be an appropriate comparator for the human pancreas (Link). Rats don't have gall bladders so will necessarily metabolise fat very differently to humans.

In conclusion for this factor, any studies done on rats or other animals should be treated with caution. A good study will raise the limitations of having done the study on animals and only make reasonable assertions for how this will translate to humans. However, that won't get them in the Daily Mail, so expect this to happen less and less often.

3) Association vs. causation.

This is the huge one. Two things can be observed at the same time and this is association (at best). Those things can be entirely coincidental or they can be connected but with no causation (in either direction) or they can be causally related (although we can't tell this from association) or they may be both caused by something else entirely. The best example I've found to use is the singing and bathing one. I can observe people in the bath singing, but I can no more say that being in the bath causes singing than I can say singing causes being in the bath! They are just two things that can be observed at the same time.

Epidemiological studies are entirely about association – they can suggest causation, but they cannot prove it. They can show us populations with below average incidence of a particular disease or illness and they can show us another differential that could be related, but they cannot tell us any more than this. They essentially help researchers to know what they should follow up with a clinical trial e.g. don't bother looking at wine consumption, because this was similar in countries where condition X varied enormously. However, do look further at beer consumption, because an association was detected between beer consumption and condition X.

This introduces another very important factor and one where manipulation can occur. Epidemiological data is often available for most countries in the world. The World Health Organisation goes to great trouble to get health and lifestyle information for as many countries in the world as possible. If researchers then select a sub set of all the data available, this should immediately be challenged – why?!

The Seven Countries Study is the most classic example of this and the one that has had the most catastrophic consequences. In The Great Cholesterol Con, Dr Malcolm Kendrick analyses the World Health Organisation data for the seven countries with the lowest consumption of saturated fat (Georgia, Tajikistan, Azerbaijan, Moldova, Croatia, Macedonia and the Ukraine) vs. the seven countries with the highest consumption of saturated fat (Austria, Finland, Belgium, Iceland, Netherlands, Switzerland and France). He found that every single one of the seven countries with the lowest consumption of saturated fat had significantly higher heart disease than every single one of the countries with the highest consumption of saturated fat. This, of course, concludes the exact opposite of the Keys' Seven Countries Study.

When I did my original research on cholesterol and heart deaths, I deliberately took all the WHO data for all 192 countries. Why would I pre select a certain number of countries? I wasn't setting out to test any pre-judged theory. I was setting out to see if there were any relationship between cholesterol levels and heart deaths and was stunned to see the pattern. So stunned that I repeated it for cholesterol levels and all deaths and was even more stunned (Link).

Clinical trials can also claim causation when they have merely observed an association. A classic example would be the 'study' being done in the first episode of Food Hospital (Link) where a small group of people were randomly split into two and one half had some white chocolate daily and the other half had some dark chocolate daily. (You can test how good a study this is already – small group = not good; random allocation = good; test is not blind, let alone double blind = not good; I didn't see any effort to establish if the group differed in any other way or if they were told to add the chocolate and make no other change whatsoever to their diet or lifestyle until the experiment ended = not good).

The voice over on the programme described the two versions of chocolate as nutritionally comparable – are they serious? I bet they have matched the same number of calories and maybe fat grams, but the carbs, sugar, protein, minerals, vitamins etc will be vastly different. Let us say that they find blood pressure drops in the dark chocolate group, they will jump to the conclusion – dark chocolate reduces blood pressure (immediate leap to causation). It could be that iron (of which dark chocolate is a rich source) reduces blood pressure and that the dark chocolate is merely a delivery mechanism. It could then be argued that the 'how' doesn't matter, the fact is that dark chocolate reduces blood pressure. However, if the causal factor is iron (and all this is just an example), then iron needs vitamin C for its absorption. So, eating dark chocolate alone may not reduce blood pressure. Both the white and dark chocolate groups may have been diligent about their 5-a-day (ha ha) and have been getting plenty of vitamin C. We can't then say that eating dark chocolate reduces blood pressure. We would have to say – eating dark chocolate can reduce blood pressure if vitamin C intake is sufficient. We can also say (again – just using this as an example) – eating anything containing iron, in the presence of sufficient vitamin C, will reduce blood pressure. We also don't know if the caffeine in dark chocolate will raise blood pressure and if something else in dark chocolate will more than counter this. You can start to see how this 'change only one thing' in clinical trials is virtually impossible to achieve.

4) Get the definitions wrong.

This is also a classic error made – particularly with our dear friend saturated fat. It can happen in both clinical trial and epidemiological studies. It happened in the original Seven Countries Study, which led to the damnation of fat and the subsequent obesity epidemic, as we replaced natural fats with unnatural carbohydrates.

I go through the Seven Countries Study in great detail in Chapter 8 of The Obesity Epidemic, because it is the study that changed the way that the world eats. In the original publication about the study – in Circulation, April 1970, the claims that Keys made were three fold:

i) CHD (Coronary Heart Disease) tends to be directly related to serum cholesterol;

ii) Serum cholesterol tends to be directly related to saturated fat as a proportion of the diet;

iii) CHD is as closely related to saturated fat as it is cholesterol.

Please look at these assertions carefully. It should be noted at the outset that Keys did NOT say that saturated fat consumption causes anything; certainly not that it causes heart disease. The study did not assert that even a consistent association exists between saturated fat and heart disease and/or saturated fat and cholesterol and/or cholesterol and heart disease (although you really would not believe this when you see how entrenched diet advice has become since – and this study is the catalytic foundation of all views that saturated fat is bad for us).

The key mistake in the Seven Countries Study, however, was one of wrong definitions. I credit Dr Robert Lustig in Chapter 8 for finding this key passage in a 1980 publication by Keys "Seven Countries: a multivariate analysis of death and coronary heart disease": "The fact that the incidence of coronary heart disease was significantly correlated with the average percentage of calories from sucrose in the diets is explained by the inter correlation of sucrose with saturated fat."

There is only one real food on the planet containing sucrose and saturated fat and that is avocado. We know from this passage above, therefore, that Keys was measuring processed food in his study. Having read all twenty volumes of the study I can confirm that a) there is barely any information whatsoever about diet in a number of the cohorts and b) references to fat include cakes and ice cream and c) Keys has assumed that meat and eggs are saturated fat – they do contain saturated fat, but they contain more unsaturated fat.

Notwithstanding that the Seven Countries Study did not find or even allege causation between fat and anything, Keys was not measuring fat. He was measuring processed products – assuming that this was not a study about avocados! Hence, any association that Keys may have found cannot isolate saturated fat from unsaturated fat, let alone fat from sugar/flour carbohydrates. Is it the ultimate irony that Keys measured processed carbohydrates thinking that he was measuring fats and then demonised fat leading to us eating more carbohydrates – the real problem in the first place?!

The same can and does happen in clinical trials. In Chapter 11 in The Obesity Epidemic I go through the 17 studies relied upon by the Food Standards Agency in their continued demonisation of fat. Each of these studies claims to be a clinical trial looking at the impact of changing fat intake in a control group vs. an intervention group. Six studies need to be discarded because they are multi factorial trials. This means that several things were changed at the same time and therefore no difference can be attributed to any one change.

For example, you may have heard of a trial called MRFIT (1990) and this actually stands for Multiple Risk Factor Intervention Trial – bit of a clue there that many things were changed all at once! The things that changed in the intervention group were smoking cessation, diet, medication for hypertension and medication for water retention (diuretics). Even with all these interventions, 8.3% of the control group died and 7.7% of the intervention group died during the study. I would have expected stopping smoking alone to make more of a difference than that.

Even the studies that were not multiple factorial – ones that tried to change diet and diet alone – could not do anything with saturated fat alone because there is no food on this planet that is saturated fat alone. Hence, every single study that tried to change saturated or monounsaturated or polyunsaturated fat intake was actually changing all three real fats at the same time.

I think that people involved in these studies simply cannot know that all three fats are in all real foods and cannot know the proportions in different foods (e.g. meat and eggs being more unsaturated fat). You would not think that this could happen, and be perpetuated for almost 50 years. You would think that someone, at some stage, would know the composition of different foods. However, when I attended a conference in Cardiff in June called Physical Activity, Obesity and Health, Dr. Jason Gill gave a very interesting presentation on "Exercise, obesity and postprandial metabolism". While talking about fat in food, the pictures on the slide behind were of cola, burgers and fries – processed food and primarily carbohydrates. Gill referred to a study in The Journal of the American Heart Association where Merrill et al allegedly tested lipids after a high-fat meal. (Ref 1) The study subjects were fed "a high-fat breakfast purchased from McDonald's restaurant consisting of approximately two sausage McMuffins with eggs, one order of hash brown potatoes, and a glass of ice water." As soon as you know the food consumed, the conclusions are meaningless. This might tell us something about McDonald's food, it might tell us something about processed food, it might tell us something about hash browns and McMuffins, but it tells us nothing about real fat or real saturated fat.

Ref 1: JR Merrill, RG Holly, RL Anderson, N Rifai, ME King and R DeMeersman, "Hyperlipemic response of young trained and untrained men after a high fat meal", Arteriosclerosis Thrombosis and Vascular Biology, (A Journal of the American Heart Association), (1989).

The price of ignorance has been immense.

5) The more obvious association.

Do you remember the recent "Eating just THREE eggs a week increases chance of men getting prostate cancer;"? (Their emphasis) (Link) I did a blog on this here exposing the many errors and mistakes in this study and the reporting of it (Link) This illustrates another error that can be made – ignoring a more obvious association. As the blog says: "Even if the eggs have any relevance at all – what else could be happening at the same time? Were the egg eating men Paleo dudes, or were they egg and soldier addicts (blame the bread), or egg and brown sauce addicts (blame the sugary gunge), or even egg and bacon addicts who hadn't selected their bacon carefully enough (blame the processed meat)."

The same error is made in the opposite direction. When people find a weak association between, say, fruit and veg consumption and any health factor (because boy do they try to find these!) they make claims such as "eating more fruit and veg saves lives". It happened just this last week with the "Eat like the English and 4,000 lives could be saved". (Link) The claims went on to say that English people ate more fruit and veg and less saturated fat and salt than the Welsh, Scottish and Northern Irish. The error works both ways:

– On the fruit and veg side – people who do eat more fruit and veg are likely to be healthier people generally. The fruit and veg consumption is then a symptom not a cause. I said on a blog once – not many people put down an apple to light a cigarette! Many people may put down a beer to light a cigarette – it's an indication of overall lifestyle.

The most staggering conclusion for me in the European published findings from the EPIC study was that the study grouped participants into five categories from the lowest intake of fruits and vegetables (0 to 226 grams a day) to the highest intake (more than 647 grams a day). Significantly, the cancer risk did not vary between the five groups. Given that those who eat virtually no fruit and veg are more likely to be McDonald's and microwave consumers and given that those eating over 647 grams of fruit and veg a day (that will be some people eating a kilo of rabbit food) are more likely to be whole food health fans (sweeping generalisation, but I think it's reasonable) – the fact that there was no discernible difference in cancer between these two groups was astonishing. So, a) the evidence is that fruit and veg is not helping English people and b) even if it were it would more likely be a symptom of a healthy lifestyle than a cause of good health.

– On the saturated fat and salt side – given that idiot powers that be think saturated fats are biscuits, cakes, pastries, pies, crisps, ice cream, sweets, confectionery, savoury snacks etc, if Wales, Scotland and N Ireland are eating more of these I would not be at all surprised if this is detrimental to health. We know that processed food, processed carbohydrates especially, are truly evil. However, for once and for all, will authorities please stop calling processed carbohydrates saturated fats?!

6) Making big numbers out of small numbers.

This one is also classic and also happens all the time. Kendrick gives a great example in his book The great Cholesterol Con. He says that he can double your chances of winning the lottery – who wouldn't want that eh? Buy two tickets he says! If you have a one in fourteen million chance of winning the lottery, you now have a one in seven million chance. That's still naff all chance in reality – but double the chance that you had before.

The same game is played with risk numbers. The headline screaming "30,000 lives will be saved" is nonsense to start with because no lives are going to be saved – we're all going to die. However, the method by which they come up with this 30,000 number is equally nonsensical.

The gist of the game is that you ignore the denominator – that's the bottom number in a fraction. (e.g. in 2/3 – 2 is the numerator and 3 is the denominator). If 20 people die in a control group and 10 die in the intervention group, the significance of this depends on the size of each group. If each group had 40 people in it, that would be a 50% chance of dying in the control group and a 25% dying in the intervention group. That's pretty bad odds in both groups, but even worse in the control group. However, if the control and intervention groups are both 100,000 in size – that's a one in 5,000 chance and a one in 10,000 chance. When the chances of dying in a car accident are one in 200, neither of those odds would worry me.

What they then do is to scale up and say – if there are 60 million people in the UK and 20 in 100,000 die in one group and 10 in 100,000 die in another group then if everyone did what the control group did, in theory 12,000 people would die and if everyone did what the intervention group died, in theory 6,000 people would die. Notwithstanding all the other factors and distortions that we have looked at already – this is quite simply how they apply the maths. This then gives the headline "6,000 lives could be saved."

That's the reality in virtually every headline that you see claiming thousands of lives could be saved.

7) The one you could never guess.

We now come to the article that inspired this article: (Link) The original journal article is here (Link).

As I said in the introduction, I circulated this amongst the thinks.org academics and asked if they knew the game being played. Uffe Ravnskov knew the game only too well and I should have remembered that he used the same argument in reference to Alzheimer's in his book Ignore the Awkward.

Uffe shared a number of references showing that taking statins is associated with cancer incidence, low cholesterol is associated with cancer and confirming that all intuition and common sense is right – cholesterol's primary role is to form the basis of, and to repair, cells and therefore cholesterol is of enormous benefit in the fight against cancer, as cells need to be protected and repaired.

The Danish study was not a clinical trial – it was an epidemiological study – so it can only establish association. The researchers used the Danish Breast Cancer Cooperative Group registry for dates between 1996 and 2003 to collect data on women in Denmark diagnosed with stage I-III breast cancer. This amounted to 18,769 women. They then followed the progress of these women for an average of 6.8 years after diagnosis and observed that women on simvastatin (a particular brand of statin made by Merck) had approximately 10 fewer breast cancer recurrences per 100 women after 10 years of follow-up. Interestingly, women on statins called hydrophilic statins (more synthetic than simvastatin) were claimed to have "approximately the same risk of breast cancer recurrence as women not prescribed a statin over follow-up". Looking at the numbers, however, the range of results is from -0.01 to 0.11. This means from a 1% lower risk to an 11% higher risk – that's not insignificant!

Anyway – how can taking any statin even be associated (forget causation) with reduced cancer risk?

Uffe has the answer – when we think about someone 'on statins', we think lowered cholesterol and therefore our mind starts to make the connection between lower cholesterol and reduced cancer (which is what researchers want us to think and only thincs.org and real food fans would know this to be counter intuitive.) However – statins are given to people with high(er) cholesterol levels and therefore the people taking simvastatin had high(er) cholesterol levels. They could have still had higher cholesterol levels than those not taking statins at every stage of the follow up. We don't have the information to determine this. Hence their high cholesterol levels could have protected them against breast cancer recurrence and, but for the statins being administered, they could have had even lower recurrence still! The women with naturally low cholesterol may have had naturally less protection against cancer recurrence. So they wouldn't have been given statins and yet would have suffered more breast cancer recurrence.

This last one alone beggars belief, let alone when you put it together with all the other games that can be played alongside.

I hope that you now have all the ammunition you need to read the newspapers and health sites daily and to understand the games that people play.

# Kellogg's Coco Pops Advert

#### February 8, 2010

Bit of a long blog this, but hopefully worth it!

1) I subscribe to the Children's Food Campaign newsletter and support their campaigns.

The CFC got a great article in The Independent, which can be seen here.

2) This was an extract from the Children's Food Campaign January newsletter: "Ever thought of avoiding Coco Pops after school?"

"A new advertising campaign from Kelloggs, suggesting to children "ever thought of Coco Pops after school?" has been eliciting outrage from parents on forums such as Netmums and Twitter. We think it's shocking that Kelloggs, who are partners of the Government's Change4Life health campaign, are encouraging children to eat more sugary cereals (Coco Pops are 35% sugar) when one of the key messages of the Change4Life campaign is "sugar swaps", encouraging families to swap snacks with added sugar for low sugar or sugar-free alternatives. If you'd like to complain, you can email Kelloggs at corporateresponsibility@kellogg.com. You might also like to copy the Department of Health into your email to make them aware of your concerns: dhmail@dh.gsi.gov.uk."

3) So, of course, I emailed Kelloggs Corporate responsibility and the Department of Health as follows:

Dear Department of Health and Kellogg's (30/1/2010)

I am writing to complain about the advert encouraging children to eat Coca Pops after school. It is bad enough that our young people start the day with a bowl of sugary cereal (coca pops being 34% sugar). It is even worse to think that children are being encouraged to have another bowl after school. We are fighting an obesity epidemic and any sugar (empty calories) either displaces other nutritional food, which adversely impacts health, or it is eaten on top of other nutritional needs, which adversely impacts weight. There is no room for sugar in a healthy diet – let alone this amount being pushed on parents and children alike as a fun thing to do with cartoon animation etc.

That Kellogg's does this is not a surprise – it's a private company looking to maximise brand profitability for shareholders. That the Department of Health has Kellogg's as a Change for Life 'partner' is a disgrace. Department of Health – you lose all credibility as an advisor to UK citizens having such blatant affiliations with the food manufacturers.

I look forward to your response

Kind regards – Zoe Harcombe , Obesity researcher

4) You then get an auto reply from the Department of Health saying they will reply within 20 days, but I did get a letter back from Kellogg's on 3/2/2010 – fair do's – pretty speedy. Here is the response (I've put in my comments along side each 'defence'):

Dear Zoe

Re: COMPLAINT TO KELLOGG's ABOUT COCO POPS ADVERTISING

I wanted to contact you following your recent email to Kellogg's about us promoting our Coco Pops cereal as an after school snack.

The reason for recommending Kellogg's Coco Pops with milk as an after-school snack is no different from recommending it for breakfast – it's a nutritionally sound product that is suitable as part of a healthy balanced diet.

The fact is Kellogg's Coco Pops is a low fat, low saturated fat food, containing just 175 calories per serving with semi-skimmed milk. It provides 25% of the RDA (recommended daily allowance) for six B vitamins and 17% of the RDA for iron and calcium, as well as encouraging the consumption of milk which is normally eaten with our products. In fact, 40% of milk consumed in Britain is with cereals. , and breakfast cereals are the leading source of iron in the diet of UK children . (Zoe comment: Coco Pops are low fat because they are a cereal and cereals are predominantly carbohydrate! Coco Pops have vitamins because they are 'fortified ' because they would be nutritionally lacking if they weren't and even more vitamins are added when people drink milk – so give your child a glass of milk when they get home).

When it comes to sugar, one portion of Kellogg's Coco Pops has just 10.5g – approximately two teaspoons. To put this into context: a portion of fruit yoghurt contains 20g of sugar and toast and jam has 13g . (Zoe comment: sugary yoghurts and jam are also full of sugar – this doesn't make our product good, but we'll compare it to other bad stuff to try to make it look good).

Breakfast cereals provide only 5% of the adult daily intake of added sugars in the diet – compared to 37% from drinks, 32% from sugar, preserves and confectionary and 14% from other cereal products such as cakes . Breakfast cereals contribute 6% of the average daily intake of sugar in children yet up to 30% of some micronutrients such a B vitamins and iron. (Zoe comment: so let's double the intake of sugar from cereals, by getting kids to eat them after school, as well as before school, as cereal manufacturers are missing out on their share of the 'junk' market. Check spelling of confectionEry also).

Sugar adds to the enjoyment of food with no detrimental effect to health – there is no scientific evidence showing a link between sugar and obesity, cardiovascular disease, diabetes, hyperactivity or cancer. (Zoe comment: I love this one! I didn't actually suggest that sugar is behind the major killer diseases of the modern day, but, now you mention it... See Warburg, see Yudkin... what was my quote again? "If we have been eating food as nature intended for 24 hours then agriculture, which gave us large scale access to carbohydrates, started 4 minutes ago and our consumption of sugar has increased 20 fold in the past 5 seconds. I wonder which substance is more likelyto be responsible for obesity, diabetes, or indeed any modern disease...")

What I hope we can agree on is there's an established link between excess calorie consumption and weight gain. So – given the obesity challenge we all face – it seems prudent to compare the amount of calories in Kellogg's Coco Pops and milk to many typical post school snacks. A serving of Kellogg's Coco Pops with milk contains around 10% of a child's calorie GDA, a suitable amount for a snack. A typical milk chocolate bar is 255 calories; a 4 finger chocolate and wafer bar is 213 calories and a bag of chewy fruit flavoured sweets is 222 calories. Kellogg's Coco Pops with milk have noticeably fewer calories and less sugar then most of these options and provide many positive nutrients the other snacks do not. (Zoe comment: No. We can't agree on this. I actually don't care about calories – they are just fuel. I care about empty calories – sugar – which deliver fuel with no nutrition. This is what an obese society cannot afford to consume).

As a mum of two I understand the need for kids to have a quick snack when they got home hungry from school. But, we don't see any evidence that encouraging Kellogg's Coco Pops as an after school snack prevents children from snacking on fruit. (Zoe comment: Are they eating both?! Not much room left for a good dinner eh?)

Independent research shows 90% of mums give their children a snack after school, therefore we are not encouraging an eating occasion that would not normally happen. The top six foods eaten being crisps, fruit, sweets, yoghurt, chocolate and biscuits. Those who said that they would choose Kellogg's Coco Pops with milk as an alternative said it would replace (in descending order) crisps, chocolate, sweets and biscuits – not fruit or yoghurt. (Zoe comment: So parents who give their kids junk now have another option. The parents that give fruit will still do so. This is the argument used by cigarette manufacturers – we don't increase the size of the market – we just encourage people to swap brands).

Therefore, having Kellogg's Coco Pops with milk as an after school snack does not discourage the selection of fresh fruit, and also encourages the consumption of milk and provides essential micronutrients – an accepted dietary recommendation.

It's for these reasons we don't see promoting Coco Pops as an after school snack as being counter to our involvement with Change4Life. (Zoe comment: see what else Kellogg's sponsor below...)

I'd like to assure you that at Kellogg's we ensure all of our marketing and advertising is rigorously reviewed so that it complies with the relevant CAP broadcast and non-broadcast advertising codes. (Zoe comment: None of this matters much because we comply with the advertising standards code, so we can do what we want!) I'd also like to advise you the current Coco Pops outdoor advertising campaign comes to its natural end this Friday.

I appreciate dialogue via a letter isn't always the most productive. So, I or a member of my team of nutritionists would be more than happy to meet with you and discuss your concerns in person.

Yours sincerely

(Zoe: I've left out the name and contact numbers for privacy, but after the job title is "State Registered Dietitian") (Zoe comment: why am I not surprised?! The Kellogg's Senior Manager for nutrition is a dietitian. The head of the Sugar Bureau is a dietitian. The British Dietetic Association (BDA) is "delighted" (their word) to be 'in bed with' the sugar and flour organisations. Kellogg's are the sponsors of the British Dietetic Association's annual conference on obesity. The American Dietetic Association is sponsored by Mars, PepsiCo, Kellogg's, Unilever, General Mills and Coco-Cola. The BDA won't tell me their sponsors – can't think why. And then the dietitian primary slogan is "Trust a dietitian to know about nutrition". Not when every dietitian I have met defends sugar I won't!)

Finally – check out the Children's Food Campaign competition for a new Coco Pops slogan \- great fun! x

# Kellogg's Special K Mini Breaks

#### February 22, 2010

I saw a full page advert in a Sunday supplement magazine yesterday for Special K Mini Breaks – Chocolate variety. Described as "Mmmmmmmmmm"; "crunch"; "delish"; "biscuit"'; "chocolate"; "crispy"; "choccy"; "biscuity"'; "crunch"; "moreish"; "99 calories a bag"; "crunchy, delicious, biscuity bites".

How to get every word possible to tempt a dieter to eat stuff that they should be avoiding?! And, of course, as people who eat Special K are Queens of calorie counting, the 99 calories a bag is going to appeal. 99 calories of what, however? This is the full ingredients list from the Kellogg's web site:

Cereals (Rice, Wheat Flour, Whole Oats, Wholewheat, Rice Flour), Sugar, Vegetable Oil, Chocolate (5%)(Sugar, Cocoa Mass, Cocoa Powder), Wheat Gluten, Glucose Syrup, Defatted Wheatgerm, Dried Skimmed Milk, Partially Inverted Sugar Syrup, Salt, Oat Fibre, Barley Malt Flavouring, Raising Agents (E500, E450a), Flavourings, Emulsifier (Soy Lecithin), Antioxidant (E320), Vitamin C, Niacin, Iron, Vitamin B6, Riboflavin (B2), Thiamin (B1), Folic Acid, Vitamin B12.

Ignore the vitamins added to give this product a false impression of containing nutrients and you have sugar in the form of sugar (twice), glucose syrup, partially inverted sugar syrup and the flavourings are no doubt sweet ones. Then you have wheat flour, whole wheat, wheat gluten and defatted wheat germ. Ever wondered how we end up eating more sugar and wheat than any other ingredients out there?!

– 100g of this product is 72g of carbohydrate and 414 calories.

– 100g of pork chop is 0g of carbohydrate and 123 calories!

– 100 of apple is 14g of carbohydrate and 52 calories.

– 100g of porridge oats (dry oats, no water) is 69g carbohydrate and 379 calories.

Even if you care about calories – there are far better ways to consume calories than to eat 100g of this frightening selection of ingredients.

I had an eating disorder once, so I know what it is like to binge and starve and be horrible to oneself. I truly believe that putting this product in your mouth is being horrible to yourself. Be nice to yourself and eat real food! Nature makes the healthiest food – not Kellogg's.

# Olive Oil can Tap Dance!

#### April 21, 2010

Time to set the record straight on olive oil, or it won't be long before we see the title of this thread as the next Daily Mail article!

