By Marika Sboros
Is the UK government dishing up bad dietary advice to its citizens? Has it wrongly demonised fat, glorified carbohydrates and harmed people’s health for decades? Is Public Health England’s (PHE) Eatwell Guide really the Eatbadly Guide, as leading obesity researcher Dr Zoë Harcombe dubs it?
Is it a guide to food industry wealth rather than public health?
Well, yes, yes, yes – and yes. That’s if findings of a new systematic review led by Harcombe and published in the British Journal of Sports Medicine (BJSM) are anything to go by.
The findings come at a time when PHE is facing mounting criticism for its links with the food industry. Critics also say the industry has had undue influence on government dietary guidelines known as the Eatwell Guide (formerly the Eatwell Plate):
On its website, the UK government describes the Eatwell Guide as “a policy tool used to define government recommendations on eating healthily and achieving a balanced diet”.
On July 3, The Sunday Times revealed that the government health watchdog had enlisted the support of an industry-funded body, the British Nutrition Foundation (BNF), to rebut a report saying consumers should eat more fat and fewer carbohydrates. The BNF is a charity whose corporate members include the who’s who of the fake food industry, among them Kellogg’s, Warburtons, Coca-Cola, Mars UK, and United Biscuits,
Internal emails showed that PHE sought the BNF’s help of to discredit the National Obesity Forum and Public Health Collaboration report. It said inter alia that nutritional advice to eat low-fat, high-carb foods has had “disastrous health consequences”.
Harcombe