Here is the Daily Mail article from 19 April 2010. Olive oil can now apparently switch off genes and previous articles have told us that olive oil cures depression, saves lives and makes people live to over 100 and dance around tables in adverts for margarine.

Now for some common sense – olive oil is oil squeezed out of mashed olives (we do the same with avocados and make avocado oil – avocados must have a different PR Agency). Olive oil with acid levels below 1% can be called "extra virgin" and 1-3% acid levels can be called "virgin" (I have no idea what virginity has to do with any of this!) Non virgin olive oil is more acidic than this. And that is it!

In terms of composition, olive oil is pure fat (water and fat can't mix so oil is always 100% fat). In 100g of olive oil there are 75g of mono unsaturated fat, 14g of saturated fat and 11g of polyunsaturated fat. In 100g of pork chop (the USDA example called "Pork chop boneless, raw, lean AND FAT" – I deliberately chose a piece of meat with no bone and still with fat on), there are 75g of water, 21g of protein and 4g of fat (slightly under 4g actually). Of this fat – 1.5g is saturated, 1.8g is mono unsaturated and 0.5g is poly unsaturated. So 60% of our 'lethal/red meat pork chop" is the unsaturated fat, which apparently is going to save the world! (And remember how low the fat is in the first place).

This is how I can say olive oil has 6 times the saturated fat of pork – in this example it actually has 9 times (14g per 100g vs 1.5g per 100g). In another super extra fatty pork example, olive oil still has 6 times the saturated fat – I try to be fair!

So let's look at the nutritional content of olive oil. There are 2 very useful measures of nutrition and the US Department of Agriculture has some really useful analysis of food products against these:

1) is the amino acid score. Anything over 100 indicates a "complete" food from an amino acid perspective i.e. it delivers all the 22 standard amino acids used by a human;

2) is an overall nutrition score weighing up vitamins, minerals etc delivered in the product. This one is measured out of 100 – where 100 is the 'perfect' nutritious food – can't find any with 100!

Sugar scores zero on both measures – no protein, so no amino acids and no nutrients, so no score.

Our Pork chop with 4g of fat above scores 151 on the amino acid score. I keep a database of real food and I have nothing higher than this on my list of 50 standard products. The same pork chop scores 39 on the nutrition scale. The maximum is 100 and the highest I have on my list is broccoli at 92 (there will be a nutrient density thing in the calculation, so broccoli has huge nutritional value to energy/calorie level).

Olive oil (get ready) scores 0 on the amino acid score – it has no protein so it cannot score anything other than zero. It then scores 5 on the nutrient scale (5 out of 100). Olives themselves score 25 on the nutrient scale – so we're better off eating olives (of course we are – we are always better off eating food in nature's most natural form).

A whole egg, by the way, scores 136 on amino acids and 50 on nutrition. Egg yolk on its own scores 146 on amino acids and 50 on nutrition – so that's where the nutrition is in the egg – the bit that Californians throw away!

Please use any of this as ammunition the next time you see a claim made about olive oil. It's a useful food – good for salad dressing; butter and lard are better for cooking (saturated fats are chemically more stable) – but that's it. Unless we can run power stations on olive oil, it's not going to save the planet!

p.s. Please note – We've now got a club forum for all questions – please post at The Harcombe Diet Club – it will appear instantly after you sign up – no moderator necessary!

Many thanks – Zoe x

# The calorie myth & eating 36,000 calories a day

#### April 29, 2010

Here's the link to a great programme on super morbid obesity

Great programme spot from one of our super fans – Melissa. This is worth the 47 mins to watch. I just wanted to draw your attention to yet another example of the calorie myth being completely absurdly applied...

The programme features 4 morbidly obese people:

Paul is 45 years old and he weighs 48 stone and consumes an estimated 36,902 calories a day.

Larry is 38 years old and he weighs 50 stone and consumes an estimated 14,349 calories a day.

Lisa is 39 years old and she weighs 45 stone and consumes an estimated 9,277 calories a day.

Jacqui is 40 years old and she weighs 26 stone and consumes an estimated 15,880 calories a day.

Quick couple of observations:

1) Where on earth do they get the 2 calories at the end of Paul's estimate?! The calories in 1 gram of fat/carb/protein are not even accurate – how do they think that they can estimate a day's consumption to that level of accuracy.

2) Why is Paul not massively heavier than Larry? He's eating 2.5 times the number of calories and can't move around (as Larry proved he could when food was put in the other room!)

Ian Campbell (former head of National Obesity Forum) is the main expert speaker on the programme.

With reference to Paul – Ian says it is physically and physiologically impossible for Paul to burn off the calories he consumes. I agree – this is a factual statement using hours in the day and maximum activity rates possible – notwithstanding the fact that Paul is bedridden. However – I would like to see what would happen if Paul's intake were changed from predominantly processed carbs to real fat/protein. He would be unable to store fat in the absence of carbs and insulin and he would be unable to consume anywhere near that intake of real food.

With reference to Larry (I made a note of the time for this one – so see how they do this for Larry at c. 12 minutes) – the narrator (Samantha Bond) quotes the usual statement that the average man needs 2,500 calories a day. Ian Campbell estimates that Larry needs about 4-4,500 calories a day "and so that extra 10,000 calories a day would equate to 3lbs of weight gain on a daily basis." Did you spot that use of the unproven calorie formula – applied directly as if fact – without even being quoted? Ian has divided 10,000 by 3500 to get 3lbs and has assumed that every excess of 3500 will gain 1lb (in fat alone – we are forgetting water and lean tissue for now), just as Ian assumes that every deficit of 3500 will lose 1lb. Neither surplus or deficit works with this formula – I have yet to find even one study to prove this formula and would be astonished if I ever did.

Let's apply some common sense here – Ian is saying that Larry will be gaining weight at the rate of 3lbs a day – that's 1095lbs EACH & EVERY year. That is 78 stone and 3lbs EACH & EVERY year. Let's forget water and lean tissue and assume he is the first person in the world only to gain fat. So – if the programme checks in on Larry next year – he should be 128 stone.

With reference to Lisa (they do this for Lisa at c. 44 minutes) – the narrator again says that the Recommended Daily Intake for an average woman is just 2000 calories. They obviously allow 3000 calories a day, for Lisa being larger and then the narrator says "If she continues to eat this daily excess of over 6000 calories, Lisa will gain almost 2lbs every day."

Ditto on the common sense – Lisa is supposed to gain 52 stone, 2lbs each & every year she continues to eat in this way.

With reference to Jacqui – Ian says that Jacqui is having "perhaps seven times the number of calories she needs just to keep her body healthy." The narrator then says "To burn off what Jacqui eats in a day she'd have to walk briskly non-stop for almost two days."

The last point is interesting because so many government officials and dietary advisors continue to think that our 'sedentary behaviour' is to blame for the obesity epidemic. Ian Campbell makes the point that Olympic rowers could not need this number of calories (my comment – and they would eat their intake in a hugely healthier way). Surely it is vastly more important to NOT put something in one's mouth in the first place than it is to think we can burn off that fuel in some way. Aside from the fact that we can only 'burn fat' when there is no glucose or glycogen more readily available for the body. These four are eating carbs continuously every waking minute (Lisa in the middle of the night also) and therefore are continually storing fat and are never in a physiological environment in which they can burn fat.

Check also – around 40 mins into the programme – the serious issue about fat cell number and size, which has become more widely accepted in recent years. It is estimated that Lisa's fat cells will have multiplied from a 'normal' number of 40 billion to 100 billion. If she loses weight, these fat cells do not disappear – she will still have 100 billion – they just shrink in size.

p.s. daftest thought of all – if Ian Campbell estimates that Larry needs 4-4,500 calories a day, let's assume that Paul needs the same. Paul is therefore eating 32,000 calories a day more than he needs. I bet Ian Campbell did the maths – that's a gain of 9lbs EVERY DAY; 2 stone every 3 days; so Paul should gain 238 stone over the coming year – and then thought "no, that's mad!" Then he would have thought – let's stick to using the 3,500 calorie theory for Larry and Lisa – it seems daft for Paul. It's daft for all of them Ian! (And everyone else who uses this formula on a daily basis – NHS, Dept of Health, NICE, dieticians, nutritionists.....)

p.s. Jan 2011 update – please note that I am sadly simply unable to keep up with comments on blogs/youtube/facebook and all the wonders of the web. Please feel free to leave a comment to have your say & for others to read. If you have any questions our forum is the best place to have them answered. Your question may well have been answered already so you can read the thousands of questions already there if you don't want to join. Many thanks for your understanding. Very best wishes – Zoe

# Weight Watchers works – according to a study  
funded by Weight Watchers

#### July 12, 2010

"One pound of fat contains 3,500 calories. To lose 1lb a week you would need to cut out 3,500 calories from your overall weekly nutritional requirements, this equates to needing a deficit of 500 calories a day."[i] (Zoe Hellman, Weight Watchers dietician)

This is the formula believed by Weight Watchers, NICE, the NHS, the Department of Health, the National Obesity Forum, British Dietetic Association, the Association for the Study of Obesity (the organisation of which Susan Jebb is the chair) and 99% of public and private health diet advisors.

I have two points to make:

1) None of these organisations even know from whence this formula came and none can prove that it is true[ii];

2) This study has beautifully proven the formula wrong – as has every study of calorie restriction since 1917.

Weight Watchers sets out to create a deficit of approximately 1,000 calories a day (a typical female needs 2,000 calories, but is 'allowed' 18-20 points. One point is roughly 50 calories, so this is an approximate 900-1,000 calories a day diet). Weight loss, with a 1,000 calorie deficit, over one year, should be 104 pounds in fat alone (more in lean tissue and water)[iii].

The Medical Research Council (MRC) presentation for the results of the study[iv], contain a graph for weight loss over the 12 months for the GP vs. WW groups (slide 8). (Please note the regain starting at 9 months with WW). Jebb says that the GP group lost an average of 2.8kg and the WW group lost an average of 5.2kg. Slide 10 confirms the difference between the two weight loss approaches as 2.4kg at 12 months.

This means, however, that the Weight Watchers group lost an average of 11 pounds in one year – less than one pound a month. According to Weight Watchers own dietician (Zoe Hellman) and the ASO's believed formula (Susan Jebb), they should all have lost 104 pounds (in fat alone) and there should have been no difference between people, with the same deficit – a formula is a formula.

In my experience of working purely in the field of obesity – two pounds a week is the minimum that people want and expect to lose. One woman said to me "With nearly half my current weight to lose, I can't cope with two pounds a week". Why was I the first person to be honest and tell this 60 year old woman that, if she lost two pounds a week, week in week out until she reached target weight, she would be the first person in the world ever to do so.

Weight Watchers have just admitted – you will be considered a success, worthy of the headline "Weight Watchers works", if you lose one tenth of what you have been led to believe you will lose.

The headline should have been:

"Weight Watchers works better than just going to the GP, says study funded by weight watchers; but you will be lucky to lose one tenth of your lowest expectation."

Maybe not as catchy, but far more honest.

Zoë Harcombe

p.s. Susan Jebb points out that she has not been paid for her involvement. a) Her involvement has likely been small (slide 7 suggests that she has not even been the key advisor to the study group). b) The MRC employs over 4000 people[v]. They need work to do and it would be interesting to know how much Weight Watchers have paid towards their employment costs for this endorsement. c) Susan Jebb is presenting at the Weight Watchers Symposium in Stockholm tonight[vi], expenses paid?

* * *

References

[i] <http://www.cosmopolitan.co.uk/your-life/diet-advice-10-big-diet-myths/v1> (under point 6)

ii] Full FOI available upon request – or on a scribd post on [www.zoeharcombe.com/thecaloriemyth/

[iii] 1000 calories deficit multiplied by 365 days and divided by 3500 = 104 pounds

[iv] <http://www.mrc-bsu.cam.ac.uk/BSUsite/CHTMR/AM_forweb.pdf>

[v] <http://www.mrc.ac.uk/About/Factsfigures/index.htm>

vi] <http://www.ico2010.org/documents/WeightWatchersprogrammeec23.06.10.pdf> (or view it [here)

(the original reference to (vi) expired)

# Statins with your burger?  
Better add a pregnancy test too

#### August 13, 2010

This story came out on 12 August 2010. I follow BBC Health news on Twitter and they announced:

"Fast food outlets should consider handing out cholesterol-lowering drugs to combat the effects of fatty food, link here

The article opens with: "Fast food outlets should consider handing out cholesterol-lowering drugs to combat the effects of fatty food, say UK researchers. Taking a statin pill every day would offset the harm caused by a daily cheeseburger and milkshake, the Imperial College London team said. It would only cost 5p a customer – similar to a sachet of ketchup."

Dr Darrel Francis, one of the team of researchers, was quoted as saying: "Importantly, even partial adherence to statin therapy conveys a mortality benefit, suggesting that statins do not need to be taken daily to have some protective effect".

I checked the source of these incredulous comments (we'll cover why below). The researchers were Emily A. Ferenczi, Perviz Asaria, Alun D. Hughes, Nishi Chaturvedi MDa and Darrel P. Francis. Their article "Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices?" was published in the American Journal of Cardiology August 2010. You can read the summary here.

Invariably, I go back to the original medical journal article and find that the media have sensationalised a serious piece of research, taken one statement out of context and blown it out of proportion. Not in this case. The researchers managed to do that in their original summary – here's an extract:

"The risk reduction associated with the daily consumption of most statins, with the exception of pravastatin, is more powerful than the risk increase caused by the daily extra fat intake associated with a 7-oz hamburger (Quarter Pounder®) with cheese and a small milkshake. In conclusion, statin therapy can neutralize the cardiovascular risk caused by harmful diet choices... Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk. Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments. Although no substitute for systematic lifestyle improvements, including healthy diet, regular exercise, weight loss, and smoking cessation, complimentary statin packets would add, at little cost, 1 positive choice to a panoply of negative ones."

The only declaration of interest for the article was "Dr. Francis is supported by grant British Heart Foundation, London, United Kingdom." (Those are the exact words – there may be an 'a' and a 'from the' missing). Professor Peter Weissberg, medical director at the British Heart Foundation is also quoted in the article. It would be fair to say that Weissberg is quite a fan of statins – Dr Michael Eades does a great blog here showing how Weissberg was defending statins back in February 2007. Eades says "The British Heart Foundation is also funded by, among others, companies that make statins." I did a quick check on the BHF site this morning and found nothing clearly declared. A separate search on Pfizer (makers of Lipitor) and the BHF reveals a funding relationship – small to Pfizer but useful to the BHF.

There are almost too many levels to go into as to why this article is both horrific and irresponsible. I am struggling to recall a more disgraceful recommendation to come from people supposedly interested in our health. I'll stick to four:

1) Cholesterol is one of the most vital substances in the human body. We literally die without it. The sensible (and non-conflicted) people working in the field of cholesterol understand how statins actually work. The body makes cholesterol (it is too vital a substance for the body to rely on you to have to consume or get from another source in any way). Statins stop the body making cholesterol. You may think that this is how they impact on heart disease (the evidence for impact is also conflicted and not compelling despite this). The more sensible view is that statin drugs work as an anti-inflammatory agent in some way and the cholesterol lowering is a very unfortunate side effect. The key reason for it being so unfortunate is that statins stop the body's own working 'up-stream' of the production of CoQ10, which has been called the energy spark plug for the body, and this explains side effects from tiredness, being less able to be active and as extreme as irreversible muscle wasting. Given that the brain has one of the highest requirements for cholesterol within the body, forgetfulness and generally being less cognitive are also well known and serious mental side effects.

2) I have no idea where Francis gets his idea of mortality benefit. The evidence is the converse. Lowering cholesterol has been shown to increase mortality – the lower your cholesterol, the more risk of dying kind of relationship. This makes sense given the life vital role of cholesterol.

The Honolulu Study was a 20 year study of cholesterol levels and mortality in 3,572 Japanese American men. The study concluded that "Only the group with low cholesterol concentration at both examinations had a significant association with mortality". The authors went on "We have been unable to explain our results". (I.e. we were expecting lower cholesterol to equal lower mortality, not the other way round). All credit to the team for their honest reporting of these unexpected results and their final statement in the abstract: "These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4·65 mmol/L) in elderly people." (Schatz, Masaki, Yano, Chen, Rodriguez and Curb, "Cholesterol and all-cause mortality in elderly people from the Honolulu heart programme", The Lancet, (August 2001).)

Framingham similarly concluded that "There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels)." (Anderson, Castelli and Levy, "Cholesterol and Mortality: 30 years of follow-up from the Framingham Study", Journal of the American Medical Association (JAMA), (1987).)

Dr Malcolm Kendrick in the brilliant "The Great Cholesterol Con", does a clever calculation on this quotation and translates this into – a reduction in cholesterol from 5 to 4 mmol/L would increase your risk of dying by 400%.

3) This study makes the usual mistake of not starting from a clear control basis. Remember the item chosen? A 7-oz hamburger (Quarter Pounder®) with cheese and a small milkshake. So we have all three macro nutrients – fat, protein and carbohydrate. We have primarily, if not exclusively processed food. We have sugar, white buns, processed meat and cheese. What were these guys trying to measure? Fat always takes the attack in the media, but this is processed food being analysed. I would mind less if the headings were "eat processed food – pay the price" but it is in the interests of the food industry to attack fat when the precise culprit is their processed food.

4) I almost can't find the words to describe the irresponsibility of the proposal that Statins should be given out like Smarties as an antidote to eating processed food. Two very bad wrongs don't make a right. I detest processed food and yet I would rather eat a burger every day than take statins. Read The Great Cholesterol Con and learn from a non-conflicted doctor what these drugs really do and how they are implicated in cancer, muscle damage, liver damage, mortaility we have seen above and, perhaps the ultimate irony, there are those who think that statins are responsible for the heart failure they are supposed to alleviate. Again – if you know the role of CoQ10 in heart muscle, you can see that this is highly plausible.

However – the ultimate irresponsibility must surely be that a pregnant woman can walk into a burger bar, day and night, and, if this bunch of drug pushers get their way, she can pick up a statin as well as a ketchup sachet and risk deforming her unborn child. Drugs are not tested on pregnant women for a reason. Cholesterol levels rise in pregnant women because it takes a lot of cholesterol to make a healthy baby (this is why eggs are relatively high in cholesterol – it takes a lot of cholesterol to make a healthy chicken or duck etc). To lower a woman's cholesterol levels while she is trying to make a healthy baby is medical malpractice in my view. Check out the patient info for Lipitor \- the statin worth about $12 billion (last time Ben Goldacre kindly quantified it for us).

"Do not take Lipitor if you are pregnant or think you may be pregnant or are planning to become pregnant. Lipitor may harm your unborn baby."

"If you get pregnant stop taking Lipitor and call your doctor right away."

"Do not take Lipitor if you are breastfeeding. Lipitor can pass into your breast milk and harm your baby."

"Do not take Lipitor if you have liver problems." (presumably because it's going to harm your liver, so you'd better have a strong one?)

Dear people of the world – your doctor may be conflicted, your heart charity may be conflicted. Anyone who tells you that statins are the wonder drug and should be given out like sachets of ketchup had better be conflicted, because I cannot think of any other reason for being so irresponsible.

# "Surgery is better than dieting,  
says conflicted doctor"

#### September 13, 2010

I often write about conflict of interest and advise that we should all read articles with the approach – who stands to gain from this article?

The Sunday Times printed a story on the front page on 12 September 2010 of which they should be ashamed. It was entitled "Surgery is better than dieting, says top doctor." The article quoted Nick Finer, indeed a well known and respected obesity expert, as saying "The only answer to Britain's obesity epidemic is to offer surgery to anyone suffering from severe weight problems." He suggested starting with the 1 million people with a body mass index greater than 35 and presumably working down from there. This would be phenomenally lucrative for pharmaceutical companies providing gastric bands, surgical equipment for the operations, drugs taken around the time of the operation, liquid diets (a pre-operation and often post-operation requirement) and, of course, the surgeons who perform these operations.

The real story is that a number of our national obesity experts (most that I have come across) have fundamental conflicts of interest, which should invalidate any so called expertise that they come out with. Why did the article not list Finer's conflicts of interests? They are easy to find – they were listed in a February 2010 journal declaration:

"Nicholas Finer: Consultant for Novartis, Shionogi, Merck, Abbott, sanofi-aventis, Amylin Pharmaceuticals Ajinomoto and GSK; received lectureship fees from Abbott, sanofi-aventis, Roche and Novo-Nordisk; received grant support from Merck, Novartis, Roche, Alizyme, Pfizer, Johnson and Johnson, Abbott and sanofi-aventis; member of the SCOUT ESC receiving payment from Abbott (honoraria/travel expenses)."

Novartis (Novartis Nutrition) make Optifast : "OPTIFAST® is now being used to induce weight loss as needed before bariatric surgery in several bariatric surgery facilities. Novartis Nutrition has also introduced a brand new line of products, OPTISOURCE™, to help patients meet their special nutritional needs after bariatric surgery. Most of these patients require lifelong protein and vitamin/mineral supplementation after the surgical procedure." This stuff costs $2500-3500 for a one year programme for one person – not sure if that was factored in to the cost benefit analysis?

Shionogi have two obesity drugs at various stages of R&D.

Merck, Pfizer and Sanofi-Aventis have Cannabinoid Antagonist products. These act to block the cannadinoid receptor 1 (CB1) and are claimed to decrease food intake and help regulate weight. (These try to work on the opposite basis of cannabis 'giving the munchies' and the psychological side effects are a concern).

A report about the USA obesity drug and bariatric surgery market lists:

– Alizyme as developing a lipase inhibitor (the goal of this is to stop fat being absorbed – as with the drug Orlistat/Alli. Absorption of fat soluble vitamins is impaired);

– GlaxoSmithKline under emerging drugs for a melanin-concentrating hormone antagonist;

– Amylin Pharmaceuticals as having an emerging Peptide YY3-36 drug;

– Amylin Pharamceuticals and Johnson & Johnson are listed as having other emerging drugs;

– Johnson & Johnson, Merck and Pfizer are listed as having delayed or discontinued drugs in this arena.

The companies profiled in the obesity drug and bariatric surgery market report are Abbott, GSK, Merck, Pfizer and Sanofi-Aventis. Roche make the drug sibutramine (withdrawn from Europe, earlier this year, following an investigation into heart disease amongst people taking the drug. It is still available in the USA). The report where Finer declared his interests was a study of the drug sibutramine and the conclusion was very favourable (would it be reasonable to suggest one would not be supported by a company if one were not supportive of their products?)

I saw Nick Finer present at the Wales National Obesity Conference in June 2010. He introduced me to a graph, for which I am most grateful, done by Marion Franz in 2007. This study reviewed 80 other weight loss studies based on the "eat less and/or do more" principle and this is where Finer gets his statistic quoted in the Sunday Times article: "the average long-term weight loss achieved by most obese adults who diet is 2-3%, so small as to be almost irrelevant." This is correct. I have seen the study and I am hugely grateful to Elsevier for permission to reproduce the chart in my book "The Obesity Epidemic". However, this evidence is for low calorie/calorie deficit dieting – it is not for low carb dieting and my own findings (reproduced in the book) are similar to those of Gary Taubes – an unavoidable conclusion that carbohydrate consumption is solely responsible for both fat storage (weight gain) and fat 'un-stored' (weight loss).

Finer is quoted in the article as saying "Humans evolved in unpredictable environments where food was scarce and our bodies are programmed to maintain our body weight at all costs." From this comes the recommendation that we should operate on 1 million of our fellow humans (for starters) to cut them open and make it such that they will never be able to eat normally, digest normally or absorb vitamins normally ever again.

There is no logic in this conclusion. Man and our ancestors have been on this planet since Australopithecus Lucy first walked upright an estimated 3.5 million years ago. We have had an obesity epidemic for about 35 years. Surely our first plan should be to return to what we ate for the 3 million, 499 thousand, 965 years before we got so fat we had to invent bariatric surgery?! How about humans return to eating what we evolved to eat? Meat, fish, eggs, vegetables, nuts, seeds and sporadic fruits if we were lucky?

The trouble is – there is no money to be made in advising the above. The 'expert' who advises a return to eating food – we shouldn't need to call it real food – will receive no funding from food, drink or drug companies. The whole reason we have the processed food industry is because of the margin that can be made from man-made food in contrast to that which can't be made from mother-nature's food. And with the modern illness accompanying modern food and drink we have modern drugs – continually being developed to 'treat' the diabetes, obesity, cancer, heart disease, indigestion, irritable bowel syndrome, blood pressure problems and so on, which I am convinced are the result of that modern drink and food. What a wonderful symbiotic relationship between the food, drink and drug industries.

This is why the real story for Sunday's paper should have been – citizens of the UK will never receive the right advice until so called experts cease to be conflicted. Or, at the very least, have to declare their interest up front so that we can see the promotion for what it is.

P.S. you may like to see another blog I did with death rates for bariatric surgery. I'm not sure if the funeral costs were also factored in to the cost benefit analysis study.

P.P.S. Ajinomoto markets aspartame. Here's Finer promoting aspartame. Here's what an independent person has to say about aspartame:

Dr. Ralph Walton, Professor and chairman of the Department of Psychiatry Northeastern Ohio University Colleges of Medicine, undertook a comprehensive review of studies available for just one sweetener: aspartame. It was called "Survey of aspartame studies: correlation of outcome and funding sources." The summary of the report stated: "Of the 166 studies felt to have relevance for questions of human safety, 74 had Nutrasweet® industry related funding and 92 were independently funded. One hundred percent of the industry funded research attested to aspartame's safety, whereas 92% of the independently funded research identified a problem." Walton's overall conclusion was "We have also become much more sophisticated about the impact of a variety of toxins on psychological processes. I am convinced that one such toxin is aspartame."

# One in ten adults dangerously obese...

#### October 25, 2010

This is the headline in the Daily Mail (25 October 2010)

The sub heading is "Wake up call for 5m Britons as diabetes toll also soars."

When will public health advisors realise that we started this obesity epidemic? When will public health advisors realise that we started this diabetes epidemic?

Since Australopithecus Lucy first walked upright, an estimated 3.5 million years ago, we have eaten food provided by mother nature. For much of that time our main energy intake has necessarily come from animals and their by products (during the ice age this is all that our ancestors would have had; during much of the rest of our evolution animals – especially their fat – would have provided our much needed calories. Nuts, when available, would have been very useful also).

Look at the evidence – in the UK obesity didn't rise above 2% since time began until the 1970′s. Obesity rates for men and women in the UK were 2.7% in 1972. They had reached 25% by the end of the millennium. So what happened to cause such a catastrophic change in obesity rates? We changed our diet advice. The USA changed in 1977-1980 and the UK followed suit in 1983-84. Obesity has increased up to 10 fold since. You may think that is just a coincidence – I don't.

We used to know that floury foods were fattening and sugary foods even more so. We now tell people to base their meals on starchy foods. The average Briton eats 400 calories a day of sugar – with no vitamins and minerals of any value whatsoever. The average Briton eats 730 calories a day of flour – with so little nutrition that it is invariably fortified. We are just doing what we have been told to do – basing our meals on starchy food; following the Eatbadly plate advice (I refuse to call it Eatwell because it's not).

That sub heading – this is a wake up call for 5m Britons. Boy I hope that it isn't! The only hope Britons have is if they have ignored the dietary advice of the past 25-30 years and they have carried on eating real food, as mum and granny told them to: liver, sardines, eggs, milk, vegetables with butter on etc. Those who are avoiding real food and eating processed food; those who are avoiding fat and eating fattening carbohydrate instead – these people will continue to get fatter and fatter until someone sues the government for making them fat and we realise the horrors of the 'experiment' we have done with the 'developed world' since the turn of the 1980′s.

Who stands to gain if you think eggs (one of the most nutritious foods on the planet) are bad for you? (Kellogg's and other cereal manufacturers).

Who stands to gain if you think butter (another wonderfully nutritious food) is bad for you? (Unilever and other margarine and spread manufacturers).

Who stands to gain if you follow the mad advice to snack/eat little and often (the best way to store fat and stay fat) all day long? (Kellogg's, United Biscuits, makers of snack foods).

Who sponsors the British Nutrition Foundation? Kellogg's, Unilever, United Biscuits, makers of snack foods and many, many more.

Who stands to gain if you eat what nature has provided for you? No processed food or drink company that's for sure. No drug company – because you will be healthy. You stand to gain and you need to take charge of your own health and not trust dietary advisors who are conflicted.

If you want to know the full story behind The Obesity Epidemic: What caused it? How can we stop it? – click here.

As for diabetes – diabetes is a condition characterised by the malfunction of the pancreas and blood sugar handling system. In simple terms, type 1 diabetes is characterised by the pancreas no longer producing insulin, so the person needs to administer insulin in some way (usually injection). Type 2 diabetes is often called "insulin resistance". Some insulin is still produced by the pancreas, but rarely the right amount, as the body has become resistant to insulin and the cells don't respond to insulin as they should. Both types of diabetes are all about carbohydrates – the macro nutrient we didn't used to eat much of and are now told to base our meals on, to snack on, to (basically) eat all the time. Our bodies are literally saying "enough is enough". I can't cope with this high quantity or low quality of carbohydrate any more – "I, your pancreas, am packing up". Hence we now have 171 million diabetics world wide – a figure set to rise to 366 million by 2030. 95% of diabetics are type 2 – all pretty much avoidable if we went back to eating food – real food – and not the processed junk that food processing companies make so much money from.

Then you have Simon O'Neill, from Diabetes UK, saying "we must keep up the mantra of five fruit and veg a day"! More conflict of interest. Five a day was invented by a bunch (ha ha) of fruit and veg companies in California in 1991. Dieticians, nutritionists and now a spokesperson from Diabetes UK are sales reps for the fruit and veg industry. Diabetics should be eating low carb veg (green leafy vegetables, peppers, salads etc) but being very cautious about baked potatoes and fruit – especially tropical fruits. It's more carbohydrate – it turns into glucose and fructose in the body as if we had eaten sucrose (table sugar – which is one molecule of glucose and one of fructose).

If we are serious about sorting obesity AND diabetes at the same time, we must stop our current diet advice madness and stop telling people to eat carbs virtually every waking minute. Meat, fish, eggs, vegetables (not potatoes), salads and dairy products should be our staples and whole grains, baked potatoes and fruit only if we are slim and not diabetic.

# Weight Watchers ProPoints plan –  
what's it all about?

#### November 1, 2010

Weight Watchers put out a press release "embargoed to 1st November 2010″. The press release that I saw had two pages – each page looked like it was designed to fold into a two sided postcard. One page was called "The SCIENCE behind the Weight Watchers ProPoints Plan" and the other was called "The Weight Watchers ProPoints plan EXPLAINED. I'll refer to them as the SCIENCE PAGE and the PROPOINTS PLAN EXPLAINED PAGE below...

THE SCIENCE PAGE

The science page essentially says "Calories have been around for nearly 200 years". The science page notes that the work was developed in the late 1800′s by a chemist called Atwater. Wilbur Atwater was also working with Max Rubner and, between them, they developed the first calorimeter and established that the approximate calorie content of carbohydrate, protein and fat was 4, 4 and 9 respectively. If I share at this stage that, in Rubner's publication in 1901,[i] carbohydrate, protein and fat were estimated to have 4.1, 4.1 and 9.3 calories per gram respectively – you can see that this has never been a precise science. (Rubner recorded the calorific value for olive oil as 9.4, so even his 9.3 was an average of four fats reviewed).

ProPoints seems to be about taking on board the fact that carbohydrate, protein and fat require different amounts of energy to be turned into energy by the body. Weight Watchers may think they are leading the way with this 'new' science, but they are playing catch up. Indeed on Radio 4 this am, Weight Watchers company dietitian Zoe Hellman opened by saying the science has been there for 10-15 years. Here is my take on the SCIENCE page:

1) The science on carbohydrate, fat and protein being different is right – the obesity world has known this for almost a decade (not 10-15 years). (It's quite fun to see Weight Watchers acknowledge this, as dieticians have been saying "a calorie is a calorie" since time began and this proves that it isn't!) Here's an extract from p23 of my book:

"...Eric Jequier, who works in the Institute of Physiology, University of Lausanne, Switzerland found that the thermic effect of nutrients (thermogenesis – energy used up in making useable energy) is approximately 6-8% for carbohydrate, 2-3% for fat and 25-30% for protein.[iii] I.e. approximately 6-8% of the calories consumed in the form of carbohydrate are used up in digesting the carbohydrate and turning it into fuel available to be used by the body. In contrast, 25-30% of the calories consumed in the form of protein are used up in digesting the protein and turning it into fuel available to be used by the body...

Richard Feinman and Eugene Fine, a biochemist and a nuclear physicist respectively, have done some outstanding research in the area of thermodynamics and metabolic advantage of different diet compositions.[iv] In their 2004 paper, they took Jequier's mid points (7% for carbohydrate, 2.5% for fat and 27.5% for protein) and applied these to a 2,000 calorie diet comprising 55:30:15 proportions of carbohydrate:fat:protein. This demonstrated that 2,000 calories yielded 1,848 calories available for energy. I repeated the calculation for a 10:30:60 high protein diet, as another example, and the yield drops to 1,641 calories."

Dr. Geoffrey Livesey has been another great pioneer in this area. He has estimated that fat has 8.7 calories per gram. Back in 2002, the United Nations Food and Agriculture Organization (FAO) assembled an international group of nutritionists, including Livesey, to investigate the possibility of recommending a change to food labelling standards to update the four, four and nine calories attributed to carbohydrate, protein and fat respectively.[ii] The group, with the exception of Livesey, decided to stick with the long-standing values because, the report concluded, "the problems and burdens ensuing from such a change would appear to outweigh by far the benefits". I would have supported Livesey, but with the recommendation that he go way further and challenge the entire application of these estimates.

To put this idea of thermogenesis (energy used up in making available energy) in simple terms – let us say that we eat 100 calories of, say, banana – the Jequier work tells us that 92-94 calories may be available to the body. Eat 100 calories of, say, white fish (a close approximate to protein) and only 70-75 calories may be available to the body. The body effectively has a 25% advantage if trying to get energy from protein vs. carbohydrate. However...

a) We should not use this as a plan to eat an unnaturally high protein diet as this can deplete the body of vitamin A and damage the liver. We need to eat real food in the natural fat/protein balance that nature provides;

b) This assumes that the body will try to use protein for energy and it likely won't. There are an estimated 1,500 calories needed for the basal metabolic rate for an average woman and these 'body maintenance' calories need to come in the form of fat, protein, vitamins and minerals – things that the body can use for building bones density, cell repair, fighting infection and generally keeping us alive. The good news is – eat good calories in the form of real food (meat, fish, eggs, dairy products, veg/salad, nuts/seeds) and the body can use these as part of the 1,500 calorie planned maintenance for the day. Eat 400 calories of sugar (no fat, protein, vitamins or minerals) as the average Briton does and the body can't use these for basic needs. Then you have to burn these off with activity, or they can be stored as fat.

2) On this SCIENCE sheet – bottom section – we find the words: "this helps to create an energy deficit which is fundamental for successful weight loss." I disagree. We can only lose weight (break down triglyceride, which is what human fat tissue is) when the body has no option but to break down triglyceride. This can only happen when there is no glucose or glycogen (the body's storage form of glucose) available in the body. Eat 3,000 calories of pure meat and fish (zero carbohydrate and therefore no glucose or insulin to store fat) and a person will lose weight. Eat 3,000 calories of sugar, white flour and processed carbohydrate and the same person will gain weight.

Weight Watchers are still calorie counting – they are still obsessed with creating a calorie deficit (and – as we will see below – they still believe the fundamental calorie myth that it's all to do with 3,500 calories and one pound of fat).

3) Finally, the bottom section of the science page states "filling and healthy foods are also great choices for healthy weight loss, as they are nutritionally superior, being higher in fibre and/or lower in salt, sugar and saturated fat." I disagree. Nutrition is about what is IN a food as much as what is NOT in a food. The nutritious macro nutrients are fat and protein (carbs just provide energy and we can get that from fat – eaten or stored – as well). The micro nutrients are vitamins and minerals and the levels of these define how nutritious a product is. The most nutritious foods on the planet are liver, sardines, eggs, milk and sunflower seeds, They all contain no sugar (sucrose) whatsoever, but they also contain no fibre. They do contain plenty of excellent saturated and unsaturated fat. Fat is our friend! It is only the enemy of calorie counters. It contains the essential fats and the fat soluble vitamins, A, D, E and K.

Are Weight Watchers saying that ProPoints will be all about eating real food and only real food? Only eat what nature intended us to eat? Check out their food products page and I think the answer will be no. The ingredients in these products are horrific. One features on my web site list of my least favourite products – check out the number and the nature of the ingredients in the Weight Watchers Double Chocolate Brownie!

Don't talk to us about nutrition Weight Watchers until you are prepared to ditch all your processed foods and tell us to eat as nature intended instead.

THE PROPOINTS PLAN EXPLAINED PAGE

This doesn't actually explain ProPoints very well at all. Maybe the idea is that you need to pay to attend a Weight Watchers meeting or pay to find out more on-line so that they can tell you as a paying person. The page says that ProPoints is new, "very different" and "takes into account the amount of protein, carbohydrate, fat and fibre in a given portion. The result is a more accurate nutritional approach."

I was on BBC Radio Wales with Ms Hellman this morning and she said that the calorie labels on foods are not accurate. I can imagine quite a few calorie counters not being happy about that!

The minimum daily ProPoints allowance is going to be 29. Call me cynical, but we all currently know that 1 Weight Watcher point is c. 50 calories. We don't actually need Weight Watchers if we can count to 1,000 – if we can only count to 20 (units of c. 50) we may need them. Maybe Weight Watchers have realised this and want a number that can't easily be converted so I'll be interested in the 'conversion' of ProPoints to calories. People will be looking for a similar conversion going forward – calorie counters count calories at the end of the day!

In addition to the daily allowance, everyone is given an additional 49 ProPoints as a weekly allowance to use however they choose. Weight Watchers will no doubt hope you'll be using them on their chocolate brownies and other processed food.

On the bottom part of the "explanation" page you can see the 3,500 calorie theory "the plan is designed to lead to a healthy and sustainable weight loss of up to 2lbs a week." That can only come from one place – Weight Watchers believe that one pound of fat equals 3,500 calories (it doesn't) and that, if you create a deficit of 3,500 calories you will lose 1lb of fat (you won't). i.e. if you cut back by 1000 calories a day you will lose 2lbs a week (and I would be 6lbs in a year's time – yeah right!) (All of this is covered extensively in my latest book: The Obesity Epidemic.

Zoe Hellman, Weight Watchers company dietician, is quoted on the top part of this page. On this link , Zoe Hellman is quoted as saying: "One pound of fat contains 3,500 calories. To lose 1lb a week you would need to cut out 3,500 calories from your overall weekly nutritional requirements, this equates to needing a deficit of 500 calories a day." (Point 6). I blow all of this apart in chapter 7 in the book. (I emailed Zoe Hellman about this on 6 April 2010 but she never replied).

There is also a note on this EXPLANATION page about fruit being 'free'. It won't count as part of the ProPoints allowance. I find this astonishing. Most calorie counters I know binge on fruit – they can eat a pound of grapes and/or 6-8 apples a day with no problem. Allowing people to eat as much fruit as they want whenever they want is going to have ProPoint dieters full of fructose and glucose all day long and make it impossible for them to be in a fat burning mode. Plus, fructose (see chapter 13 of my book) is now called "the lipogenic (fattening) carbohydrate" in the obesity world. Fructose goes straight to the liver to be metabolised – where it can be turned into fat if insulin is present. Insulin is present whenever we eat a carb (like fruit) and hence fruit – especially fruits with lots of glucose like bananas – can turn the body into a wonderful fat storing machine.

In this paragraph about fruit, Zoe Hellman refers to five-a-day as if it is a scientific principle in the top part of this "explanation" page. "We've made it easier than ever before to take in your five a day", she says. This is not science. In Chapter 13 of The Obesity Epidemic I give the background to give-a-day. It started as a marketing campaign by fruit and veg companies in California in 1991, working with the American National Cancer Institute (NCI) (who have since trademarked the term). There was no evidence at the time that it would provide any benefit for cancer, let alone any other health condition. There has been none since (see the April 2010 a study in the Journal of the National Cancer Institute written by Paolo Boffetta, as the lead of a large group of European researchers).

Vegetables in butter are nutritionally useful (not as good as liver, sardines or eggs) but fruit is not that nutritious, too high in sugar, metabolised by the liver and best avoided by anyone needing to lose weight. Five-a-day is marketing, not science.

THE BOTTOM LINE

As Stunkard and McLaren-Hume proved in 1959:v] "Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it." Stunkard and McLaren-Hume's own statistical study showed that only 12% of obese patients lost 20 pounds, despite having stones to lose, only one person in 100 lost 40 pounds and, two years later, only 2% of patients had maintained a 20 pound weight loss. This is where the often quoted "98% of diets fail" derives from and it refers to calorie controlled diets. The [2007 Franz study updated the research on this topic and concluded the same – a fraction of the weight we expect to lose is lost and most of that is regained. There is simply no evidence in the obesity journal world of calorie restriction producing sustained weight loss.

Here's another extract from p68 of my book where Weight Watchers themselves prove that people will lose a fraction of what they expect...

"On July 12 2010, under the headline "Weight Watchers does work, say scientists", Sarah Boseley, health editor for The Guardian wrote a wonderful endorsement for Weight Watchers following a study done by the Medical Research Council (MRC), funded by Weight Watchers.[vi] The original presentation of results from the MRC revealed that 772 people were studied: 395 people were simply given weight loss advice from their doctor (the GP group) and 377 were funded to attend Weight Watchers (419 of the 772 completed their respective programme). The study was a year in length and the likely deficit was at least 1,000 calories per day (a typical Weight Watchers allowance is 18-20 points, which approximates to 900-1,000 calories vs. an average 2,000 calorie requirement for a woman). The article reported that the GP group lost an average of six pounds (we know from the Franz study that 'advice alone' people did well to lose anything) and the Weight Watchers group lost an average of 11 pounds. The Weight Watchers group should have lost 104 pounds in fat alone. This study provided irrefutable proof that the calorie theory is wrong, which should have been front page news in itself, but this was not the story of the article. The story was "you'll lose twice as much weight with Weight Watchers." The headline should more accurately have been "Weight Watchers works better than just going to the GP, says study funded by Weight Watchers; but you will be lucky to lose one tenth of your lowest expectation." Not as catchy, but far more honest."

At the end of the day, it doesn't matter if Weight Watchers make a slight adjustment to the idea that protein is 4 calories per gram or that carbohydrate is 4 calories per gram. It doesn't really matter what calorie number we assign to each food. Counting/restricting calories does not work – and we have known this since Benedict's study in 1917. If calorie restriction did work, we would not have an obesity problem, let alone an epidemic.

p.s. Jan 2011 update – please note that I am sadly simply unable to keep up with comments on blogs/youtube/facebook and all the wonders of the web. Please feel free to leave a comment to have your say & for others to read. If you have any questions our forum is the best place to have them answered. Your question may well have been answered already so you can read the thousands of questions already there if you don't want to join. Many thanks for your understanding. Very best wishes – Zoe

* * *

References

[i] Max Rubner, "Zeitschrift fur Biologie," Festschrift zu Voit, (1901).

[ii] Dr. Geoffrey Livesey, "The Calorie Delusion: Why food labels are wrong", New Scientist, (15 July 2009).

[iii] Eric Jequier, "Pathways to Obesity", International Journal of Obesity, (2002).

[iv] Richard Feinman and Eugene Fine, "A calorie is a calorie violates the second law of thermodynamics", Nutritional Journal, (2004).

[v] Stunkard A. and M. McLaren-Hume, "The results of treatment for obesity: a review of the literature and report of a series", Archives of Internal Medicine, (1959).

[vi] http://www.guardian.co.uk/society/2010/jul/12/weight-watchers-works-say-scientists

http://www.mrc-bsu.cam.ac.uk/BSUsite/CHTMR/AM_forweb.pdf

# Cholesterol & heart disease –  
there is a relationship, but it's not what you think

#### November 23, 2010

I do a fortnightly newsletter called "Diet & Health Today" in our on line support club. The club is there to help people to lose weight by eating food – real food! Apparently that makes us radical and controversial. The main article in Diet & Health Today is called "The Big Issues" and we have tackled things from "how we have misapplied thermodynamics to weight loss" to "what role does exercise play in losing weight".

This is a copy of possibly one of the most serious Diet & Health Today articles that I may do. It is dedicated to Anne (Annem in the club) who asked me a great question about cholesterol. It made me do what I had been meaning to do ever since I read Dr Malcolm Kendrick's The Great Cholesterol Con...

Dr MK ran some analysis on World Health Organisation (WHO) data. The WHO has extensive data from almost 200 countries on more health measures than you could imagine – definitely worth a look one rainy, wintry afternoon. This is where Dr MK presented the world with two different Seven Country Studies – (for those of you who aren't familiar with the history, it was the Ancel Keys' Seven Countries Study that started all the fat heart hypothesis stuff). Dr MK took the seven countries with the lowest saturated fat intake and then the seven countries with the highest saturated fat intake. You may need to read this twice – but he found: "Every single one of the seven countries with the lowest saturated fat consumption has significantly higher rates of heart disease than every single one of the countries with the highest saturated fat consumption."

The next chapter in The Great Cholesterol Con goes on to look at cholesterol and heart disease (and overall death rates) and quotes many great studies where it is shown that lower cholesterol is associated with higher mortality. However, it did leave me thinking – having run the data on saturated fat and heart disease, let's just run all the data on the cholesterol and heart disease and get to the bottom of this hypothesis from all parts of the allegations.

It actually didn't take that long – less than a couple of hours one Saturday afternoon. You go to the WHO statistics area of their web site and then pick data for cholesterol from risk factors (how judgemental to start with!) and then look under: Global burden of disease (mortality); All causes; Non communicable diseases and then G Cardiovascular disease (shortened to CVD). CVD deaths include ischemic heart disease and cerebrovascular disease – that means fatal heart attacks and fatal strokes to us. You find the most recent year where you can get both sets of data to compare like with like. This turns out to be 2002. You download their very user friendly spreadsheet data (CSV) – cut and paste it into an excel file and then try to remember how the heck to do scatter diagrams in excel!

Before telling you the results, we need to go back for a quick reminder on what we know about cholesterol and then hopefully this can serve as a factsheet for all the cholesterol questions we continually get.

The role of cholesterol

It is virtually impossible to explain how vital cholesterol is to the human body. If you had no cholesterol in your body you would be dead. Every single cell of your body is covered by a membrane (think of a membrane as the 'skin' or protective barrier around each cell). This membrane is made largely of cholesterol, fat and protein. Membranes are porous structures, not solid walls, letting nutrients and hormones in while keeping waste and toxins out. If cholesterol were removed from cell membranes they would literally explode from their internal water pressure. Human beings quite simply die without cholesterol.

Cholesterol is vital for hormone production – the sex hormones and therefore the entire human reproductive system are totally dependent on cholesterol. Hence, not only would humans die without cholesterol, the human race would die out.

Cholesterol is vital for digestion. The human body uses cholesterol to synthesise bile acids. Without cholesterol-rich, bile salts, the human body could not absorb essential fatty acids or the fat soluble vitamins (A, D, E and K) and serious, even life threatening, deficiencies could develop. (It is interesting, therefore, that nature puts cholesterol in virtually every food that contains fat – providing a digestion mechanism in tandem).

Cholesterol is vital for the brain, central nervous system and memory functions (hence how the side effects of statins include memory loss, mental confusion and people generally just not feeling themselves). Even though the brain is only 2% of the body's weight, it contains approximately 25% of the body's cholesterol. The vital connections between nerve endings in the brain, which help to conduct the electrical impulses that make movement, sensation, thinking, learning, and remembering possible, are largely made up of cholesterol.

Cholesterol is critical for bones and for all the roles performed by vitamin D. Vitamin D is best known for its role in calcium and phosphorus metabolism, and thus bone health, but we are continually learning more about potential additional health benefits of vitamin D from mental health to immune health. Vitamin D can be ingested (and is, interestingly again, found in foods high in cholesterol) and it can be made from skin cholesterol. Modern 'health' advice to avoid the sun, take cholesterol-lowering drugs, eat a low cholesterol diet (whatever the heck that is supposed to be) – combined with there not even being a recommended dietary allowance for vitamin D – is undoubtedly contributing to avoidable modern illness.

One of the key reasons that we need to spend approximately one third of our lives sleeping is to give the body time to produce cholesterol, repair cells and perform other essential maintenance.

This gives you the headlines of the vital functions that cholesterol performs, but hang on to that bottom line – it is utterly vital and we die instantly without it.

You may be familiar with the term essential fatty acids or essential amino acids (proteins break down into amino acids). The term 'essential' used like this in nutrition means that it is essential that we consume it in our diet because the body can't make it. The body makes cholesterol. That says to me that cholesterol is even more vital than essential fatty acids or essential amino acids – even though these too are life critical – and therefore the design of the human body is such that it was not left to chance that we needed to get cholesterol from food. Of the 500 or so roles that the liver has – one is to produce cholesterol. It is too vital to be left to chance.

What went wrong?

So, how did something so life vital become more vilified than a mass murderer? I think it comes down to three things (and I don't take credit for this view – it is there to be worked out by anyone who traces back the history and Kendrick, Uffe Ravnskov and all the thincs.org guys have led the way):

1) Rabbits;

2) Ancel Keys;

3) Money!

1) In 1913, a Russian chap called Nikolai Anitschkow decided to feed rabbits purified cholesterol and he managed to get their blood cholesterol levels in excess of 1,000 mg/dl (nearly 26 mmol/L! Most UK people have levels of 5-7 mmol/L). He then noticed the formation of "vascular lesions closely resembling those of human atherosclerosis" forming in the arteries of the rabbits. The obvious flaw in the experiment should have been that rabbits are strict herbivores. They do not eat animal products, which is the only source of cholesterol. Hence rabbits are in no way designed to digest cholesterol or animal fat and no one should be surprised if cholesterol or animal fat ended up stuck in any part of the poor rabbit. The only surprise is that no one thought to ask Anitschkow why he was feeding cholesterol and animal fat to herbivores. Interestingly, far less well known is that a parallel test was done on rats and dogs (omnivores) and feeding cholesterol to these species failed to produce lesions.

2) Ancel Keys. Remember the Minnesota experiment that I so often refer to? A brilliant and unbiased piece of research, which has given the world one of the best insights into low calorie dieting ever done – it was pure genius. This study made Ancel Keys the man of the moment and I guess he wanted to follow it with something equally impactful. There is an anecdote in The Great Cholesterol Con and on p113 of The Obesity Epidemic where Henry Blackburn, one of Keys' closest colleagues, tries to explain what may have fuelled Keys drive to find a connection between diet and heart disease.

What is little known is that Keys originally tried to establish a link between cholesterol in food and cholesterol in the blood (our cholesterol levels when we have a blood test) because he thought (probably because of poor Bugs Bunny) that cholesterol in the blood causes heart disease.

Keys did multiples of studies, changing the diets of his human 'guinea pigs', and he presented his conclusions in The Journal of Nutrition, November 1955: "It is concluded that in adult men the serum cholesterol level is essentially independent of the cholesterol intake over the whole range of natural human diets. It is probable that infants, children and women are similar." i.e. I only tested adult men and there is no relationship between cholesterol eaten and cholesterol in the blood and it is probable that there will similarly be no relationship for women or children.

In 1997 Keys put this even more assertively: "There's no connection whatsoever between cholesterol in food and cholesterol in blood. And we've known that all along. Cholesterol in the diet doesn't matter at all unless you happen to be a chicken or a rabbit."

Did you know – even the UK Food Standards Agency (FSA) and UK National Health Service (NHS) admit this?

– "However, dietary cholesterol has little effect on blood cholesterol. More important is the amount of saturated fat in your diet". (National Health Service). (Notice the second sentence? They just couldn't let the theory go).

– "But the cholesterol we get from our food has much less effect on the level of cholesterol in our blood than the amount of saturated fat we eat". (Food Standards Agency). (This link may disappear, as the FSA is bowing out of giving nutritional advice).

What the government advice should say is: The body makes cholesterol. The cholesterol you eat has no impact on the level of cholesterol in your blood – not "little", but "no" – (and we've known that all along). And they should also explain how saturated fat can determine blood cholesterol levels and then provide irrefutable evidence that it does. But it must be hard for public health bodies to even go this far. As we saw in a recent thread – the FSA also now accept that there is no limit on the number of eggs we can eat:

If only Keys had stopped here, but he wanted to find an explanation for heart disease and he was not about to be deterred. For some reason, which I find inexplicable, he then turned to fat (the entire literature on this topic is very vague about "fat" vs. "saturated fat" so his early writings are also very vague on the topic). Here's a bit of Mensa logic for those who like this kind of thing:

i) Only animal foods contain cholesterol (meat, fish, eggs, dairy). NO non animal foods contain cholesterol.

ii) All animal foods contain fat – saturated and unsaturated. Some may be very low in fat (e.g. white fish), but they all contain some fat.

iii) If there is no link whatsoever between increased consumption of foods containing cholesterol and blood cholesterol levels, there can be no link whatsoever between increased consumption of animal foods and blood cholesterol levels since only animal foods can be increased in consumption to increase consumption of cholesterol!

So, Keys first did the graph that was presented at the Mount Sinai hospital (which is the one shown in the Tom Naughton video and in Dr Robert Lustig's "Sugar: The Bitter Truth" ) and then went on to do the Seven Countries study – which I have read all twenty volumes of and take apart piece by piece in Chapter Eight of The Obesity Epidemic: What caused it? How can we stop it (on this page).

As Kendrick's two unbiased seven country studies showed – there is not even an association between saturated fat and heart disease – let alone a causation. However, Keys published his seven countries study and the rest, as they say, is history.

3) The Robert Redford film All the Presidents' Men that had the memorable quote "follow the money". This is absolutely at the heart of everything in the diet industry from national dietary organisations to the food, drink and drug industries and individuals in between.

The Ancel Keys work interestingly claimed that saturated fat consumption (A) caused heart disease (C) not directly, but by raising cholesterol (B). Hence A was supposed to cause C through B. For this to even get off the starting blocks, A and C have to be related (plot one against the other and there has to be a clear relationship); A and B have to be related and B and C have to be related. None of these in fact holds. The Kendrick study shows that A and C are not related. There is no logic that A and B could be related – because of the problem of fat and cholesterol being found in the same foods and Kendrick presented many studies that showed B and C were not related. I aim in this article to put the nail in the coffin for any idea that high cholesterol is even associated with high heart disease. We will, in fact, show that the evidence confirms the opposite.

By having cholesterol as this middle-man, this has allowed an entire pharmaceutical industry (and stupid cook books) to come up with ways of lowering cholesterol. The most lucrative of these has clearly been statins – drugs designed to stop the body producing the cholesterol that it is designed to produce. It never hurts to remind people that one statin alone, Lipitor, has been worth $125 billion to Pfizer since 1997. Taubes has a deeply troubling passage in The Diet Delusion where he looked at the committee who approved a lowering of the target cholesterol levels for the USA population. From memory (it's a big book to find a reference!), a number of people were on the committee and all but one were funded by pharma companies and one didn't want the target cholesterol level lowered. I wonder which one! (Anyone reading this – if you can find the page number I'd be so grateful – my copy has so many scribbles on I can barely read it).

So, cholesterol will remain the mass murderer for as long as statins are as lucrative as they are or until the public are enlightened and courageous enough to say no to doctors who try to put them on this medication (like my mum was after reading Dr MK!)

A small technicality

On p35 of The Great Cholesterol Con, Kendrick says: "How can eating saturated fat raise LDL levels? It is not merely biologically implausible, it is biologically impossible. Boy does that statement make me a hostage to fortune!"

I arranged to meet a biochemist at a local university to try to get to the bottom of this statement. The biochemist (who has more qualifications than I've had dark chocolate) was sadly so brainwashed in the 'fat is bad' theory that he just kept saying eating fat raises cholesterol. When I asked him to talk me through the biochemical pathway from fat digestion through to how this impacts cholesterol he said he didn't know the digestive process well enough – we would need to add a dietician into the conversation. This was alarming enough. I then said – we eat 39 grams of butter per person per week in the UK and about 1.4 kilos of flour – didn't he think it was more likely that the flour was making us fat and sick. He said it only took a drop of arsenic to kill us. I left shortly afterwards.

Kendrick has to be right (isn't he always?) LDL (remember this is not cholesterol – it is a low density lipoprotein) is the left over from IDL (intermediate density lipoprotein), which is the left over from VLDL (very low density lipoprotein). VLDL is one of the measures you get in your blood cholesterol test (actually they estimate it – they don't measure it – they only measure total cholesterol and HDL leaving two other unknowns in an equation with four variables and you thought this was scientific). (They also call VLDL 'triglyceride', which is confusing and unhelpful). Cutting a complex story short (it is explained in my book in different passages), carbohydrates can impact VLDL levels (starter for 10: Acetyl-CoA being the start of the process by which the body makes cholesterol and part of the Kreb's cycle whereby the body turns glucose into ATP), but I really have found no way in which the fat that we eat can do so. Because fat is not water soluble, it is packaged into a lipoprotein in the digestive system. The lipoprotein that fat goes into is the biggest one – the chylomicron – and then it travels off into the body to go and do the essential repair and maintenance jobs that fat does. Does the fat say – hang on Mr chylomicron – we need to go via the liver and see if we can mess up the body's VLDL production in some way?! Do ask this 'how' question (in detail) of someone who thinks that this is possible. I am still open to someone answering this, but I'm not holding my breath.

Fructose, on the other hand, we do know goes straight to the liver to be metabolised. Could that, and other carbs, impact VLDL production? The evidence I have already seen is strong that they do.

The serious bit

The WHO data is split into men and women. I first did the scatter diagrams for average (mean) cholesterol levels and CVD deaths. Then I ran the Pearson correlation coefficient on these numbers. This gives us the term called "r". "r" tells us if there is some kind of a relationship: an r score of 0 would indicate no relationship; an r score of 1 would indicate a perfect relationship. A negative r score is called an inverse relationship e.g. the price of concert tickets is likely to be inversely related to the number of concert tickets bought – fewer tickets being bought at higher prices.

The "r" score for men revealed that there was a small relationship of 0.13 – however this relationship was inverse. The diagram and correlation shows that higher cholesterol levels are associated with lower CVD deaths and lower cholesterol levels are associated with higher CVD deaths. In women, the relationship is stronger – to the point of being meaningful. The r score was 0.52 – but, again, inverse. For women, higher cholesterol levels are quite significantly associated with lower CVD deaths and lower cholesterol levels are quite significantly associated with higher CVD deaths. Please note that I have added r squared on the graphs below (excel can do this for us) and it can confirm that you've got your r numbers right and r squared tells us the strength of any relationship we have observed.

All you need to do is to look at the lines going down to the right and wonder how on earth we ever got away with telling people that cholesterol causes heart disease. High cholesterol is associated with lower heart disease and vice versa – for all the data available in the world. High cholesterol is not even associated with high heart disease, let alone does it cause it.

It gets worse. I then kept the cholesterol information and changed the death rates to total deaths – all deaths from any cause – cancer, heart disease, diabetes, strokes – all deaths. You can see the diagrams for men and women again below. This time there is a significant relationship for both men and women: 0.66 for men and 0.74 for women – again inverse. There is a significant association between higher cholesterol levels and lower deaths and lower cholesterol levels and higher deaths for men and an even more significant relationship for women.

This is serious. I've shown it to a couple of academics (Professor sort of things) with whom I've been having great debates, as I want to see what the view is from people who wholly believe the fat/cholesterol/heart/death hypothesis. (Kendrick talks in his book about what happened when he showed an intelligent colleague his two seven countries studies and the evidence was just dismissed instantly). It is most useful to know what the resistance arguments will be before starting to invite the resistance. The two arguments I got back were:

1) "Ah yes – but this is only an association."

Ah yes – but a) we changed global dietary advice back in 1977-1983 on the back of an association in Seven (carefully hand picked) Countries that miraculously became a causation even when the association was far from established and b) it is an association that's the opposite to the one that the world currently holds true and c) that's what epidemiology is supposed to be about – establish an association and then investigate if there could be any causation or useful learnings. So – go out with a new paradox – that high cholesterol is associated with low deaths and then see what dietary advice emerges.

2) "But that's total cholesterol – the key thing is the ratio of good to bad cholesterol."

Oh boy! The chemical formula for cholesterol is C27H46O. There is no good version or bad version. HDL and LDL are not even cholesterol, let alone good cholesterol or bad cholesterol. They are lipoproteins – see above – and they carrycholesterol, triglyceride, phospholipids and protein. Do you think that taxis are people? Or do you think that they are carriers of people (and luggage, and pets and fresh air and other things).

Back to – this is serious. Why are we lowering cholesterol when lower cholesterol is associated with more deaths from heart disease and all causes for men and women?

The doctors' Hippocratic oath is "First do no harm".

This also says to me – even though saturated fat has nothing to do with cholesterol, it doesn't actually matter. Even if it did – cholesterol is only associated with CVD deaths in an inverse way. If fat did raise cholesterol – as public health officials like to claim – it could save lives! Please note I am always really careful with language in this area and never jump from association or relationship to causation. Someone may be in the bath and they may be singing – if we observe this in many cases, we may claim that there is an association. We cannot say that bathing causes singing or that singing causes bathing.

Our global dietary advice was changed in 1977 in the US and 1983 in the UK as a result of a biased study of seven handpicked counties. Had the data been available for the 192 countries we can analyse now, or had Keys even considered all the data that was available to him at the time (for France etc), our conclusion may have been that we need to protect cholesterol levels in the body. We may have realised that the last thing we should be trying to do is lowering cholesterol – unless we're trying to lower life expectancy for some reason.

Zoë Harcombe

# The White Paper on Public Health (Andrew Lansley)

#### November 30, 2010

The long awaited White Paper on public health has been published (30/11/2010).

As someone working exclusively in the field of obesity, I had expected the paper to address the single biggest avoidable health crisis in the UK – obesity. The word obesity appears a dozen times in the 98 page document, but only to describe it as a problem, or to assign statistics to the scale of the problem – I could see no recommendations at first sight, other than a note under 3.53 that "employers have the opportunity to improve health outcomes." I am sure employers will welcome this responsibility during the worst recession many have faced in their lifetime.

Let's start positively:

There are some things that I like about the White Paper

1) Creation of a Public Health England – we have a Public Health Wales and with the right independence and leadership and remit this can be a positive force. However, there needs to be clarity of role. Each country has a Chief Medical Officer whose role includes public health, indeed majors on public health. As with all public bodies, roles and responsibilities need to be clearly determined with CAN DO (as I coined the phrase when I worked as an HR Director) Clear Accountability; No Duplication or Overlap.

2) The Professor Sir Michael Marmot work on health inequalities. I had the privilege of hearing the Cochrane lecture, delivered by Professor Sir Michael Marmot, at the Wales NHS conference on 11 November 2010. The comparative health and longevity and healthy years of life are indefensibly different for people from different income groups and this cannot be allowed to continue. However, I remain to be convinced if handing responsibility for this to local government will make any difference. It hasn't for education or economic development, so what will be different to make this work?

Things I disagree with:

1) In the Foreword, Lansley says: "It is simply not possible to promote healthier lifestyles through Whitehall dictat and nannying about the way people should live."

I completely disagree.

– We introduced a clunk click every trip seatbelt campaign. Robert Gifford, of the Parliamentary Advisory Council for Transport Safety charity, said seatbelts had saved 35,000 lives in the UK during the last 25 years.

– We introduced a smoking ban and an estimated 40,000 lives have been saved.

The UK government could and should introduce a sugar tax, as has been introduced in Denmark and Finland. Finland have also taken steps to get Pepsi out of schools by 2012 – still not soon enough in my view, but way ahead of the UK. The government could make an enormous difference to our health (obesity and diabetes especially) by banning food companies from advertising to children (as Sweden has done since 1991); banning sugary drinks and confectionery in school; banning cartoon characters in sugary cereal marketing and attempts by the cereal makers to get children (and adults) to eat more of their processed food; banning similar marketing by the fast food industry who want humans eating more burgers, more fries, more milkshakes, more white flour pizza, more chicken in 'secret' ingredients and so on.

This is the biggest outrage of the white paper – it is possible. Lansley doesn't want to go this route because he is more concerned about the food and drink industry than the nation's health. I challenge him to prove me wrong on this and take decisive action against the food and drink companies.

2) Lansley is doing the exact opposite to taking decisive action against the food and drink industry. He is meeting with them at Unilever house, with Unilever in the chair. His Foreword goes on to say: "All of this will be supported by work with industry and other partners to promote healthy living".

As Professor Philip James, Chair of the International Obesity Taskforce, said on BBC Newsnight last week – this is utter madness. Food and drink companies have one purpose – to grow. They need to deliver increasing returns to shareholders and their 'well being' depends on them selling more of their food and drink. The biscuit companies need humans to eat more biscuits; the cake companies need humans to eat more cakes; the cereal companies need humans to eat more cereal; the confectionery companies need humans to eat more confectionery; the fizzy drink companies need humans to drink more fizzy drinks – human beings end up being nothing more than consumers in the food and drink companies' pursuit of growth.

The food and drink companies love the current dreadful public 'health' dietary advice. They love everything being about calories and energy in and out. They will happily keep the focus on exercise – we need to exercise more; we're fat because we're sedentary kind of thing. Heaven forbid that the public stops eating processed food because they realise it makes them fat.

As I detail in my latest book "The Obesity Epidemic: What caused it? How can we stop it?" , many food and drink companies actually have the government "eatbadly plate" (I think it is supposed to be called "Eatwell Plate") on their web sites. They love the box of cornflakes on there (branded Kellogg's in earlier versions of the plate); they love the cola on there (yes really); the Battenberg cake, sweets, biscuits, white bread, sugary baked beans, fruit in syrup, fruit juice – and many more – all the processed food that they love to sell us and they want us to consume more and more of.

Our waistlines grow in sync with the growth in sales of processed food and drink. How on earth can we think that food and drink companies will lead a campaign to reduce waistlines and, inevitably, their sales in parallel. The cure to the obesity epidemic lies in returning to eating food – real food – the food we ate before two thirds of us were overweight. It does not lie in eating the processed food that we have eaten during the time in which obesity has increased nearly 10 fold – the stuff that Lansley's partners make. It really is utter madness.

3) I disagree with point 7 in The Executive Summary: enhanced nutrition is heralded as a "formidable public health achievement". Our nutrition could be the best it has ever been, but it is far from this. I analysed the UK Family Food Survey (2008) with the following conclusions:

a) Vitamins: If you take the higher of the Recommended Dietary Allowances (RDA's) for the USA and Europe, UK intake falls short for Vitamins A, C, D, E and Folic Acid. Interestingly the fat soluble vitamins (those delivered in foods with a fat content) are A, D, E and K. K was not recorded, but the deficiencies in A, D and E make it likely that our low-fat obsession is making us deficient in all the fat soluble vitamins. This should be of deep concern to our governments. Instead, when they present the latest annual food survey we are again told to eat less fat – and to become even more deficient in these vital nutrients. The vitamin E deficiency is both interesting and worrying – vitamin E is the body's natural antioxidant and is known to repair damage in the blood vessels. I wonder if that has anything to do with heart disease?

b) Minerals: The average UK citizen is lacking in every mineral recorded by the National Food Survery, compared to the higher of the RDA's for the USA and Europe. The UK is missing even the low European target in all but calcium. (No wonder so many people are now taking osteoporosis tablets with 500mg assumed to be adequate for calcium). Since so many of the minerals are not even recorded, we may be able to assume from the deficiencies in those that are recorded, that the overall picture is bleak.

A recent report confirmed that one in five middle class children are effectively suffering rickets – what was considered to be a disease of the Victorian period. This is a direct result of our negligent low fat dietary advice, telling people to avoid the health benefits of the sun and cereal companies ruling our breakfast choices, when we should be eating eggs. (Doubly ironically, on p11 of the white paper – bullet 1.1 says "once common conditions such as rickets" have been "consigned to the history books". If only....)

This is not a formidable public health achievement Mr Lansley – it's a disgrace.

4) Bullet 9 of the Executive Summary is, as a number of media commentators have already noted, "high on rhetoric" and "low on substance". It is described as a "Radical new approach". It is far from radical, although inviting food and drink companies to set policy may be new and catastrophic. A sugar tax would be new and radical; banning food and drink company marketing to children would be radical; using a tax on processed food to subsidise real food (especially directed towards people less able to afford real food) would be radical. All of these could have an enormous impact on obesity and health. Having a "ladder of interventions" and adopting "the least intrusive approach" is only radical and new in its certainty to be ineffectual.

A few other points:

In the main body of the paper:

1.6 – "People in England are healthier and living longer than ever".

I disagree. I rarely see a healthy person. Two thirds are overweight; one quarter obese; one in three will die from a modern illness – heart disease; another one in three will die from another modern illness – cancer. Approximately three million British citizens are suffering diabetes – another modern illness. The average person that I see walking around the UK is fat and sick; tired and depressed – all, I would argue, as a result of the appalling dietary advice that they have been given over the past 30 years. We are keeping people alive longer, as a result of modern medicine and pharmacology (not always in a good way), but there are too many people "existing" rather than "living". As point 1.10 says, and surely this is contradictory, "some 15.4 million people in England have a long standing illness."

1.30 – "only 3 in 10 adults eat the recommended 5 portions of fruit and vegetables a day".

This is bad science. 5-a-day has no scientific foundation whatsoever. It was a marketing campaign started by the American National Cancer Institute and c. 20 fruit and vegetable companies in California in 1991 – the influence of the food industry in demonstration. Nearly 20 years later, this marketing slogan still has no evidence base (see reference 278) and yet it features in government, Department of Health, documents as if it is scientific. A 5-a-day marketing slogan, which could have had a significant impact on the health of English people, would have been liver, sardines, eggs, sunflower seeds and a green leafy vegetable. The fruit juice that mums are trying to get into their children, thinking they are following sound government advice, is fuelling the obesity epidemic and damaging our children's livers. (There is more nonsense implying that 5-a-day is sound in point 3.31).

There are then 5 questions for consultation on which public comment is invited:

a. Are there additional ways in which we can ensure that GP's and GP Practices will continue to play a key role in areas for which Public Health England will take responsibility?

b. What are the best opportunities to develop and enhance the availability, accessibility and utility of public health information and intelligence?

c. How can Public Health England address current gaps such as using the insights of behavioural science, tackling wider determinants of health, achieving cost effectiveness and tackling inequalities?

d. What can wider partners nationally and locally contribute to improving the use of evidence in public health?

e. We would welcome views on Dr Gabriel Scally's report. If we were to pursue voluntary registration, which organisation would be best suited to provide a system of voluntary registration for public health specialists?

– nothing about should we have food and drink companies writing our obesity and drinking strategy. Just the usual vacuous 'consultation' questions that are designed to only invite comments on the least contentious areas in the secure knowledge that consultation won't change the government's plans anyway. As for evidence in public health? 5-a-day?!

I await the obesity paper in the spring.

Zoë Harcombe

# UK Women are the "World's Worst Dieters"

#### December 23, 2010

This story was in the Daily Mail December 22 2010. The headline says "World's Worst Dieters" but the article is only talking about women, so we need to be fair to men here.

SPA Future Thinking, a market research firm did a "Question of Taste" survey. They surveyed 1,534 women around the world in the following countries: Brazil, China, France, Germany, UK and USA. Some of the key findings were:

1) Although most adults are on a diet (defined by some kind of restrained eating) for much of the time, 34% of British women had gained, rather than lost, weight over the previous year. This compared to 19% of German women who had gained over the previous year (that's still a lot of people on the rise in the absence of many people losing).

2) 86% of British women had not lost weight since the previous year – this was the worst 'dieting success statistic'. This is interesting because we have known for 50 years that sustained weight loss (on eat less/do more diets) has a 98% failure rate:

"Having reviewed the literature from the first half of the twentieth century and having done their own study Stunkard and McLaren-Hume (1959) concluded "Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it." Stunkard and McLaren-Hume's own statistical study showed that only 12% of obese patients lost 20 pounds, despite having stones to lose, only one person in 100 lost 40 pounds and, two years later, only 2% of patients had maintained a 20 pound weight loss. This is where the often quoted "98% of diets fail" derives from." (From The Obesity Epidemic: What caused it? How can we stop it?)

This statistic is astonishingly supportive of Stunkard and McLaren-Hume's finding. They found that only 12% of patients lost 20 pounds. This survey is saying only 14% lost anything at all.

3) Half of the British women surveyed said that they exercised for less than 3 hours a week. Here's the really interesting exercise bit, however – French and American women exercised the least – with almost a quarter doing less than half an hour per week. Using the most recent World Health Organisation estimated prevalence for female obesity per country, we find the following (the WHO takes women as aged 15+):

– Brazil 24.5%;

– China 3.6%;

– France 7.6%;

– Germany 22.1%

– UK 26.3% and

– USA 48.3%

So – the most obese and closest to the least obese exercise the least. The Daily Mail article quotes "diet experts" (not named) as saying "people are simply doing too little exercise." On this evidence it doesn't do the French any harm. Could it be that French women eat meat, fish, dairy and vegetables and very little refined carbohydrate and American people are told to base their meals on carbs?

4) British women were only second in reliance upon convenience food – USA 'won' this category with 20% reliant on convenience food. The British figure was 13%. The other countries were in single figures – France and Germany at 6%.

If you want to be a successful dieting statistic this time next year, here are my top 3 tips:

1) Eat food – real food only and no processed food;

2) Eat three meals a day – stop snacking every couple of hours;

3) Manage your carbohydrate intake. Most people should be able to lose weight successfully with just tips 1&2. If you have weight to lose and are not losing by including 'good' carbs in your diet – these are the ones that need to go. Very carb sensitive people are becoming increasingly commonplace (hence the 171 million diabetics in the world –WHO data again) and they often need to cut back to naturally reared meat, fish, eggs, vegetables and salads to lose weight – no potatoes or grains or fruit or even dairy products in extreme cases.

# Red meat & cancer & very bad journalism

#### February 25, 2011

I am struggling to think of a diet & health story, which has been reported worse than the one dominating the press this week – and there tends to be at least one in the press every day. The newspapers seem to think that "artery-clogging" is an adjective to precede either, or both, of the words "cholesterol" and "fat" – whereas "life-vital" would be more appropriate words.

The story on red meat and cancer has to take the biscuit, however...

The story started to break on 20 February 2011 – we were forewarned that a report from the Scientific Advisory Committee on Nutrition (SACN) was about to be released. "Red meat does increase cancer risk, new report will confirm" screamed the Daily Mail headline. The article opened with the following three sentences:

"Britons should cut their consumption of red and processed meat to reduce the risk of bowel cancer, scientific experts are expected to recommend in a report."

"The Scientific Advisory Committee on Nutrition (SACN) was asked by the Department of Health to review dietary advice on meat consumption as a source of iron."

"In a draft report published in June 2009 the committee of independent experts said lower consumption of red and processed meat would probably reduce the risk of colorectal cancer."

So, SACN was asked to look at meat consumption as a source of iron and are going to conclude instead that lower consumption of red and processed meat would probably reduce the risk of colorectal cancer (bowel cancer)? (All the emphases are mine).

Notice how red meat has become red and processed meat – could these two substances possibly be more different? Real meat (by weight) is the most nutritious food on the planet – offal is best, red meat next best and white meat the next best for essential fats, essential proteins (amino acids), vitamins and minerals. Processed meat should not be ingested by a human being – full stop. Putting these two together is like putting drinking water and coca-cola together or sardines and sugared, breaded fish sticks. This is irresponsible and ignorant in the extreme.

Then notice the word probably \- despite the fact that SACN were asked to look at meat and iron – we expect them to recommend that lower consumption will probably... No one reads that caveat – the damage is done in the sensational headline screaming out from every newspaper and on line news tweet on the 20 February.

So, 25 February 2011 arrives and the SACN report is published. All 374 pages of a report called Iron and Health \- all about – Iron and Health!

The headline writers obviously don't read the report – we know the headline already – "red meat causes cancer".

BBC Breakfast kicks off the day of meat demonisation. Dr Alison Tedstone is the spokesperson from the Department of Health and she doesn't slip up during the interview in her careful use of the words "red and processed meat." She specifically says: "Our experts have said that there's a probable link between red and processed meat and bowel cancer." Note that probable and red and processed again. Plus note the word link \- there is no causation being claimed – so, there might be a link between one terrific food and one evil food and bowel cancer? Um – I wonder which one might be the problem. The fab Susanna Reid starts to ask the right question "Why would red meat?..." and then corrects this to "why would red and processed meat be a particular problem?" Tedstone says that there are a number of "plausible" mechanisms by which "red and processed meat" "might be a problem", "we don't exactly know why..." But, despite not knowing why, we are then told to limit our red and processed meat consumption to around 70g per day – approximately 2 slices of meat a day. Boy, those cavemen should have been dropping like flies.

The London Evening Standard was one of the first to run the story: "Eat less meat: Government experts warn Britons." Experts from the SACN are expected to tell consumers to eat no more than 70g of "red or processed meat" a day. The headline says meat; the first sentence adds "or processed" in straight away. Is that because processed meat is the real killer? Does the sentence not hold if we just talk about meat?

The article goes on: "Some 1,900 cases of bowel cancer could also be prevented through cutting red meat consumption to under 70g per week." Hang on a minute – how so?! The very next sentence describes the process by which processed meat is chemically altered. The sentence after says: "It is thought this process causes the formation of carcinogens, which can damage cells in the body and allow cancer to develop." I have little doubt that processing meat causes carcinogens which can damage cells etc. But Ermentrude, out in the field near my house, grazing on fast growing grass in the Welsh rain and occasional sun – surely Mother Nature didn't put her there to kill me?

The Evening Standard article ends with two telling sentences:

"Last year, experts from the Harvard School of Public Health in the US found that eating processed meats can increase the risk of heart disease and diabetes... However, unprocessed red meats, such as beef, pork or lamb, do not raise the risk, the study found." So there is a difference between real meat and processed meat – we'll just leave it to the end to point it out. This is disgraceful reporting.

BBC weren't content just with TV coverage. They ran a story and tweeted on it in the morning – no doubt as a matter of urgency – I guess we need to know before we choose our lunch? "Eat less red meat to reduce cancer risk" the story instructed. First sentence? You guessed it: "People should cut back on red and processed meat to reduce their risk of getting cancer, the government says."

Then the Department of Health tweet arrived: "Red meat link to bowel cancer." Followed by the, now very familiar: "It (SACN) concludes that red and processed meat probably increases the risk of bowel cancer..."

At this point it is important to go to the original source and see what SACN actually said. I haven't read all 374 pages – I usually start any report with the conflict of interest and then look at the summary. If anything in the summary is not clear – you can always delve deeper.

The conflict of interest is always interesting. In this case we have the chairman, Professor Peter Aggett with theSACN 2008 annual report declared interests as: Astra-Zeneca; Nestec; ILSI (I cover this 'sugar protecting' body in my book "The Obesity Epidemic"), Wellcome; Yakult and Cadbury Schweppes. The vice chair, Dr Ann Prentice, has declared interests as: Institute of Brewing & Distilling; Mars; National Association of British & Irish Millers; Optimal performance limited; Tanita; Coca-Cola; The Beverage Institute for health and wellness (yes, really) and Weight Watchers. Professor Sue Fairweather-Tait has declared interests in Coca-Cola, GlaxoSmithKline, British Egg Information Service, Unilever and Totus Medica. Those are the worst.

The headlines of the report are then:

– In a 1998 Department of Health report, the COMA (Committee on Medical Aspects of Food & Nutrition Policy – the predecessor for SACN) "highlighted possible links between red and processed meat and colorectal cancer". Since red meat is an important source of iron in the human diet, SACN were asked to look at "the possible associated adverse implications of a reduction in meat consumption on other aspects of health, particularly iron consumption." That was the brief – the possible link between processed meat and bowel cancer had been mentioned 13 years ago.

– The Terms of Reference were (and I quote) "To review the dietary intakes of iron in its various forms and the impact of different dietary patterns on the nutritional and health status of the population and to make proposals." Hence calling the report "Iron and Health" – 'cos that's what it's about.

– SACN started off the report with a bunch of excuses for why it has taken 13 years to write a report, which is so critical that the BBC needs to tell us (the wrong headline) about it twice before lunch.

– The conclusion of their task was as follows: "The modelling exercise indicates that reducing total red meat consumption (*) of consumers in the upper range of the distribution of intakes, down to 70g/day, would have little effect on the proportion of adults with iron intakes below the LRNI" (Lower Recommended National Intake).

(*) Note – in this paragraph (30) "Red and processed meat" is mentioned three times in as few lines before this summary sentence that seems to change this to "total red meat". It is clear that red and processed meat is what we're talking about. The title above para 30 is "The potential impact of reducing red and processed meat consumption on intakes of iron and zinc."

Paragraph 36 reiterates that there is merely a possibility of a link between red and processed meat and bowel cancer. The logic then goes:

– "red and processed meat is a source of iron"

– "it is not possible to quantify the amount of red and processed meat that may be associated with increased colorectal cancer risk"

– "It may be advisable for adults with relatively high intakes of red and processed meat to consider reducing their intakes"

– "Modelling indicates that this would have little effect on the proportion of adults with iron intakes below the LRNI"

So, we're not worried about population iron intake if the high red and processed meat consumers cut back.

And that's what the SACN report was about.

But, never let the science get in the way of a good story...

Red meat is going to kill you!

# Five-a-day – is it enough?!

#### March 23, 2011

This is a blog about an article in The Independent, in which I was quoted. You may not be able to read the article on line for very long because The Independent has really annoying moving adverts down both sides of the page. However, you just need to whiz through it to get a feel for the debate – the article is what you'd expect from The Independent – a middle of the road drive through some big issues, but let's not really go anywhere.

I discovered during the writing of my book "The Obesity Epidemic" that five-a-day was invented by a bunch (ha ha) of fruit & veg companies at a meeting with the American National Cancer Institute in 1991 (not 1998, as the article says). The American National Cancer Institute has since trademarked the term and the fruit & veg manufacturers, logistics and packaging companies hit the jackpot with this marketing slogan, as it is now 'out there' in c. 25 countries across 3 continents.

It was good to see Tim Lang, Professor of Food Policy at City University London confirming the lack of evidence in the article: "It was a political fudge," Lang says, "there was very little evidence basis for it. They just chose a figure that was aspirational but not so high as to be perceived as impossible to reach." Lang, it seems however, would be happy if the bar were set at 9-a-day – as it already is in Australia & Greece. However, as happens with non-evidenced bases messages that spread, Denmark advises 6-a-day, Ireland 4-a-day and I detail the whole range of variations on p204 of my book.

This article is not about the debate as to whether or not there was evidence before the creation of 5-a-day that 5-a-day would do anything to help cancer because there can be no debate. There was no evidence at the time that eating 5 portions of fruit & veg a day would help cancer – which was the only medical condition involved at the outset. There can be little debate that evidence has been found since – the EPIC (European Prospective Investigation into Cancer) concluded in April 2010 as follows. (Please note that this study was set up in 1991 – surely coincidence ;-) ):

April 2010 – report from the EPIC study:

In April 2010 a study was published in the Journal of the National Cancer Institute written by Paolo Boffetta, as the lead of a large group of European researchers. The study sought to quantify if cancer risk were inversely associated with intake of fruit and vegetables. The article analysed data from the EPIC study, involving 142,605 men and 335,873 women for the period 1992-2000. This review of almost half a million people found that eating five portions of fruit and vegetables a day had little effect on cancer risk and the very small difference observed could be explained by other factors. The study also grouped participants into five categories from the lowest intake of fruits and vegetables (0 to 226 grams a day) to the highest intake (more than 647 grams a day). Significantly, the cancer risk did not vary between the five groups. The overall conclusion of the study was that:

"A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation."

The British arm of the EPIC study reported the same later on in 2010:

November/December 2010 – report from the EPIC study:

A report published in the British Journal of Cancer 30 November 2010, written by Professor Tim Key – UK leader for the EPIC study, concluded:

"The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established."

This post is about the report which stimulated interest in The Independent article:

January 2011 – report from heart people at Oxford using the EPIC data:

The article refers to a report published in the European Heart Journal on 18 January 2011. It was covered in the press at the time, but The Independent picked up on it last week (16 March 2011).

Let's just be clear at the outset what's going on here. A huge, and no doubt hugely expensive, study has been done across Europe, involving half a million people, trying to establish even an association (not causation) between cancer and fruit & veg intake and the study has not been able to conclude this (and that alone says something, as most statistics can be manipulated, as we will see just below).

So, people studying heart disease have used the cancer study data to see if they can come up with an association (never, never leap to causation) between fruit & veg intake and heart disease. To be fair – the conclusion in the "abstract" (summary) of the report is as follows:

"Results from this large observational study suggest that a higher intake of fruits and vegetables is associated with a reduced risk of IHD mortality. Whether this association is causal and, if so, the biological mechanism(s) by which fruits and vegetables operate to lower IHD risks remains unclear."

(NB ischaemic (ischaemia = reduced blood supply) heart disease = heart disease excluding strokes)

So, the researchers didn't make the causation mistake in their summary. However, in the abstract, we have the following details about methods & results:

– There were 1,636 deaths from IHD from a study of 313,074 men and women from 8 European countries. That gives a death rate of 0.52% from IHD in nearly 10 years (the average years of follow-up was 8.4).

– The journal says: "Participants consuming at least eight portions (80 g each) of fruits and vegetables a day had a 22% lower risk of fatal IHD [relative risk (RR) = 0.78, 95% confidence interval (CI): 0.65–0.95] compared with those consuming fewer than three portions a day. After calibration of fruit and vegetable intake to account for differences in dietary assessment between the participating centres, a one portion (80 g) increment in fruit and vegetable intake was associated with a 4% lower risk of fatal IHD (RR = 0.96, 95% CI: 0.92–1.00, P for trend = 0.033)."

So, in the method & results details, they do make the leap from association to risk – this is done all the time in studies and is bad science. They have effectively observed that there seems to be an association between people being in the bath and singing. They can no more say that being in the bath increases one's risk of singing than they can say singing increases one's risk of taking a bath. Or that either increases the risk of anything.

Note the second sentence – not the one that gave the 22% lower risk headline in The Independent article – that's the memorable thing that sticks in the minds of the public and makes them rush out to add fruit & veg to their likely expanding waist lines. "After calibration of fruit and vegetable intake to account for differences in dietary assessment between the participating centres"... i.e. after adjusting for the fact that different centres were assessing intake differently, the difference is tiny (0.96 vs 0.92) – they surely cannot claim this as significant even for association, let alone causation.

Lies, Damned lies & Statistics

What newspapers want is the screaming headline "30,000 lives will be saved" (No lives will ever be saved, by the way – we're all going to die. We may be able to delay likely time of death by a couple of months (see Dr M Kendrick's brilliant analysis of the maximum possible impact of statins in "The Great Cholesterol Con"), but you're going to die) or "22% lower risk of X". This is wrong, misleading and, quite frankly, dishonest.

Forgive me for not paying the $40 to be able to view the full article for one day. I don't know if the article would detail the categories of fruit & veg that the deaths were divided between and the numbers of people in each category, but I could guess "fewer than 3 portions"; "3-5″; "5-7″ and more than 8 and then let's say it looked something like the following...

If you start from the assumption that people in each of 4 fruit & veg consumption groups were distributed evenly in terms of number of people and deaths, then 78,269 people would be in each group (total 313,074) and 409 deaths 'should' have occurred in each group (total 1,636) (notwithstanding that there are too numerous to cover reasons as to why deaths would not be distributed evenly – nothing to do with fruit & veg). For the deaths in the 8+ group to be 22% lower than the deaths in the fewer than 3 group, keeping the deaths in the 3-5 and 5-7 groups at 409, deaths in the 8+ group would be 369 and deaths in the fewer than 3 group 449. Hence 0.47% of the higher intake group would have died during the period reviewed and 0.57% of the lower intake group – not such an impactful headline when you state the facts.

But here's the killer point – this is merely an observation. What lifestyle do you think people lead who are consuming more than 8 portions of fruit and veg per day? Do you think they put down their cigarettes, or recreational drugs, to free up a hand to eat an apple? Do you think they are sat on their fat and lazy backsides watching TV munching crudités? Or do you think people consuming 8 portions or more of fruit & veg a day are generally 'healthy' people – shunning processed food in favour of fresh, naturally active, not smoking, managing stress levels and so on. So this study might have observed that overall healthy people have fractionally lower heart disease than people who have less healthy lifestyles.

Hardly hold the front page now!

For a final couple of points:

1) We MUST start distinguishing between fruit and veg. Veg can be quite nutritious – especially the dark green leafy vegetables and especially when cooked in/eaten with butter to deliver the fat soluble nutrients within. Fruit is so different – high in fructose (and glucose) – which is the perfect fattening combination in the world of obesity (indeed fructose along has been called the fattening carbohydrate for some time – it just takes public health advisors a dangerously long time to catch up.) Low starch vegetables and salads definitely have a place in a healthy, enjoyable and varied diet. But, as Gary Taubes says, "If you are overweight, fruit is not your friend", and that's the world in which I work – obesity.

2) There are so many other far more important factors which could and should be looked at and yet no one is going to get funding for a study looking at the damage being done to human beings by the staggering British and American consumption of sugar and white flour. The Sugar Bureau and Flour Advisory bureau wouldn't like it and our eatbadly plate (the UK role model of health eating) is, inexplicably, trying to drive precisely this food consumption – a la "base your meals on starchy foods". Whatever you do, don't eat meat, eggs and butter, which are stacked with vitamins and minerals, essential fats and essential proteins (there is no such thing as an essential carbohydrate – interesting).

What people are NOT eating is likely more important than what they are. People who DON'T eat sugar, flour and processed food are vastly more likely to be healthy than people who consume the 400 cals of sugar and 730 cals of flour that the average Brit (and American) eats per day. The Seven Countries Study made exactly this error – it concluded that America ate a lot of fat and Japan ate very little and this was why heart deaths were so different. Japan also ate no processed food whatsoever at the time (1956-1970) and the American coca-cola, burger, hot dog culture was well under way in the USA. It was not any real fat in real food that had anything to do with heart disease – it was any processed food (carbs or fats) that the Americans were eating.

If the idiot powers that be try to get people to eat 8-a-day, instead of the already fattening and unjustifiable 5-a-day, obesity will rise even faster and more certainly than it is now. People are trying to eat 5-a-day in addition to everything else they are eating. People are also majoring on fruit, rather than veg (because it's sweeter) and consuming fruit juice, dried fruit and other fattening things. Childhood obesity is being fuelled by trying to get 5 portions of fruit juice, dried fruit, sweetcorn on pizza etc into already fat little Johnny.

Or – as The Independent 'helpfully' illustrates how we can get our 8-a-day – sweet potatoes (actually higher in carb than normal potatoes), dried fruit, salty soup, sugary baked beans, banana milk shake – and you wonder why we have an obesity epidemic!

# Bariatric Surgery: What's it all about?

#### April 14, 2011

Wednesday 13th April 2011 must have been "Free PR for bariatric surgery day". I could not read a paper, watch the TV, listen to the radio, or even scan twitter without seeing stories about how marvellous bariatric surgery is and how we should be doing far more of it. The spokespeople in the numerous media reports were invariably bariatric surgeons who stand to make even more money the more of these operations that they do. They are certainly gaining £'s in their single minded effort to convince the world that the only way to lose lbs is by allowing them to operate on the obese people that mankind made fat and sick in the first place.

This article, therefore, is a summary of what we all may like to know about bariatric surgery: What exactly is it? How is it supposed to work? What are the risks/side effects? Is there an alternative that we haven't considered? Not least if this seems a bit scary and extreme.

What is Bariatric Surgery?

Bariatric surgery is the collective term given to a number of different procedures all designed to 'interfere' with a person's digestive system.

The main different types are:

1) A Gastric Bypass (also called the Roux en Y Gastric Bypass procedure). This operation was first done in 1967 in the USA. In 2008 there were 200,000 such procedures done in the USA. It was originally always done as an open operation (cutting the stomach open) and sometimes still is done in this way. More commonly nowadays, however, it is done "laparoscopically". This means it is a less invasive operation – small cuts are made (usually 0.5-1.5cm) and then the surgeons can use cameras to pin point the area they want to work on without having to open up the whole stomach area. This reduces time spent in hospital to 2-3 days and there is a shorter recovery time also. Most people still need 2-3 weeks off work and can't drive for a couple of weeks.

Gastric Bypass is a very accurate name for what is happening here – the stomach is literally bypassed – so that food doesn't go where it used to go – and where it should go. All you need to know, from a nutrition and health perspective, is that the majority of nutrients (vitamins and minerals, vital for life and human health) are absorbed in the small intestine. In the pictures above, you can see that the small intestine is bypassed and nutrients can not, therefore, be absorbed properly. This surgical procedure is irreversible.

2) A Gastric Band is less invasive than Gastric Bypass surgery. This is done through key hole surgery, with four small incisions. An adjustable band is placed around the top of the stomach, as shown in the diagram, and it can be adjusted after the procedure. The operation is done under general anaesthetic, taking about an hour and the person can be released in 24 hours and be back to normal activities within a week or two. Unlike gastric bypass surgery, banding is reversible although this is not advised as weight gain is likely to occur.

Anne Diamond and more recently Vanessa Feltz have had Gastric Band surgery. Sharon Osbourne is probably the most well known example of a reversal of this procedure. Sharon had a Gastric Band fitted in 1999 and then had it removed in 2006. Sharon's reason for having it removed was "I keep wanting to eat more and more....I'm a pig"! She was being physically sick every time she 'overate' (probably normal amounts for someone without a gastric band) and this can't be pleasant. No matter how much we want to be slim – Sharon obviously found that some things are just so intolerable and uncomfortable that she made a decision that may seem unimaginable to some of us.

3) A Gastric Balloon is a soft silicone 'balloon' that is inserted into the stomach 'deflated'. The c. 20 minute operation doesn't need a general anaesthetic, mild sedation (whatever that is) is induced instead. The balloon is inserted through the mouth and guided down to the stomach where it is then inflated until it takes up a big part of the stomach area. The balloon needs to be removed after 6 months because of the risk of erosion from stomach acid. The removal takes about the same time – 20 minutes – and, again, can be done under mild sedation.The idea is then that the person has had 6 months to improve their 'eating behaviour' and doesn't need a band. Yeah, right!

Often a balloon is used to try to help someone lose some weight before they then have a band or a bypass. This may happen with someone who is dangerously obese and the surgeons don't want to risk a general anaesthetic until the person has lost some weight.

There are other procedures, which fall under the collective term 'bariatric surgery':

– A Sleeve Gastectomy removes 85% of the stomach. Effectively a new 'sleeve' or tiny stomach is created. It is alleged that this enables some of the nutrients to be absorbed, because a stomach of sorts is still there. However, the key thing to find out is what they plan to do with your small intestine. The small intestine is actually more than 6 metres long and this is where the majority of nutrients are absorbed. I'd want to know what they were planning to do with my 6 metres! This is obviously irreversible.

– A Duodenal Switch. I have absolutely no idea why someone would opt for this procedure. The full name is "Biliopancreatic diversion with sleeve gastretomy". You've got the idea of the Sleeve Gastrectomy above – so this procedure involves having 85% of the stomach removed. Then you get clear direction on what is planned for your small intestine. The procedure makes a new pathway from the end of the new small stomach to the colon (also known as the large intestine). The colon is where food should end up after digestion and from there it is evacuated from the body as faeces. In this procedure, food bypasses the majority of the small intestine (the duodenum particularly), which limits the amount of food that can be absorbed.

– Stomach Stapling used to be quite common – this involves pretty much stapling the stomach (as if you were stapling paper, to give you the imagery) so that the stomach is made smaller. It is simply less favoured now and the bypass and band options are preferred instead, having similar and apparently safer outcomes to stapling. Staples had an unfortunate habit of becoming infected or tearing another part of the person's inside and causing internal bleeding etc. I wouldn't put a staple in my finger, so why would we think putting a few inside our body is a good idea?!

And those are pretty much the surgical options available under the term 'bariatric surgery'.

How are they supposed to work?

1) A Gastric Bypass has a pretty direct way of making the person consume less food than is needed for energy and health (and that's the right way to describe what's happening – the individual will have insufficient energy and nutrition from food permanently after the operation). One of the private weight loss surgery information sites says "Over-eating causes abdominal discomfort and vomiting." You may still feel like overeating (most likely you will), but, if you do so, you will regret it very quickly and violently.

Some people become scared to eat and this will be quite an effective way of losing weight, health and energy from that point onwards. For others, the temptation and cravings are too great and they do try to eat their craved foods and they will feel terrible very quickly. Many will put up with feeling so ill because of the power that their fix has over them.

2) A Gastric Band works literally by making the stomach so small that the person can hardly eat anything before they feel full (very temporarily). If they eat more than the tiny area above the band can hold they are likely to be sick and throw back up the food that they have tried to eat.

This is a pretty drastic way of trying to get people to eat less.

3) A Gastric Balloon is intended to work in a similar way to the Gastric Band – by making the stomach area smaller so that the person feels full sooner and stops eating. (Yeah, right, again!) The person will also feel sick and will actually vomit if they eat 'too much'.

The literature for Gastric Bypasses and Bands admits that mal-absorption of vitamins and minerals is a problem (that's a bit of an understatement) and that people need to take vitamin supplements and be regularly tested for anaemia and that iron, B12 and calcium deficiency are especially common. All fat soluble vitamins are likely to be compromised – vitamins A, D, E and K – just as they are when Orlistat/Alli/Xencial is taken in tablet form to try to stop fat being absorbed by the body. Messing around with the entire digestive system has a similar disruption to the body's ability to be able to absorb fat.

The National Obesity Forum produced a booklet, written by Dr David Haslam, Colin Waine and Anthony R Leeds. At the end of the booklet, Haslam declared an interest as a consultant for Lighter Life and Leeds declared an interest as an employed medical director for the Cambridge Diet. The booklet was funded by the Cambridge Diet. This is a conflict of interest as liquid only diets are advised for a couple of weeks before surgery and many people will find they can only consume liquid diets for a period of time after the surgery.

The bit that is interesting to note in this booklet is the admission: "The risk of complications is dependent on the nature of the surgery and the degree of bypass... All are likely to develop vitamin B12 and iron deficiency. Many UK patients have low or deficient vitamin D status pre-operatively due to low exposure to sunlight, low dietary intake and effects of their previous experience of weight loss regimens. Vitamin D status and bone health therefore need to be watched. Serum trace elements such as Zinc, Selenium and Copper levels have been shown to fall in the majority of patients post-bariatric surgery."(my emphasis)

There are so many interesting comments to make about just this short passage:

a) Note the admission that vitamin D intake in the UK is deficient and the admission that diet has played a part in this. What are the best sources of vitamin D? Eggs and dairy foods. So dieticians tell us to avoid eggs and have low fat dairy foods (when fat soluble vitamins, like vitamin D, need fat to accompany the vitamin or it is pretty useless);

b) Note that word "All" – I added the emphasis – not the authors. All bariatric surgery patients are likely to develop vitamin B12 and iron deficiency. What does that mean? Anaemic, extreme tiredness, pale skin, low energy, palpitations, breathlessness, pins & needles, confusion, depression, poor concentration and so on. And that's just 1 vitamin and 1 mineral. There are 13 vitamins and c. 16 minerals that will be seriously affected by effectively removing the ability to absorb nutrients vital for life.

c) How would we like selenium deficiency? It can cause heart arrhythmias and loss of heart tissue, deterioration of muscle tissue, muscle pain and weakness etc. Or maybe zinc deficiency? Dandruff, eczema and hair loss if we're lucky and inflammatory bowel disease, growth retardation, pre-eclampsia (serious complication in pregnancy) and loss of sex drive if we are not so lucky.

We talk and act as if vitamins and minerals are optional and it doesn't matter if we take away the body's ability to absorb them. Vitamin comes from the Latin word "vita" meaning life. They are literally life or death substances.

Risks and side effects:

What are the risks and side effects of the most common procedures: Gastric Bypass and Gastric Banding?

1) Nutritional deficiencies (and all the minor and serious and even life threatening conditions that come with deficiencies in any individual vitamin and mineral) are not risks – they are virtually guaranteed. The 'prescription' following gastric bypass is "lifelong vitamin supplementation required."

2) The post-operative information, which can be found on private surgery web sites, has a number of FAQ's. Here are a couple of the most Frequently Asked Questions:

Q Will I lose my hair after surgery?

A) Yes there is a possibility

Q) Will I have baggy skin or stretch marks?

A) Unfortunately you are likely to be left with a large amount of loose skin.

Q) Will I lose weight straight away?

A) Following a bypass you can expect to lose a stone a month for the first year. Following banding a loss of 3kg per month is normal. (My comment – this is hardly different to what calorie counting promises, but doesn't deliver. Weight regain is documented to occur in 98% of cases following calorie deficit diets (Stunkard & McLaren-Hume 1959). Whether the person manages to eat less/do more through willpower, or because they have had surgery, matters little. The only difference being that the gastric options make it less possible for people to eat the fuel that they actually need – because they will be sick and/or ill if they do).

3) The 'complications' list for Gastric Bypass includes: infection (an estimated 1 in 20 patients); internal bleeding (an estimated 1 in 50 patients); leakage from stapled sites (one of the biggest causes of fatalities resulting from the surgery); blood clots; deep vein thrombosis (DVT); breathing difficulties; pain; vitamin and mineral deficiencies (they're a given); heartburn and bowl obstruction. The private weight loss surgery sites themselves admit that about 1 in 50 patients need corrective surgery because something has gone wrong.

I've got a 1 in 14 million chance of winning the lottery and I still think it might happen – I'm not sure a 1 in 50 chance of internal bleeding is worth gambling on. The 'complications' list for Gastric Banding includes: band slipping/twisting and stomach obstruction; infection; erosion into stomach and injury to stomach and nearby organs.

4) There are then what the patient may consider to be complications: not being able to eat normally; serious bodily responses if they succumb to a binge (even a 'small' one); not being able to join in at family meal functions and celebrations; feeling hungry all the time; having to eat little and often and all the blood sugar swings that go with this; having little or no energy, as you can no longer put fuel in your petrol tank in effect; stomach pain and all the health complications that go with just not feeling well and nourished.

5) Life may never be the same again. When I first saw this headline I thought "there's just no pleasing some people". If you read the whole story and not just the headline, it is quite upsetting. Tim Daily can no longer eat any solid food. He is literally wasting away and is suffering from malnutrition and is now fed through a tube into what is left of his stomach. If he does eat any actual food the pain is so excruciating he needs to take morphine.

This has literally ruined the man's life and I suspect he will be dead in a few years from effective starvation. He has a one in four chance of death if he tries to have corrective surgery. That is one heck of a rock and a hard place and one heck of a 'side effect' .

6) Finally death itself. Some private web sites promoting bariatric surgery will admit that death rates for Gastric Bypass operations are 1 in 200. Try 1 in 50 said a CBS report into a Washington study. One of the most comprehensive reviews that I found was in the Journal of the American Medical Association (2005) – an extremely prestigious journal. This article found that, from a total of 16,155 patients who underwent bariatric procedures (mean age, 47.7 years; 75.8% women), the rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs. 1.5%, 4.8% vs. 2.1%, and 7.5% vs. 3.7% at 30 days, 90 days, and 1 year, respectively). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs. 1.7% at 30 days, 6.9% vs. 2.3% at 90 days, and 11.1% vs. 3.9% at 1 year). So, according to this study, up to 11% of patients for 'stomach' surgery weight loss operations are dead within a year.

My view on bariatric surgery:

You can probably tell that I am not a fan and these are the main reasons why:

1) The most important one is that it is not necessary. I am shocked at the idea that we would rather remove 85% of someone's stomach, than have people return to eating what we used to eat before we became so obese that we needed to invent bariatric surgery. There is another option, which can be used as a first resort as well as a last. It is healthy and is likely to lead to lost weight and gained health. However, I am considered radical for suggesting it. Surgeons who want to remove our digestive systems are welcomed onto the breakfast TV sofa and I am ostracised for daring to suggest that we just need to eat real food, as provided by nature. The excuse given will be that nature is 'out to get us' and put real, essential, fats in real meat, fish and eggs with the intention of killing us and so we must not eat what nature provides – we must eat what food manufacturers provide instead. You would not think that humans would be so stupid as to believe this, but, when PepsiCo alone is worth $44 billion and is larger than 60% of the countries of the world (comparing revenue with GDP) – there is no place for truth. There is no money to be made pushing Mother Nature's natural products. The profit to be made by food & drink companies, pharmaceutical companies and/or bariatric surgeons is the real issue here.

The first/last resort should not be surgery. The first resort should be 1) eat real food 2) three times a day and 3) manage carb intake to manage weight. The last resort should be to take these 3 rules to the extreme of a virtually 'zero' carb diet. Then the body cannot store fat and it has to use its own fat for fuel. My recommendation would be the best of Harcombe/Atkins. "Only eat real food" (Harcombe) has to be the fundamental guiding principle for any healthy eating/weight loss plan and then the very low carb/ketosis principle of Atkins is a very useful one, which we have known about for over 150 years (since Banting et al).

Hence – the last resort should be to eat unlimited real meat and eggs from grass reared animals (nothing processed); real fish (meat, eggs and fish can be cooked in butter, lard or olive oil) and then 20 grams of carbohydrate a day. The carb intake can include dairy from grass reared animals, vegetables (not potatoes) and salads, but there will be no room for fruit, whole grains or large portions of dairy.

People would be better off using the carb allowance for green vegetables and salads (this would approximate to one coffee mug of green veg/salad at each of two main meals and the third meal would be carb free – (non-processed) bacon & eggs for example). This will just make meals feel more 'normal' and filling. There is no need to be hungry, no need to suffer ill health, vitamin or mineral deficiency, no need to be low energy (it may take a while for the body to get used to using fat for fuel and not carbohydrate) and there is no need to die from having your entire digestive system completely compromised. Surely that is a far better 'last resort'?

2) Another issue I have with bariatric surgery is that it fundamentally believes in the 'eat less' principle (the person won't be able to do more as they will have no energy). Everything we know about 'eat less' studies – the 80 studies from the outstanding review (Franz et al 2007) in that famous chart in the club – says that the weight returns and the body will continually adjust to lower calorie intake. All the evidence for the past 100 years also supports this.

You will find many studies on line and I have come across clients who have had surgical procedures only to regain the weight. I give an example in "The Obesity Epidemic" book of a man I sat next to at dinner at an obesity conference. He had had a Gastric Bypass and had lost a reasonable amount of weight (never got a BMI below 30, so stayed technically obese). He was steadily regaining the weight when I met him.

One of the main reasons for this is that, after bariatric surgery, people are invariably only able to digest the things that we avoid. He could eat bread, potatoes and the pudding quite easily – he couldn't digest the lamb and no doubt fish would also have been problematic. People who have had surgery will be living on carbs, little and often, continuously throughout the day and will be horribly hungry and their likelihood of developing type 2 diabetes must be high.

3) The third point that I would like to make about bariatric surgery (and many supporters of these operations make this point also) is that it does nothing to change the underlying problem that caused the obesity in the first place. It does not give people the understanding about food addiction and cravings that we have. It does not address the mind games and emotional connections with food that we have made. The poor person who has their stomach reduced to the size of an egg will still have all the food addiction and immense cravings that we all know only too well. Can you imagine having that incredible desire to eat and knowing that you would feel horribly physically ill if you gave in to it?

There is a term called 'dumping' used to describe a situation that people who have had bariatric surgery can experience. If you have ever fainted and had that most indescribably awful feeling when you come round (your blood sugar is on the floor; you feel sick/nauseous; hot and cold; you feel an urgent need to poo; you feel like you have died or wish you had – I faint at blood tests most times and I know this dreadful feeling only too well). If someone who has had bariatric surgery eats a small bar of confectionery they may well experience all of this and then some. That would terrify me on a daily basis.

Contrary to commonly held beliefs, people who have bariatric surgery rarely reach normal weight. They are lucky to even get into the overweight category and regain is likely.

The final point should not need stating, but clearly does, as the bariatric surgeons will be at pains to play this down. How can I support the mutilation of the human body? (the definition of mutilation is to deprive one of a limb or essential body part – I would consider my digestive system fairly essential). Do we have any idea of the long term effects of bariatric surgery? Dr Natasha Campbell McBride, a world authority on the gut, calls the gut "our second brain". What would she say about effectively removing our second brain? If mutilation really were the last resort then maybe we would have no alternative but to consider this option – but we are far from at that point yet.

# MyPlate – the new American USDA  
food pyramid

#### June 3, 2011

The new American Food Plate was launched on Thursday 2nd June 2011. Here it is – or you can see the original on the USDA web site.

Let's start with the positive:

1) It's much easier to understand that the current American Food Pyramid (2005):

This was so complicated (and seemingly needed to be individually tailored), that many people just carried on using the old American Food Pyramid (below – introduced 1992), which directed Americans to have: 6-11 grain portions a day; 2-4 fruit portions; 3-5 vegetable portions; 2-3 dairy servings and 2-3 meat/egg/fish/bean/nuts/egg servings per day. Hence Americans could have 26 portions of food a day – all having an impact on blood glucose levels. And we wonder why America led the world in getting fat and sick.

MyPlate is served with some advice, as a side dish

Here is the accompanying dietary advice in black; my comments in red alongside:

Balancing Calories

• Enjoy your food, but eat less. (Less than what? An anorexic? Less than you are eating now? Less than you need for health?)

• Avoid oversized portions. (Requires too much judgement to be useful advice – what is oversized to you may not be to me or vice versa. Plus – it is very difficult to 'overeat' real food – organic meat/fish/eggs/veg – it is very easy to 'overeat' processed food. Hence nature sorts out portion sizes for us)

Foods to Increase

• Make half your plate fruits and vegetables. (i.e. Fructose & glucose & glucose).

• Make at least half your grains whole grains. (there is debate on this in the informed nutritional world – whole grains have more nutrients than white grains (still far fewer than quality meat/fish/eggs), but white grains are less abrasive than whole grains and therefore less likely to cause irritable bowel syndrome or bowel cancer. It's all glucose to the body either way).

• Switch to fat-free or low-fat (1%) milk. (The UK is deficient in vitamins A, D, E and our government doesn't bother recording vitamin K in the National Food Survey, but no doubt we are deficient in all four fat soluble vitamins. I doubt that the USA is any better, so we would be well advised to consume real fats in real food – like milk from ruminants freely living on grass. Nature sensibly puts real fat with real fat soluble vitamins in real food. Man stupidly takes them out).

Foods to Reduce

• Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers. (Don't eat anything processed).

• Drink water instead of sugary drinks. (Good advice. Better still "Don't drink anything processed").

So the new MyPlate is simpler, but does this make it any better... Here are my key concerns for America's national (public) health and for the nutritional advice in this new model...

Three national health concerns about MyPlate

1) This will do nothing to solve the obesity epidemic.

I have written 135,000 words on The Obesity Epidemic: What caused it? How can we stop it? In a nutshell we changed our diet advice (America in 1977-1980 and the UK followed suit in 1980-1983) and obesity has increased 10 fold since in the UK; America started from a slightly higher base, so has 'only' increased by a few multiples and not 10! We changed our advice away from "Farinaceous and vegetable foods are fattening, and saccharine matters are especially so" (Tanner, The Practice of Medicine, 1869) to "Base your meals on starchy foods." This has had catastrophic consequences for human weight and health and cataclysmic benefit for the food, drink and drug industries, which profit from us being fat and sick.

MyPlate will do nothing to change this. It is still telling humans to "Base your meals on starchy foods" instead of realising, as we did for the 3.5 million years before the last 30 years of 'conventional wisdom', that carbs are uniquely fattening (and unnecessary for human health). Grains are just glucose, fruit is fructose and glucose (a particularly uniquely fattening combination – the same as sucrose – table sugar), vegetable are glucose (potatoes and starchy vegetables especially so) and dairy (processed yoghurts) and protein foods (beans etc) chosen can also have a carbohydrate content.

2) This will do nothing to solve the nutritional crisis.

We seem to have forgotten why we eat. We eat because there are 13 vitamins and c.16 minerals vital for human existence, let alone health and well being. All the plates and pyramids are obsessed with macro nutrients (fat, protein, carbohydrate); they seem to have forgotten mico nutrients (vitamins & minerals) entirely. Remember that slogan "Take care of the pennies/cents and the pounds/dollars look after themselves"? This applies nicely to nutrition. "Take care of the vitamins and minerals and the fats, protein and carbs will look after themselves."

Our dietary advice should start from – how do we get our vitamins and minerals (notwithstanding that the concepts of "Recommended Dietary Allowance" (RDA), let alone "Adequate Intake" (AI) are a joke – as Sally Fallon Morell says "Why am I only allowed a certain level of nutrition?"!) I did just this in my book The Obesity Epidemic. I've put three examples (for omnivores, vegetarians and vegans) as an Appendix to this post.

MyPlate will do little to nothing to improve the health of the American nation. We should be telling people to base their meals on meat and eggs from animals freely grazing on grass; fish and vegetables/salads. Quality dairy (again – only products from grass living animals are worth consuming), nuts & seeds (in moderation if overweight) and local, seasonal fruits (in moderation if overweight) are useful additions to the meat/fish/egg/veg base. Almost half the plate is taken up by fruits and grains – high glucose/low nutrition relative to meat/fish & eggs. No attention is given to the quality of food (other than the emphasis on whole grains, which is debatable (see red notes above)). The importance of eating animals that have predigested cellulose for us (arguably their role in the circle of life, along with fertilising the soil without needing oil) is not addressed. The epidemic of (type 2) diabetes will continue unabated with this level of carbohydrate intake.

3) The food industry will still love this.

The food industry, in fact, wasted no time in saying how much they loved it. Kellogg's and General Mills (sponsors of the American Dietetic Association) (ADA) will love that grain segment – that's cereals for breakfast then. Unilever and CoroWise (more ADA sponsors) should be happy – dietitians will be telling people to put hydrogentated spreads on their copious amounts of bread – certainly not that natural butter product. The dairy industry (another ADA sponsor) will be very happy – they've got their own little segment all to themselves. When chips and potatoes count as veg, the fast food companies will be happy (Aramark – the 'dining away from home' ADA sponsor – should be happy anyway). Plus, no one is really going to opt for water instead of phenomenally promoted Coca-cola & Pepsi (not least when these are also ADA sponsors and therefore able to convince dietitians of the marvel of calorie-free, aspartame-laden, fizzy concoctions).

Here's how it works for the fast food industry: Burger (protein), bun (grains), fries (vegetables), tomato slice (fruit), lettuce leaf & gherkin (more vegetables), strawberry milk shake (more fruit & dairy) – the perfect meal!

Anything that the food industry likes is a fail. The food industry would hate my advice – see below!

Three nutritional/technical concerns about MyPlate

1) The USDA appears not to know the difference between a food group and a macro nutrient!

There are 3 macro nutrients: fat, protein and carbs. There are essential fats (i.e. fats we must eat); there are essential proteins (i.e. amino acids we must eat); there are no essential carbs (i.e. there are no carbs that we must eat). Yes the brain does need glucose, but that doesn't mean that we need to eat it. Indeed, anyone wanting to lose weight should relish in the fact that the brain needs glucose. Don't eat it and then the body send out a signal to break down body fat to get glycerol/glucose. Result!

MyPlate has 4 food groups: vegetables, fruits, grains and dairy and one macro nutrient – protein! Protein is actually in everything. Literally everything from lettuce to apples to oats to beef. Hence MyPlate has protein in every segment. This is not necessarily a bad thing, but they still don't know food groups from macro nutrients!

My food groups would be: meat; fish; eggs; dairy; vegetables & salads; nuts & seeds; fruits; beans & pulses and grains. That would make 9 in total. 5 of my food groups – meat; fish; eggs; nuts & seeds and beans & pulses – would end up in the one macro nutrient group on MyPlate – the protein segment. This should be the major part of the plate, not the minor part and the USDA should know a food group from a macro nutrient.

2) The USDA is as fat phobic as ever.

We changed our dietary advice c. 1980 (and started the obesity epidemic in so doing) because we developed this mad idea that fat is going to kill us. The Dietary Guidelines for Americans 2005 list: ice cream; sherbet; frozen yogurt; cakes; cookies; quick breads; doughnuts; margarine; sausages; potato chips; corn chips; popcorn and yeast bread as saturated fats. These are not saturated fats – not primarily, not even secondarily. They are first processed foods, secondly major sources of carbohydrates and thirdly, almost all then have more unsaturated fat than saturated fat (not that any real fat is better or worse than any other, but these are not real fats, and they are not saturated fats). Don't eat any of these heaps of junk because they are processed heaps of junk. However, real fats in real food are absolutely vital for human health and we are suffering epidemic levels of deficiencies, in vitamins A and D particularly, in the UK and the USA.

Where is the fat on MyPlate? Where is the quality offal and red meat? the mackerel? the sardines? the quality dairy foods? the real butter? the free range eggs? Where are the vital fats that we need? Emphasizing protein and carbs and not fat is seriously harmful to health. Fats are vital, carbs are not. Protein is vital, but consuming protein in an unnatural balance (without the fat that nature provides naturally alongside) is a rapid route to vitamin A depletion and liver and other health damage. Ask bodybuilders!

3) MyPlate is a visual guide, which is easy to understand but then falls victim to "The law of unintended consequences".

MyPlate is clearly intended to be volume guide "Make half your plate fruit and vegetables" is one of the instructions. The UK eatbadly plate may appear to be a visual "this is how your plate should look", but, when I asked the UK Food Standards Agency where the proportions in their food groups came from (listed below), the answer was based on weight.

• 33% Starchy foods (bread, potatoes, pasta, cereals etc)

• 33% Fruit and vegetables

• 15% Non dairy protein (meat, fish, eggs, beans etc)

• 12% Milk and Dairy products

• 8% Foods high in fat and sugar (101% due to rounding)

I did another interesting experiment in The Obesity Epidemic: What caused it? How can we stop it? I started with 100 grams of starchy foods and then calculated the weight of the other categories, to maintain the proposed proportions. The weight of fruit and vegetables would also be 100 grams; non dairy protein would be 45 grams; there would be 36 grams of milk and dairy and 24 grams of foods high in fat and sugar.

Using a sample of foods from the USDA food database, I estimated the calorie averages for 100 grams of each of these food groups as 333, 42, 188, 183 and 595 respectively. This would give the estimated calorie values (for each of these weights) of 333, 42, 85, 67 and 144 respectively. If these are then scaled up in proportion for a 2,000 calorie a day diet, the five groups end up with 992, 125, 255, 198 and 430 calories respectively. The numbers will vary for each person's interpretation of the plate, but you can see how one third of intake in the form of starchy foods can represent half of calorie intake and another third from fruit and vegetables just 6% of energy. The supposedly smallest segment, being so energy dense, can form a perhaps unanticipated 21% of calorie intake.

The same will happen with MyPlate – potatoes and chips as 'vegetables' not withstanding, the energy intake (which is what the body registers) for vegetables will be small relative to, say, nutritionally inferior grains.

MyAdvice

This would be my advice by the way:

1) Eat food – we shouldn't need to call it real food.

2) Eat that real food three times a day – unless you are a cow, or want to be the size of one, stop grazing!

3) If you need to manage your weight, manage your carb intake. Gaining weight is literally defined by the formation of triglyceride (body fat) and this is beautifully facilitated by eating carbs, which provide glucose for the glycerol part of the triglyceride structure and insulin to enable fat storage. Losing weight is literally defined as breaking down triglyceride (body fat) which can happen when the brain wants the glycerol part for glucose or the body wants the fat part for energy/repair. So, weight gain happens in the presence of carbohydrate/glucose/insulin and weight loss happens in the absence of carbohydrate/glucose/insulin.

MyPlate

MyPlate will encourage you to eat 70% of your food intake in a form that contains carbohydrate and allows you to eat 100% in this way. Nothing like what we have been eating for 3.5 million years and nothing like what we need to eat to end the epidemics of being fat and sick.

This is another tragic missed opportunity to do something about the weight and health of Americans. Follow MyAdvice and not MyPlate and you'll buck the trend.

Appendix

In The Obesity Epidemic, for Appendix 3, I did an experiment where I tried to get the Recommended Daily Allowance (RDA) for 12 vitamins (information for B7, Biotin, was not available) and 8 minerals (calcium, magnesium, phosphorus, copper, iron, manganese, selenium and zinc). These were the nutrients for which the United States Department of Agriculture database had information and for which there was an RDA. Having said this, there were no RDA's for vitamins B5, D and K or for the minerals calcium and manganese – an 'Adequate Intake' was recommended.

– Omnivores can get the RDA's/AI's from the following 5 foods: 100 grams of liver, 200 grams of sardines, 200 grams of whole milk, 100 grams of sunflower seeds and 200 grams of broccoli (1,300 calories). There will be infinite combinations of real foods that can provide the RDA's/AI's, but I started from the ones known to be highly nutritious.

– For vegetarians, the RDA's/AI's's could be met with these five foods: 500 grams of whole milk, 450 grams of eggs (10 medium eggs), 300 grams of spinach, 250 grams of raw mushrooms grown in sunshine and 50 grams of sunflower seeds (1,360 calories). Dietary advisors applaud people for choosing a vegetarian diet, but then tell them to avoid eggs and to consume low-fat milk. It then becomes practically impossible for a vegetarian to meet even minimal nutritional requirements.

– Vegans can't get B12 naturally and they would need to eat 2.25 kilograms of (raw sunshine grown) mushrooms in a fat delivery mechanism (e.g. vegetable oil – unhealthy per se) to get the 'adequate intake' for vitamin D and an unusual food like oriental dried radishes to get their calcium – and to repeat this daily. For completeness, the five vegan foods would be 2.25 kilograms of mushrooms, 175 grams of porridge oats, 25 grams of sunflower seeds, 100 grams of oriental dried radishes and 300 grams of spinach (in more vegetable oil) and a vitamin B12 supplement. Without the calories in the vegetable oil, the vegan basket adds up to 1,644 calories – the highest of all three sample ways of getting our nutritional requirement.

# Who's teaching our children  
about 'nutrition'?

#### June 7, 2011

I came across a school book for GCSE in Home Economics: Food & Nutrition recently. As someone who has studied nutrition extensively – and found virtually everything being taught to be wrong – I was naturally curious.

Kellogg's & Coco-pops

I picked up the main textbook "Examining Food & Nutrition" by Jenny Ridgwell (1996). The age of the book was bad enough, but I was then absolutely horrified to have the book open on a picture of Kellogg's Coco-Pops – the very product against which the fabulous Children's Food Campaign have been campaigning so passionately. I have also blogged on this in the past. Flicking to the very next page and almost half of this page was covered by a picture of Bran Flakes (see the scans of the pages below). (The Children's Food Campaign have also done a brilliant expose of the way in which the food & drink industry are feeding junk messages to their next generation of consumers).

In disbelief, I turned to the inside cover to try to understand how this could be allowed. The companies thanked at the beginning of the book included: the Food & Drink Federation (members include every food & drink company in the UK that you can think of – Cadbury, Coca-cola, Kellogg's, Mars, Pepsi, Unilever, United Biscuits – as examples, as well as more 'federations' like The sugar Bureau, The Federation of Bakers etc) and Sainsbury's. Kellogg's & Unilever are also especially singled out for thanks in the first paragraph. The second paragraph goes on to thank: The Federation of Bakers; The Co-op; Kellogg's again; Lo Salt; Quorn makers Marlow Foods; National Dairy Council; Sainsbury's again and Whole Earth. Most of the companies are thanked for allowing their product placement pictures to be used – what?! Kellogg's should be thanking the publisher and a GCSE curriculum should not touch this blatant marketing to children in any circumstance.

A balanced diet

The books starts teaching our children nonsense as early as the first page of content. Under the heading "What is a balanced diet"? the entire text (literally – every single word under this heading – all that children apparently need to know about a balanced diet) reads as follows: "A balanced diet provides all the necessary nutrients in the appropriate proportions and quantities to meet our needs. One way to follow a balanced diet is to make sure we eat a variety of foods which supply a range of nutrients. Carbohydrates in the form of starchy foods such as bread, pasta, cereals and potatoes should be a major part of a balanced diet. We should also aim to eat at least five portions of fruit or vegetables each day."

No mention of essential fats. No mention of essential proteins. The only macro nutrient singled out to form the "major part" of a 'balanced diet' is carbohydrates – ironically – the only macro nutrient that is not essential in any way. Get the bread, pasta, cereals and potatoes – things forming the major part of processed foods – mentioned on the first page. And why five a day? Why teach children things that have no evidence base and were started by fruit and veg companies as a marketing campaign? (In 1991) Does the book author even know this? Does she care?

On P10, we have the old (1994) "Balance of Good Health" plate, which has a prominent picture of puffed wheat cereal and breakfast flakes cereal – a quick glance and it passes for Bran Flakes no problem. We have the usual appalling array of processed food, which is still featured on the Eatbadly Plate \- the September 2007 replacement for the BOGH plate. On the BOGH version of the plate in our children's book, we have white bread, white rice, sugary baked beans, sugary yoghurt, crisps, lemonade, cake and man-made spreads (don't put nature's butter on view, whatever happens).

On P13 (scan below) we have a picture of Bran Flakes – beautifully positioned – full length all the way down the right hand side of the page. You can't miss it. On p23 we have a tub of low fat spread and this fat-phobic section of the book stresses that we should choose (Unilever) low fat spreads and not (nature's) butter.

There is one interesting fact that this section states correctly (I was surprised a) that they knew this and b) that they admitted it) "cholesterol in food has very little effect on blood cholesterol levels." For "very little" read "none". However, the text goes on to say "saturated fats from the food we eat are important factors which affect blood cholesterol levels." This is the subject of significant debate, which the book should have known about even in 1996 when it was published, but all the more reason to have school textbooks as up to date as possible – particularly in an evolving topic, such as nutrition. (I would like the book to explain, biochemically, precisely how any real fat eaten in real food can raise cholesterol. I would also like the book to explain, given that cholesterol is only found in animal foods – meat, fish, eggs, dairy – and given that eating these has no impact on cholesterol in the blood – why are children/people told that these will raise cholesterol levels when we know that they don't).

P 26 & 27 are the Unilever thank you pages – a double page spread of spreads. Ha ha. "Gold low fat spread" (I did say this was an out of date textbook); "Gold unsalted low fat spread" and "Gold lowest low fat spread." There is then a table comparing two Unilever "Gold" products with a Waitrose spread and two from their rival St Ivel. Unilever win the calorie count (the focus of the table) by a mile. Go Unilever! (Butter was not in the table and the table did not measure natural levels of vitamins A and D, or butter would have cleaned up. Go away Nature!)

Then we have the p34 Coco-Pops and P36 Bran Flakes promotions to children. Because these foods have little to no natural nutrition, they are invariably fortified. The textbook fronts this off by saying "Some foods are fortified with vitamins which are manufactured. These are identical in structure to vitamins found naturally in food and behave in the body in the same way." Really? You don't need fat to accompany fat soluble vitamins any more? I've seen numerous studies showing that the whole food, with the accompanying macro nutrients, antioxidants and phyto nutrients, is the best way to get vitamins. And what about minerals? Or essential proteins? Or essential fats? Do we not need these?

This is what our children are being taught – lies to position food industry products as nutritious equals to real food. Mother Nature doesn't need to fortify her foods – they are naturally abundant in nutrients. If cereals have to add vitamins in to have any nutritional value, what does this say about them? They are high calorie, sugary vitamin tablets – that's what.

On p45, all about dietary fibre, the first four products listed are not the products highest in dietary fibre, nor the products in alphabetical order, they are the cereals – All Bran, Weetabix, Porridge oats and cornflakes. Only one of those can come in a natural form – oats. Tomatoes, lentils and peas are at the bottom of the list.

P99 devotes just one side (less than the space devoted to Bran Flakes packets) to eggs and cannot find a good thing to say about them. Salmonella and cross contamination are mentioned and eggs are described as little more than things that bind ingredients together. This is part of the dual strategy of cereal manufacturers 1) promote one's own sugary products and 2) denigrate what people used to eat for breakfast, so that your products become the preferred alternative. It is disgraceful for a GCSE textbook to be supporting this propaganda.

What caused the obesity epidemic?

I could go on turning the pages with misinformation after misinformation. No mention of the difference between retinol and carotene and the necessary, and not always possible, conversion to obtain vitamin A in the right form; margarine claimed to be a good source of vitamin D – not naturally it isn't. That's an even higher calorie vitamin tablet. No mention of vitamin K1 and K2, or the need to get both plant and animal forms of this vitamin. Vitamin E is declared as "deficiency rare." Last time I looked at the UK Family Food Survey, the average Brit was getting barely the ridiculous UK Recommended Daily Allowance (we are apparently only 'allowed' a certain level of nutrition) and this, 10mg per day, is two thirds of the minimum USA 'allowance' – unless we need less of this vital antioxidant than our American friends? There is no mention that vitamin B12 is the unique nutrient that is only found in animal foods (hence why humans are not intended to be vegan). Instead, the textbook tells children that B12 is found in breakfast cereals – the high calorie vitamin tablets again. Not naturally it isn't – again.

My favourite page is p173 where there is a highly revealing graph (the one on the right hand side of the page scan below), which tells us lots about the obesity epidemic, but the book doesn't realise that it is sat on a gem. Rather amusingly, the text next to the graph says "The chart below shows how our eating habits are changing. We are slowly changing to a healthier diet."

The graph then shows that, between the years of 1971 and 1991 (don't forget how out of date this is) the index of breakfast cereal consumption has gone up from 100 to about 170; the index of white meat (think KFC) has gone up to approximately 175. The index of red meat (beef and veal – quality stuff) has gone down from 100 to approximately 60 and the index for eggs has more than halved from 100 to less than 50. So – having breakfast cereals for breakfast is apparently healthier than eggs. Just one thing – obesity for men was 2.7% in 1972 and 22.6% in 1999 and obesity for women was 2.7% in 1972 and 25.8% in 1999. So, during this time when our diet was 'healthier' – according to the companies funding our children's text books – obesity multiplied almost ten fold, diabetes type 2 has reached almost epidemic levels and childhood obesity has become a household term.

WJEC Board

The WJEC specifications for teaching this Home Economics: Food & Nutrition GCSE include in their specification of tasks (p17):

Cereals make an important contribution to the diet.

(a) Investigate the role of cereals in the diet.

(b) Develop a range of ideas for dishes using cereals.

(c) Plan a course of action for making a selection of dishes using cereals.

(d) Make and present the selection of dishes.

(e) Evaluate your work.

I could understand if they wanted children to know about the super foods liver, eggs or spinach, but fortified cereals?

And finally, because the exam is what this is all about at the end of the day, take a look at this specimen exam: one mark for knowing that strawberry milk shake is higher in calcium than orange & mango juice and another point for knowing that the fruit juice is higher in vitamin C. Question 4 is all about how can we eat at least 4 slices of bread a day – that should fuel the Federation of Baker profits and childhood obesity nicely. Question 9 beggars belief – "Explain how the addition of modified starch is of benefit to the consumer." Would I get any marks for saying – it is of no benefit to the consumer. The chemically altered FrankenFood that is modified starch is of great benefit to the producer because it extends shelf life, it is cheap, it speeds up the thickening process (saves more costs) and it takes lumps out of things otherwise so hideous that people probably wouldn't eat them.

Next time you're at parents evening – start asking the teachers about how and what they are teaching, not how your little darling is performing. I hope that your little treasure skips nutrition class – better to learn nothing than to learn these appalling, conflicted messages.

# The Vegetarian Myth – Lierre Keith

#### August 4, 2011

This could well be the most controversial blog post yet – where do each of us draw the line on eating and/or wearing animals and/or their products. Or, as Lierre Keith suggests, should we be drawing a circle and not a line?

This is a review of The Vegetarian Myth and the Amazon reviews confirm that it is the marmite of the book world – people love it or hate it. (Hopefully not about to be banned in Denmark however!) I have to confess that I loved it because it raised some huge issues – you don't get much bigger than how can we feed the human species and neither 'side' has an answer to this one – we have way too many people already on this planet for any sustainable option and things are continuing to get worse.

This review is intended to provide a useful and convenient summary – reading the book for your self is still highly recommended. I will quote Keith verbatim where possible – her writing style is quite beautiful and should be read first hand.

Gary Taubes has his critics on the internet, but they pale into insignificance compared to those queuing up to attack Lierre Keith. In Chapter 1 she says: "I got hate mail before I'd barely started this book. And no, thank you, I don't need any more." There are many similar 'cute' comments and humour throughout the book, which I really enjoyed.

I also enjoyed the feminist passages in the writing, for which Keith has also been attacked. It took me back to my days at Cambridge when I saw an article written by the Student Union president referring to 'she' and 'her' all the way through. Why does this only apply to women, I wondered? And then, of course – silly me – this article does apply to both genders, but then so does every article talking about 'he' and 'him' and yet nothing 'jars' when we read that. Keith uses the female third personal singular a couple of times – just to keep you on your toes. She also gets (appropriately in my view) angry with those who think it has been OK to trash the planet during their infinitesimally small time as guests here – for their own greed and personal gain. They tend to be male (CEO's, world leaders, lawyers etc) and they are certainly 'macho'. Go girl!

Attacking the vegetarian

In Chapter 1, Keith notes exactly why her book has attracted the anger and outrage that it has. "'Vegetarian' isn't just what you eat or even what you believe, it's who you are... I'm not just questioning a philosophy or a set of dietary habits. I'm threatening a vegetarian's sense of self."

Keith herself was vegan for 20 years and describes the health complaints that she has been left with, as a result of her dietary choice: from degenerative spine disease (irreversible) to depression and anxiety (much improved since ceasing to be vegan). She still suffers nausea and serious digestive problems and pain, which make it difficult for her to eat in the evening (if she plans on sleeping that night). Keith explains the chosen route was an obvious one made by her and friends when young: "All the friends of my youth were radical, righteous, intense. Vegetarianism was the obvious path, with veganism the high road alongside it."

She pleads in the opening chapter: "You don't have to try this for yourself. You're allowed to learn from my mistakes... I'm asking you to stay the course, read this book, please. Especially if you have children or want to. I'm not too proud to beg."

Keith ends this introduction with the humble statement: "Ultimately I would rather be helpful than right." I was very little way into the book before I realised she is both.

The three arguments for (and against) vegetarianism

(Please note – the terms vegan/vegetarian can be used virtually interchangeably throughout the book – Keith applies the same arguments to both views. One just draws the line in the sand in a different place).

The book is perfectly structured. There are three arguments that vegetarians make as to why we should all be vegetarian and Keith structures the book in three parts to reflect this:

1) The moral argument – we should not kill;

2) The political argument – we can only feed the world if everyone is vegetarian;

3) The nutritional argument – it is healthier to be vegetarian.

The only thing that I won't be able to answer, while writing this review, is how I would have responded reading it, had I still been vegetarian at the time. It would be wonderful if any vegetarians could try this and share their views. I know that there would have been a time when I would have been as angry as many vegetarian and vegan readers of the book have been. I don't know, however, how I could have countered Keith's arguments.

I do know that I never believed that there was a nutritional argument for being vegetarian. I have known enough about nutrition, for long enough, to know that liver, meat and fish are incomparably nutritious. This is why I never considered becoming vegan. I could not think how I could get vitamin A, B12, D, iron, zinc etc in anywhere close to sufficient amounts without supplements and it never felt right to be taking nutrients in a tablet when food could provide them.

I became vegetarian for the moral argument. I subsequently strengthened my belief by adopting the political argument. The essence of my belief was that I could be healthy enough without eating animals and animals would be better for this decision. I knew that I could not be optimally healthy, but felt that I was making a moral sacrifice in an age when humans were in a position to 'do the right thing'.

Keith knocks down all three beliefs as follows:

The moral argument

I am covering the arguments in the order that Keith does and I could not believe how quickly Keith changed my views in this first part of the book. Even though the Barry Groves and Sally Fallon Morell presentations at the Weston A Price Foundation conference in March 2010 had ended my 15 year period of being vegetarian, I still believed that there was a clear line in the sand on 'killing for food' and that vegetarians were on the right side of the line. Oh boy!

In a nutshell the moral vegetarian argument is "we should not kill". Keith's response is:

a) There is absolutely nothing, nothing at all, that even a vegan can eat that something has not died for (several living things in fact);

b) Man is not at the top of a food chain – that is an arrogant view that only 'man' could hold. All humans are part of thecircle of life. Our bodies end up as food for the soil, just as every other animal that dies (ideally on the prairie) leaves their nutrients and minerals to go back into the soil for new life.

a) When Keith expanded upon the first point, I was kicking myself within seconds. How could I have been so naive? Keith shared her original vegan view: "I wanted to believe that my life – my physical existence – was possible without killing, without death. It's not."

Before long, the examples came thick and fast and became irrefutable. How many slugs are killed for a lettuce? How many millions of species in a tablespoon of top soil are trashed every second by Cargill? How many rabbits and mice are killed in cultivated fields by industrial size farming equipment? How many fish die, so that rivers can be diverted to irrigate the vegan's grains? How many wolves and bison have been killed because we turned their homeland into farmland – for grains and plant food? Keith answers the last one: "There were somewhere between 60 and 100 million bison in the United States in 1491. Now there are 350,000 bison and only 12 to 15,000 of those are pure bison that were not cross bred with domestic cattle. The land held between 425,000 and a million wolves; only 10,000 now remain." "The North American prairie has been reduced to 2% of its original size and the topsoil, once twelve feet deep, can now only be measured in inches."

b) Point (b) is so integrally linked to (a) – one of the reasons that no life is possible without death is that the soil upon which life depends relies upon death to return nutrients to the land. Keith explains her first hand experience of trying (and failing) to grow her own food without anything needing to die... (Any vegan that argues that they can grow their own lettuce, with nothing having to die, has to read the whole of this moral section of the book. Keith tried it and then some! The full story is funny and powerful at the same time).

Organic Gardening magazine soon explained to Keith that the first commandment of organic growing was "feed the soil, not the plant." She learned that Nitrogen, Phosphorus and Potassium was the "triple Goddess of gardeners." All three are minerals given back to the land when animals (including humans) die. (Calcium is also a limiting factor for soil – also found in the bones and remains of animals that die and so generously give back their nutrients to the land). We can get nitrogen from fossil fuels, or nitrogen can be given back to the land by the circle of life and death. We are not far from the time (peak oil and all that) when we have the stark choice – use fossil fuels for fertiliser for food or for running the power upon which modern life has come to depend. What do we do when the oil runs out? Manure and carcasses or fossil fuel for fertiliser? – that's our choice.

As this part of the book unfolds, Keith hits you with one stark fact after another:

– "70% of all water from rivers and underground reserves is being spread onto irrigated land that grows one third of the world's food," writes Fred Pearce in When the rivers run dry."

– "Of China's 23,000 miles of large rivers, 80 percent don't support fish anymore." "Set aside the fossil fuel for the fertilizer and transportation. If you live in Vermont or California and eat vegan brown rice – this is what you're eating: dead fish and dead birds from a dying river."

– "We're out of topsoil, out of water, out of species, and out of space in the atmosphere for the carbon we can't seem to stop burning."

You come to realise that the ultimate role that we (humans) can play in this universe is to continue to be a part of the universe when we die. Whatever happens to our soul, our body is food for worms, which are food for birds, which are food for cats, which are food for their predators and so on. Humans often look for significance – for a sense of purpose in life. Our purpose is as part of the whole circle of life. All of us have this part to play.

Keith continues, "The native prairie is now 99.8% gone. There is no place left for the buffalo to roam. There's only corn, wheat and soy." With all that land cultivated for vegetarian food, which was once home to free roaming animals, there is also no natural process by which the top soil can be rejuvenated. There is only so much that fossil fuel fertiliser can do to repair the damage being done by overworking our scarce land in the name of profit. No wonder (GM) Genetically Modified crops became a necessity – we have to modify crops when we have destroyed the earth to the point that it cannot yield 'normal' crops.

"'You can look a cow in the eye,' reads an ad for soy burgers. What about a buffalo?" asks Keith. "Five percent of a species is needed to ensure enough diversity for long-term survival, and less than 1 percent of the buffalo are left."

Keith concludes: "It is my conviction that growing annual grains is an activity that cannot be redeemed. It requires wholesale extermination of ecosystems – the land has to be cleared of all life." We use 5.6 billion pounds (weight) of pesticides per year (a statistic I found elsewhere) – pesticides being designed to kill any living thing that also wants to feed on (our) growing food.

I realised in this part of the book that it comes down to black and white and shades of grey. To the vegan, the world is black and white – "meat is murder." Keith describes this as "a simple ethical code... but it is the black-and-white thinking of a child." This is a critical part of the book and one with which I resonated very strongly. I was far more black and white in my 20's. Things were right and wrong. (Good days and bad days!) This is very child-like thinking. The simple world of a child is right and wrong. The more mature world of the adult has many shades of grey.

The shades of grey in this killing debate are inescapable – you may draw the line at eating cows, but not dogs; you may draw the line at eating chicken, but not red meat; you may draw the line at eating fish, but not meat; you may draw the line at eating eggs, but not the flesh of animals; you may draw the line by wearing leather shoes, but eating nothing from an animal; you may have a vegan diet and wardrobe – but bison, birds, fish, rabbits, mice and thousands of living creatures in top soil have died for your soya burger and lettuce.

It's not that vegans are right and vegetarians are wrong, or vegetarians are right and omnivores are wrong, or omnivores are right and carnivores are wrong – it's about where we each choose to draw our line. Better still, to return to the arrogant view that 'man' thinks he is at the top of a food chain, Keith concluded "I'm not going to draw a line. I'm going to draw a circle." We are part of the circle of life, just as any other animal is. They and we need to live and die to give back to the land, so that birth and death can continue.

I remember non-veggies saying to me when I was veggie "If we didn't eat the animals they wouldn't be here" and I just couldn't comprehend the point that they were making. Would that be such a bad thing? Surely the animals would be better off not living if they were just going to be killed for food? ('Better to have loved/lived and lost, than never to have loved/lived at all' kind of thing. That's a massive philosophical argument in itself – we're all going to die – is it worth being here at all?!) Couldn't we keep animals and not kill them? I just didn't think of the practicalities that no farmer keeps ruminants (that's the collective term for grass grazing animals – cows, sheep, goats etc) as pets. Animals are kept for food and they always have been within communities throughout history. Each settlement would safeguard the delicate balance between the 'goose and the golden egg' – to protect any givers of eggs/milk and the time when it comes to eat the giver of these vital foods. I don't want a world without sheep & lambs, or cows & calves, in the fields. I want natural manure from these grazing animals nourishing the land naturally. I don't want oil used to mow the grass, which ruminants could have eaten and then more oil used in fertiliser instead of manure. Animals are a vital part of the circle of life, not a line that modern, arrogant, man thinks he can draw on the land. This brings us nicely on to...

The political argument

The political vegetarian argument is that we can only feed the world if everyone is vegetarian. Keith quotes Jim Motavalli, who, in turn quotes the British group Vegfam: "a 10-acre farm can support 60 people growing soybeans, 24 people growing wheat, 10 people growing corn or only 2 producing cattle." The maths behind this is not provided and Keith can't work out where it could come from, but she notes that any such statistics will always find against cattle because they start from the premise that the cattle is fed grain. Hence, of course land would produce more grain to be eaten as grain than if that grain were fed to cattle and the cattle output were subsequently calculated. What Keith (and every real food person) argues is – we should not be feeding grain to cattle. Not ever. Not in any circumstances. The maths then falls over.

Keith opens the political argument section with a detailed description of the digestive system of a ruminant. The term ruminant means a cud-chewing animal, characterised by having four stomach compartments – the first being called a rumen. Keith describes how a cow, for example, is entirely reliant upon a magical internal ecosystem comprising bacteria, fungi and multiples of microbial cultures. The cow is feeding on the bacteria and the microbes are living within (feeding upon) the cow – it is the way of life for/in a ruminant. Grains turn the normally neutral rumen (first stomach) acidic, which makes the cow sick and bloated (not dissimilar to the effect that grains have on many humans!) Hence we should not be feeding ruminants grains. Ruminants, by definition, need to chew on cud – grass.

Joel Salatin (one of the role models of the local sustainable model) then does the maths for his 10-acre farm in Virginia. He produces 3,000 eggs, 1,000 chickens, 80 hens, 2,000lbs of beef, 2,500lbs of pork, 100 turkeys, 50 rabbits and a few inches of topsoil. No fossil fuels needed whatsoever. The chickens get a bit of supplemental grain (they can 'stomach it', literally) and everything else eats grass. Keith compares the calories and nutrition from this organic farm vs. the malnutrition, pellagra and fatal disease that the soy, wheat, corn community would end up with. It is incomparable in favour of eating the sustainable (animal) way.

The arguments against the political vegetarian are numerous:

a) Agriculture (turning the little arable land that the world has into grain and soy fields) is destroying the planet. It 'murders' the top soil and is completely unsustainable, in that nothing is being done to reverse the damage. Instead – food manufacturers are looking to create GM 'frankenfoods', which can still grow when all life and health has been removed from the land. As Keith says: "Who cares if more food can be produced by farming when farming is destroying the world?"

b) Manure and animals living and dying on land is the natural way to fertilise – to replenish the top soil so vital to life. To replace animals in the food chain with soy and grain is to destroy the entire circle of life. This is also completely unsustainable. There is a finite amount of fossil fuel in the world to use for fertilisers. There can be a sufficient amount of manure from the right number of animals occupying the right land space.

As Keith challenges: "Political vegetarians need to answer this question – what is going to feed your food? Fossil fuel or manure?"

c) It is nonsense to say that we are feeding grain to cattle, which could be used to feed humans. We are feeding grain to cattle, which they cannot digest, because grain is so cheap and so subsidised, that grain manufacturers have to dump it somewhere. Grain to America is the butter mountain of Europe. If grain production were not so lucrative and well subsidised, there is no way that cattle would be fed grain – they might be left to eat the grass that they are supposed to eat. I say 'might' because grain also causes cattle to fatten quickly (as it does humans) and this makes the cattle heavier, quicker and thus makes the animals more lucrative in the process. Win win for Cargill. Lose lose for the ruminants and the earth, which they have not been allowed to renourish.

d) When we factor in all the water and oil and fossil fuels used to 'feed' the land in the way that animals would do naturally, the price of grain is the planet itself. Richard Manning is quoted as saying "A typical farm in 1940 produced two calories of food energy for every calorie of fossil energy used. By 1974 that ratio was 1.1. As of now, it takes more than a calorie of fossil fuel to produce a calorie of fuel for a human – somewhere between four and ten calories of fossil fuel for a calorie of food." When fertilisers, pesticides, machinery, harvesting, transportation and so on are taken into account, an acre of corn requires about 50 gallons of oil.

e) What limited land there is in the world suitable for agriculture, America has more than its share. Encouraging the world to eat grains and soy (the USA food pyramid, the USDA dietary guidelines) makes the world dependent on America for its food – the ultimate dependence. Western countries support the giant food producers with subsidies totalling $360 billion. This substantially reduces world prices. As Oxfam has observed: "Exporters can offer US surpluses for sale at prices around half the cost of production – destroying local agriculture". US aid is anything but – it is destroying local farmers and communities – making the world dependent on America to eat.

As Keith says "This is why there are no international aid agencies that suggest vegetarianism as a solution to world hunger: it isn't one."

Gary Taubes once joked "My wife says I blame everything on carbohydrates."

In my view, the most serious thing that we need to blame on carbohydrates is that we have exploded the world population to completely unsustainable levels as a direct result of carbohydrates. When communities were based around sustainable, local, lands and foods, the population of the world could only ever be a number that could be sustained.

Agriculture and grains have enabled an unsustainable explosion in the number of people that we could feed, but this has never been done in a sustainable way. I thought I was a lone voice in thinking this until I read the following in The Vegetarian Myth:

"Breaking our dependence on the sun and nature's fertility meant an explosion in grain production and a concomitant expansion in the human population. There are now over 6 billion humans. Understand: billions of us are only here because of fossil fuel, because we figured out how to transform stored energy into edible energy. As the natural gas and oil get more expensive, and then prohibitively expensive, there will be no way to keep that grain coming. And then? It doesn't sound like a party I want to attend."

The world population is due to reach 9 billion by 2050, about the time that the oceans are forecast to be empty of fish and long past peak oil. Keith estimates that we already have multiples too many people in the world – at least 10 times too many, maybe 100!

The stark reality is that this is an argument that neither the omnivores nor the vegetarians can win. There is nosustainable way to feed the current population – let alone the level that is forecast within the next 40 years. Grain, soy and agriculture are completely unsustainable, for any population level, as they destroy the planet without replenishing it in any way. Meat, fish and eggs are equally unsustainable, for the current population level, as there is not enough grazing land in the world for enough animals to feed us all and we have polluted and raped the oceans of their bounty. Had we not destroyed pastures for grain, the world population would have grown naturally and sustainably to sustainable levels.

Toward the end of this part of the book is a blunt message – forget peak oil. "Peak soil was ten thousand years ago, on the day before agriculture began."

We then move to...

The nutritional argument

Even though I never bought this argument, I'll cover it for completeness and because it is a very interesting part of the book and because many people do use this as a reason for being vegetarian. Unfortunately, dieticians and many charities (World Cancer Research Fund, British Heart Foundation, Diabetes UK) seem to be on hand to encourage this position. The nutritional arguments are as follows:

a) Humans evolved to eat plants and not animals;

b) Animal foods contain cholesterol and this will kill us;

c) Animal foods contain fat and this will kill us;

d) Vegetarian and vegan foods are healthy;

e) Animal foods contain fat and this will make us fat.

Keith devotes over 100 pages to this, Part 3, of the book and the attention that she devotes to each argument is impressive. As an example, I address the 'what did we evolve to eat' debate in Chapter 12 of The Obesity Epidemic, but Keith goes into it in far more detail. She goes through three roles of teeth, four actions of the jaw, four digestive processes, nine activities of the stomach, two of the gall bladder and every detail on gut flora, the colon and even the length of the small intestine to compare humans, dogs and sheep. She quotes Dr.s Michael and Mary Eades to provide the conclusion: "In anthropological scientific circles, there's absolutely no debate about it – every respected authority will confirm that we were hunters. Our meat eating heritage is an inescapable fact." I concluded the same from anthropological research.

I also looked, as Keith did, at the possibly of getting sufficient vegetarian food for the 3.5 million years since 'man' first walked upright. Notwithstanding the 30,000 years of ice age endured 40,000-10,000 years ago, when no vegetation would have been available, there is simply no evidence that our planet could have yielded sufficient vegetables and fruit for man to have consumed sufficient calories to survive. Grains were not available until the emergence of agriculture. Half the vegetables possibly available to our ancestors would not have been edible without cooking and fire was not discovered until somewhere between 1.5 and 0.5 million years ago. Let alone the seasonality of vegetation and the likelihood that nothing would have been available in certain parts of the world and for many months anywhere else.

That's as far as I went. Keith also goes into the enzymes in plants and the toxins that they emit – in an effort not to be consumed and to survive – as any living thing tries to survive. She then picks up the argument – OK – should we have become vegetarian when grains did appear – notwithstanding the fact that we never had them before? She presents a compelling argument that we have simply not evolved to eat grains (this is the mainstream Paleo view) and that they are seriously harmful to human health. Lines such as these are punched out on successive pages:

– "Grains are essentially sugar with enough opioids to make them addictive."

– "The diseases that insulin affects directly are the cause of the vast majority of death and disability in the US today. Heart disease, high blood pressure and diabetes are all caused by the insulin surges that grain and sugar demand."

– "You can call it complex carbohydrates if you want, but it's sugar."

– "According to the USDA, we should be eating a diet that is 60% carbohydrate. Your body will turn that carbohydrate into almost two cups of glucose and each and every molecule has to be reckoned with."

– Quoting the Eades again: "The actual amount of carbohydrates required by humans for health is zero."

– And my favourite: "you've (vegetarians) damaged your digestion, from too many blood sugar highs and lows, and too much adrenaline. It can be fixed, but you're going to have to eat real protein and fat and not sugars. You need to leave adrenaline for emergencies only; can we agree that breakfast shouldn't be one?"!

b) The cholesterol argument has been covered more extensively by Kendrick and Ravnskov (and me in The Obesity Epidemic). Keith mentions a couple of the key points, and nails it beautifully with the following one liner: "One of the main functions of the liver is to make cholesterol, not because your liver wants you dead, but because life isn't possible without cholesterol."

c) The book provides another really nice summary on the position on fat. I go into this in more detail than I've seen it elsewhere with my original analysis of the Seven Countries Study and an assassination of the Truswell article, which is a summary of all the evidence relied upon by government authorities telling us that fat is a killer. (I also point out that when our governments talk about fat, they are in fact talking about refined carbohydrates, but that's another story).

Keith's summary is very clever. She explains that fat consumption declined almost 25% in the past 15 years (the book was published in 2009) and, at the same time, type 2 diabetes has increased by a factor of more than ten; cardiovascular disease recorded at time of hospital discharge has increased 25%, the incidence of stroke is rising and cancer "continues its relentless and increasing toll."

Keith also covers the fat soluble vitamins, essential fats and other nutrients in real fat vs. the unnatural levels of omega-6 to 3 ratio, as a result of our obsession with cheap vegetable oils. "You tell me what to blame: the saturated fats we've always eaten – for four million years – or the industrially manufactured oils that until recently were used in paint." Quite so!

d) Sugary cereals, soy (as it is called in the USA – it's called soya in the UK) and vegetable oil spreads/margarines are promoted as healthy by the food industry. Of course they are – they are phenomenally lucrative. Kellogg's alone is a $13billion company. They are new products, only introduced to the food chain in little more than the past 100 years in the case of cereals and in nearer 20 years in the case of modern soy and vegetable oil products. Keith states: "The food industry has developed over 100,000 new processed foods since 1990." That is staggering and surely 'foods' should be in inverted commas!

These 'foods' rely as much on knocking real food, as they do on promoting themselves as healthy. Vilify eggs and promote sugary cereal as the alternative. Attack butter and hydrogenated margarine can come to the rescue. Lie about hormones in cow's milk and everyone will turn to soya in their Starbucks. It is horrific to think that big business can get away with it. As Keith says "Try to comprehend the scale of this: food companies spend $33billion a year in advertising."

Keith dedicates a few pages to a horrifying review of the health concerns surrounding soy(a). Quoting Dr Kaayla Daniel (one of the speakers at the March 2011 Weston Price Conference), author of The whole soy story: the dark side of America's favourite health food the allegations unfold. Soy(a) is delivering hormone doses not dissimilar to the contraceptive pill (in snack size portions of soy – let alone the levels eaten by vegans). Soy(a) is implicated in serious thyroid disturbance (think thyroid, think weight). "Those who ate tofu at least twice a week had accelerated brain aging, diminished cognitive ability, and were more than twice as likely to be clinically diagnosed with Alzheimer's disease." "In fact, the more tofu eaten, the more cognitive impairment and/or brain atrophy."

We had a vegan in our online club who said something about 'you only ever get animal illnesses' – bird flu and mad cow disease? Keith's humour appears again when she closes the section on soy(a) with: "According to a vegetarian bumper sticker 'There's no such thing as mad tofu disease.' You might want to rethink that"!

Food manufacturers must love vegans – virtually all vegan calories must come from food manufacturers. There's very little that the vegan can get from the local farmer. That alone is reason enough for me to not want to be vegan!

e) The final argument was very interesting – especially people interested in weight loss. One of the arguments for avoiding animal foods is that fat contains (approximately) 9 calories per gram and carbs approximately 4. Hence many dieters become vegetarian as a convenient way of avoiding higher calorie foods. (The fact that these foods are zero carb doesn't matter to calorie counters). Keith notes that "Somewhere between 30 and 50 percent of the girls and women seeking treatment for anorexia and bulimia are vegetarian." Keith says "The overlap in my life is a perfect 100. Everyone I've known with an eating disorder has been a vegetarian and that includes two anorexic men who were both vegans."

There is an interesting 'chicken & egg' argument – the dieter likely chooses to avoid animal foods to avoid calories but, also, vegetarian diets are typically low in tryptophan, which is the precursor of serotonin. Hence vegetarian diets can also cause depression, anxiety and eating disorders. "Veganism, I quip, is one part cult, one part eating disorder. I hear those words and I wish they weren't true because of what they mean about me." That's what Keith said. I could have said the same.

Note on all 3 arguments

We need to make it clear that real foodies abhor factory farming every bit as much as vegans and vegetarians. We want it abolished. It is heinous – unhealthy for the animal and the human. It fails all three arguments. There is no moral argument for keeping animals in factory farms – their role is to graze freely on grass and to feed the soil with their manure and digestion. There is no political argument for factory farms – feeding grain to ruminants, who cannot digest it, is a terrible use of the world's resources and is inevitably less efficient than feeding grain to humans (notwithstanding the harm that this could also do). There is no nutritional benefit in eating an animal that has never seen grass, let alone grazed freely on it. Much of the arguments made by vegans and vegetarians use the extreme examples of factory farming to make their case. We hate that too. Where we differ is on the value – morally, politically and nutritionally – of animals living freely and providing food for others in the circle of life, as they always have done.

The summary

The summary chapter in the book is a tour de force. Exquisitely written, it builds on a theme "what do I have for breakfast?" and all the things that we should think about to answer this question. We may not want to face the facts, but Keith sees this as no excuse to stay in denial. If delivered as a speech, you could see that no one in the audience would be sat down at the end. I have never seen such rousing prose.

The questions to be asked of vegetarians become these:

1) Moral – what do you think that you eat for which nothing has died? (I can understand that you may draw your line at not eating animals, but animals died for your food nonetheless. Please stop telling children "meat is murder" when bison, wolves, buffalo and rabbits died for your grains, as did the soil alongside).

2) Political – how can the agriculture that has destroyed, and continues to destroy, the planet be a sustainable way to feed the world? Without ruminants performing biological functions of soil, plants soon die as the soil structure is destroyed. Are you OK that your food is made from oil, not soil? What will feed your food when the fossil fuel runs out? (Let us work together to abolish the factory farming that we both abhor, and let us work together on the only sustainable way to feed the world – dramatically curtailing the world's population).

3) Nutritional – (particularly for vegans) pick any non-animal food and let me pick any animal food and let's compare vitamins and minerals. Where do you get retinol? B12? D? K2? Iron? and zinc? – to name just the most obvious nutrients provided by animal foods (some of those, exclusively so). What do you think we have eaten since time began? What did we eat during the 30,000 years of ice age? If there is any nutritional argument for being vegan, why would supplements be life critical? (not least, B12).

I sincerely hope that no one is vegetarian for nutritional reasons alone i.e. that the animal arguments are of no matter to them – they simply think that it is best to avoid real meat and fish and maybe eggs and dairy. If anyone is, they should be the easiest to return to healthy eating. If people choose not to eat animals, because of animals, then the question becomes – are you prepared for your health to suffer, as a result. Because it is less healthy to eat soya and grains than it is to eat meat and fish. Remember – in all of this – factory farmed meat and eggs don't count. We are not talking about processed meat. That's as bad as any processed food. We are talking about "Ermentrude", grazing in the fields.

Keith pulls no punches in this final section: "You can't have it both ways, vegetarians. If you want to save this world, including its animals, you can't keep destroying it. And your food destroys it."

Keith presents three questions to help answer the question – what should we have for breakfast?:

i) Does this food build or destroy topsoil?

ii) Does it use only ambient sun and rainfall, or does it require fossil soil, fossil fuel, fossil water, and drained wetlands, damaged rivers?

iii) Could you walk to where it grows, or does it come to you on a path slick with petroleum?

She gets stronger: "Despite the deepest longest of your hearts, vegetarians you are wrong. To save this world, we must know it, and then take our place inside it. As long as I believed the annual grains of a plant-based diet would save the world, I couldn't see that they were destroying it. This exact moment – reading those words – will take courage. I know you've got it. Are you willing to use it?"

"What separates me from vegetarians isn't ethics, or commitment. It's information." Lierre Keith.

And with that line, and with this book, we can no longer be in denial.

# Red meat & diabetes?

#### August 12, 2011

There is an article widely reported in the media today (11 August 2011). The original research was published in the American Journal of Clinical Nutrition. You can see the abstract for free and the article then costs $12. I bought the article, so that I can comment on the full picture and not the abstract and certainly not on the basis of the usual dreadful reporting that goes on in the UK media – if not elsewhere.

The study

The team looked at three studies for which there was food questionnaire information available:

– 37,083 men in the Health Professionals Follow Up Study (1986-2006);

– 79,570 women in the Nurses Health Study I (1980-2008);

– 87,504 women in the Nurses Health Study II (1991-2005).

In total 13,759 incidents of type 2 diabetes were recorded from 4,033,322 person-years of follow-up. That's a 0.34% incident rate to start with. Hardly justifying the headline "Diabetes threat from two slices of bacon a day."

The conclusion

You can see the conclusion in the abstract: "The pooled HRs (95% CIs) for a one serving/d increase of unprocessed, processed, and total red meat consumption were 1.12 (1.08, 1.16), 1.32 (1.25, 1.40), and 1.14 (1.10, 1.18), respectively. The results were confirmed by a meta-analysis (442,101 participants and 28,228 diabetes cases): the RRs (95% CIs) were 1.19 (1.04, 1.37) and 1.51 (1.25, 1.83) for 100 g of unprocessed red meat and for 50 g ofunprocessed red meat, respectively. We estimated that substitutions of one serving of nuts, low-fat dairy, and whole grains per day for one serving of red meat per day were associated with a 16–35% lower risk of T2D. "

There must be an error with the two words that I have highlighted in red. Is the article really saying that eating 100g ofunprocessed red meat has 1.19 risk (presumably relative to not eating any unprocessed red meat) but that eating 50g of unprocessed red meat has a 1.51 risk? i.e. claiming that people who eat 100g of unprocessed red meat have 'a 20% greater risk of diabetes' but people who eat half this amount have 'a 50% greater risk'?! Do they mean unprocessed at the first mention and processed at the second? (I've emailed Frank Hu – watch this space. Update – email back by return, fair play! Confirmation that this IS an error and AJCN will be asked to correct).

The overall conclusion is: "Our results suggest that red meat consumption, particularly processed red meat, is associated with an increased risk of T2D."

Issues

1) On p. 2 of the full study we have the significant error at the outset. Under the heading "Assessment of meat consumption", we have this telling passage: "Questionnaire items in unprocessed red meat consumption included 'beef or lamb as main dish', 'pork as main dish', 'hamburger' and 'beef, pork or lamb as a sandwich or mixed dish', and items on processed red meat included 'bacon', 'hot dogs', and 'sausage, salami, bologna, and other processed red meats.'"

We reach the fundamental issue, which renders the study futile, in this one passage. Real food supporters define unprocessed meat as that which has been naturally reared and processed meat as any and every other meat. Take the Weston Price Foundation definition of real meat for any study. Real unprocessed meat comes from animals that have been living their entire life freely outdoors grazing on (ideally fast growing) grass in rain and sunshine. These animals must have been eating grass, which they are designed to eat and not grain which they cannot digest. Unless they have been chewing the cud, which, as ruminants they are designed to do and pre-digesting vitamin D blessed grass for those who cannot digest cellulose – humans – there is no point in consuming them.

Hamburgers are not real meat. Presumably a lamb curry takeaway qualifies as "beef or lamb as main dish" – this is not real meat, as real food supporters would define it. The fundamental point of the study is about red meat – processed and unprocessed. To make any relevant claims, the study should have looked at those who eat no meat (every single other factor unchanged), those who eat real meat (every single other factor unchanged) and those who eat processed meat (every single other factor unchanged). The fact that other factors cannot be held constant is one of the major reasons why the UK Food Standards Agency had to admit (in the context of fat and heart disease studies):

"However, the ideal controlled dietary trial for prevention of heart disease (a long-term intervention trial with differing levels of saturated fatty acids and measuring coronary disease endpoints) has not yet been done and it is unlikely ever to be done".

Plus – the second critical point related to the so-called unprocessed meat – what is "beef or lamb as main dish" eaten with? rice? potatoes? carbs? What are hamburgers eaten with? burger buns? chips? ketchup? carbs? What are "beef, pork or lamb as a sandwich" eaten with – bit of a clue there – bread, likely hydrogenated fat margarine, emulsified mayonnaise, and, no doubt, more ingredients in the bread alone than in the varieties of real meat available to humans.

It doesn't matter what the survey did or concluded next – they did not measure real meat vs processed meat or isolate this consumption from any other macro nutrient.

2) Diabetes is a condition related to blood glucose levels and insulin – either the body's failure to release insulin to respond to a rise in blood glucose levels (type 1) or because cells are unresponsive (resistant) to insulin released (type 2). The macro nutrient most relevant to diabetes therefore is carbohydrate. Fat has no relevance and the relevance of protein is debatable, but negligible compared to that of carbohydrate. So, what is most likely to have any impact on diabetes – the processed (don't call it unprocessed) hamburger, or the bun, fries and ketchup? To claim an association between one part of food intake and not the whole is meaningless.

The report even notes that they conducted a sensitivity analysis with "adjustment for other major dietary variables (whole grain, fish, nuts, sugar-sweetened beverages, coffee, egg, potatoes, fruit and vegetables, all in quintiles)." Why not take the dietary questionnaires (however unreliable these notoriously are) and run an association with all dietary carbohydrate and incidence of diabetes over time. Biscuits, cakes, confectionery, bread, sugary cereals, pizza – the 400 calories of sugar and 700+ calories of flour that the average American eats daily. Are those eating more than their share getting more than their 'share' of diabetes?

This study was called "Red meat consumption and risk of type 2 diabetes..." Notwithstanding that it is about processed meat and even more processed meat and association with type 2 diabetes, when will we see the study "Carbohydrate consumption and risk of type 2 diabetes..."?

3) To be fair – the study did not claim causation. Research papers rarely do. They propose association and let the media run the "just two rashers of bacon can increase the risk..." headlines. Association does not mean causation – either way round. We should not be able to jump from association to 'meat consumption causes diabetes' any more than we should be able to jump from association to 'diabetes causes meat consumption'. Not only is causation usually assumed, a direction of causation is assumed. The people who developed diabetes may have all worn blue socks – does that mean that wearing blue socks increases the risk of anything?

4) Table 2 of the report negates the idea that there is any trend. Data is presented for the three studies, for five different levels of meat intake. The serving sizes are determined relatively, by quintile, so, as an example, for the Health Professionals Follow-up Study for what the study assumes to be unprocessed red meat, the five different serving categories are 0.17 servings per day, 0.43, 0.65, 0.94 and 1.44 servings per day). Finally, three models are presented for each of these different meat intake levels, by study:

– an age adjusted model;

– a model adjusted for age, alcohol consumption, physical activity, smoking, ethnicity, menopausal stage for women, family history of diabetes/hypertension/hypercholesterolemia, quintiles of total calories and a dietary score for diabetes that the team made up (more on that below);

– a model adjusted for everything above and BMI.

All of this is then done for their opinion of unprocessed red meat, processed red meat and total red meat (that should be total processed meat). You can see that this is indeed a multi variate model!

There is not a steady trend between meat intake and the incidence of diabetes in every model variant of every study. For the Health Professionals Follow-up Study (HPFS), increased (what they call) unprocessed red meat intake from 0.65 servings per day to 0.94 servings per day was shown to have a reduced incidence of diabetes in all three models.

It is not clear how the dietary score for diabetes impacted the assumptions and therefore results, but the team "created a low diabetes risk score as a diet low in trans fat and glycaemic load and high in cereal fiber and the ratio of polyunsaturated to saturated fat." What the ratio of two fats, which nature can put naturally in foods in different proportions and man can put very unnaturally in foods in different proportions has to do with the risk of diabetes I do not know.

5) The final point to make, as is the case with all presentation of numbers from studies to achieve maximum impact (and likelihood of media reporting) is that there are lies, damned lies and statistics. If you buy two lottery tickets each week, I can halve your chance of winning by allowing you only to buy one. Your odds of winning are now (for example) one in fourteen million instead of one in seven million – still absolutely naff all. However I have halved your chance of winning. Imagine I halved your 'chance' of developing diabetes in a similar, playing with numbers, kind of way...

Let's take some actual numbers from Table 2 as an example:

Processed red meat, age adjusted model, from the HPFS...

– 0.02 servings of processed red meat per day (one serving is 28g so that's half a gram of processed meat!) is associated with 340 incidences of diabetes in 138,550 person years. That's an incidence rate of 0.25% or 1 in c. 400 people.

– 0.12 servings of processed red meat per day (that's 3 grams – can any of you actually measure your intake to that level?) is associated with 409 incidences of diabetes in 121,238 person years. That's an incidence rate of 0.34% or 1 in c 300 people.

(This is raw data – adjusted for age only – not adjusted for smoking, exercise, calorie intake, family history of diabetes, weight etc i.e. impossible to isolate two different minute meat intakes and assume that this is the only difference.) This aside, this is presented as – if at 0.02 servings per day you have a 1.00 'risk' of developing diabetes, at 0.12 servings per day you have a score of 1.38 i.e. a 38% higher risk. There's the headline "3 grams of bacon a day and you have a 40% greater risk of diabetes." There's how numbers are played with to frighten the life out of you and to make sure that you have sugary cereal for breakfast instead of eggs from grass living chickens.

The bottom line

This is a study about processed meat and even more processed meat and observed associations between intake of each and incidence of diabetes. No biochemical pathway is proposed for how fat/protein is supposed to impact a condition of glucose/carbohydrate handling deficiency. The obvious connection between the buns, chips and ketchup being consumed with the hamburger has not been made.

To let the media have the last word – the Mail article tells us how it is: "There is now widespread evidence that red meat **drastically** (my emphasis – couldn't resist it) increases the likelihood of major health problems including heart disease, strokes, and some types of cancer."

Accuse modern, processed meat of all this and more – all modern food in fact. Hang processed 'food' generally for crimes against human health – heart disease, strokes, cancer, diabetes, Alzheimers – all modern illness. Throw the book at the man-made horrors. But, if we really think that nature put all the essential fats, essential amino acids, full range of B vitamins, fat soluble vitamins, iron, calcium, magnesium and zinc in red meat and was trying to kill you at the same time, we wouldn't be here today!

# Nutrition – where will a student  
be taught the truth?

#### September 12, 2011

I've had so many queries from people about studying nutrition that this blog is probably long overdue.

Nutrition is a fascinating topic. There is little more important to human health than what and how we eat. Modern epidemics of obesity and ill health are capturing media headlines and the attention of curious minds alike. This is a subject about which many people want to know more. However...

When I am asked to recommend a course on nutrition I can't. I am not aware of a single programme being offered anywhere in the world, which is evidence based and which presents facts, rather than the current myths presented as facts. That doesn't mean that there isn't one, but I don't know of one and I would be surprised if there were one given the extent of the misinformation being perpetuated by the vast majority of people working in this field.

What do you want to learn?

My starting advice to someone interested in studying nutrition would be to be specific about what you want to know. The British Dietetic Association curriculum for training as a dietician is detailed here. If this is your first higher qualification, the background in basic sciences and biology may be useful to you. For those who already have a degree and/or studied science to a reasonable level at school, reading a cell biology, physiology and biochemistry textbook will deliver the required background.

My passion is obesity. There is more than enough to study on this topic to do nothing else for the rest of one's life. Hence I am not interested in (using the attached curriculum by way of example) immunology, microbiology, (food hygiene), clinical medicine, pharmacology, sociology and social policy, communication and educational methods and definitely not interested in 'food' science. Nature provides food – that's the only food I want to understand. I'm not particularly interested in dietetics for the prevention of general disease (besides the fact that eating real food will achieve this naturally) and I'm only interested in public health to the extent of how we managed to get ourselves in the midst of an obesity epidemic.

Becoming a dietician

When I set out to study nutrition more formally, I investigated training as a dietitian. I rejected the prospect very quickly on two grounds:

i) With 1.5 billion overweight people in the world, this is more than a big enough arena in which to specialise. As detailed above, I have no interest in the vast majority of the dietician curriculum and have no time to 'waste' on such topics when I could be spending that time reading obesity journals.

ii) Upon investigation of the weight management part of the course, I discovered that the first lesson is the calorie formula. I would be told that energy in equalled energy out and that to lose one pound of fat a deficit of 3,500 calories must be created.

Thus the one part of the course that I would be interested in, would be of no use to me. Presumably I would need to reproduce answers that I know not to be true to pass, or fail as a result of giving my honest answer. A quick analysis of the 58 page curriculum document confirms that I made the right decision: the word weight does not appear once; the word obesity does not appear once; the word calorie does not appear once and the word diet only appears six times and in a very general context of the word diet e.g. UK diet or diet and lifestyle.

A third reason became apparent when I was researching for my book The Obesity Epidemic: What caused it? How can we stop it? Conflict of interest...

Here are the sponsors of The American Dietetic Association. Here are the program partners of the Dieticians Association of Australia. Here are the major partners of the Dieticians Association of Australia. Here are the associate partners. I detail in my book, The Obesity Epidemic, how unwilling the British Dietetic Association is to disclose its conflicts of interest. After a number of email exchanges, a BDA spokeswoman confirmed "we have been delighted to work with the Sugar Bureau..." The chief executive's foreword (Andy Burman) in the 2008-09 annual report of the BDA notes "We now have our first national partners with Danone and Abbott and we hope to announce new partners over the coming year or so." There is reference to a "Bird's Eye" education award, but no mention of other partners or sponsors. The accounts for 2009 showed a turnover of £2,359,013 with no details of the source for this revenue. The notes to the accounts, which could add detail to this number, are for the eyes of BDA members only. A press release, dated 1 March 2007 entitled Kellogg's: commitment to health and wellbeing, informed me that Kellogg's had been the lead sponsor for the British Dietetic Association's annual obesity intervention campaign since 2002 (and may still be).

Here are the members of the British Nutrition Foundation. Here are the sustaining members of the British Nutrition Foundation.

It is a complete disgrace that our nutritional 'education' has been infiltrated in this way. The partner that most disturbs me is Abbott Nutrition. This company makes an infant formula called Similac. The feeding guidelines on the Similac web site range from 1-2 weeks to 9-12 months, so this is clearly a product designed for babies. The can of baby formula, of the part that is not water, contained 43% corn syrup solids and 10.3% sucrose. "It's a baby milkshake," said a horrified Robert Lustig in the video "Sugar: The Bitter Truth". I wanted to analyse a product for myself, so I chose Similac Isomil Advance, Soy Formula and the composition of this was 50% corn syrup, 14.2% soy protein isolate, 10.4% high oleic safflower oil, 9.7% sucrose, 8.2% soy oil and 7.5% coconut oil. If a baby is unfortunate enough not to be breastfed, the infant can be started on a diet of 60% sugar from the first moment something is put in its mouth.

It is clearly in the interests of 'food' companies to partner with those giving us dietary advice – and to start as close to birth as possible. Does the public know that our advice is so conflicted? How can we "Trust a dietician to know about nutrition" (their slogan) when this conflict of interest exists?

Nutritional 'education'

That's the conflict inherent in our nutritional training, what about the content of programmes?

I only know one way to learn and that is to "get the facts". I am a thinker, not a feeler. If I am told something I need it to be evidence based. I want to know the source of everything – where did that come from? when did this become known and so on. This stood me in good stead studying economics (maths, statistics options) at Cambridge. Applying the same rigour to the subject of nutrition was the most shocking thing I have ever done.

During the three years of full time research for The Obesity Epidemic, the following nutritional beliefs did not hold up to scrutiny. Please note – these points are only in the part of nutrition related to dietary advice and weight loss. There may be many more errors in the teaching of nutrition outside my areas of interest.

Starting at the very beginning – dieticians state that "energy in = energy out." "You can't change the laws of the universe", they say. But there is no law of the universe that says "energy in = energy out." I detail in The Obesity Epidemic exactly what the laws of thermodynamics say and which law we have misunderstood and which law we have ignored.

We are then told that 1lb = 3,500 calories. It doesn't.

We are told that we will lose 1lb if we create a deficit of 3,500 calories. We won't.

We are told that 98% of diets fail (true for calorie deficit diets) but are continually told to "eat less/do more" despite this.

Five-a-day is a marketing myth. Eight-a-day (drinking) is similarly fabricated. Alcohol guidelines are numbers "picked from the air." Fruit is essentially sugar (fructose/glucose – aka sucrose) with vitamin C and not much else by way of nutrition. Offal, red meat and butter, the foods most often condemned by diet advisors, are nutritionally exemplary.

Saturated fat is life vital. Mother Nature is not trying to kill us.Cholesterol is life vital. Our own body (which makes our cholesterol) is not trying to kill us. The formula for cholesterol is C27H46O. There is no good or bad version.Grazing (don't); fibre (pointless); sedentary behaviour (how humans were designed to be) – there's so much that we have got terribly wrong.

As Kaayla Daniel said at the 2011 Weston Price Conference – "If you're told it's bad, it's good and if you're told it's good, it's bad – work on that basis and you can't go far wrong!"

Check out this free ebook or any of these presentations: Calories, Energy Balance, Thermodynamics and Weight Loss; Ten diet myths; The Obesity Epidemic to find out more.

Conclusion

I cannot recommend any dietetic or nutrition course because I know of none that will teach the truth about everything from thermodynamics to the role of insulin in fat storage. My genuine recommendation is that you need to study via amazon (Sean Croxton, Underground Wellness, concluded the same) and medical journal web sites.

Read Mary Enig and Sally Fallon Morell on fats; Uffe Ravnskov, Duane Graveline and Dr Malcolm Kendrick on cholesterol and the lipid hypothesis; The Diet Delusion (Gary Taubes); critical reviews of all of these and weigh the evidence for yourself. There will be many more non-conventional wisdom works for different areas of interest. The seminal journals to be read include Benedict (1917); Newburgh & Johnson (1930); Hugo Rony (1940); The Minnesota Starvation Experiment/The Biology of Human Starvation (1950); Stunkard & McLaren-Hume (1959). The Seven Countries Study (1970); The COMA report (1984). There are 400 references here for convenience – the books and journal articles are recommended.

When I started to question the origin of the calorie theory (1lb = 3,500 calories, so to lose 1lb you need to create a deficit of 3,500 calories), I asked the Department of Health, the National Health Service, the National Obesity Forum, The National Institute for Clinical Excellence, the Association for the Study of Obesity, Dieticians in Obesity Management and the British Dietetic Association. None could source the calorie theory. None could prove it.

The British Dietetic Association reply was: "Unfortunately we do not hold information on the topic that you have requested." It was suggested that I contact a dietitian. I happened to be with several dietitians at an obesity conference later that month (June 2009), so I asked fellow delegates and no one knew where the 3,500 formula came from. No one knew where the 'eatwell' plate proportions came from. One dietitian said to me "You've made us think how much we were just 'told' during our training, with no explanation. A group of us over there don't even know where the five-a-day comes from."

I rest my case!

### Other books by Zoë Harcombe

## The Harcombe Diet:

## Stop Counting Calories & Start Losing Weight

You've tried every diet under the sun. You've lost weight and put it back on. The more you diet, the more you crave food. You've given up hope of being slim. This book explains why. Count calories & end up a food addict. Stop Counting Calories & Start Losing Weight!

ISBN 978-1-907797-11-8

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### Other books by Zoë Harcombe

## The Harcombe Diet:

## The Recipe Book

Real food; great taste; optimal health – that's what The Harcombe Diet® is all about and here's how to do it. With over 100 recipes for Phase 1, another 100 for Phase 2 and some seriously special Phase 3 cheats, this is the ultimate diet-recipe book. If you want to eat well, lose weight and gain health – this is a must for your kitchen shelf.

ISBN 978-1-907797-07-1

Copies available on www.theharcombediet.com

### Other books by Zoë Harcombe

## Why do you overeat?

## When all you want is to be slim

This book will explain Why do you overeat? when all you want is to be slim. It will tell you about the three common medical conditions, which are causing insatiable food cravings. It will give you the perfect diet to overcome these three conditions and so to end food addiction and overeating forever.

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## The Harcombe Diet for Men:

## No More Mr Fat Guy

Men want to lose weight too - fast - and they won't go hungry. They want steak, pasta, cheese and the good things in life - including wine. They'll exercise if they want to; they won't count calories and they want all the answers in just a few pages... So here it is - The Harcombe Diet® for men!

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### Other books by Zoë Harcombe

## The Obesity Epidemic

## What caused it? How can we stop it?

"The Obesity Epidemic is the most comprehensive demolition job on the arrogance and ignorance of the health profession I have ever read". Barry Groves. Author Trick and Treat: How 'healthy eating' is making us ill.

ISBN 978-1-907797-00-2

Copies available on www.theharcombediet.com
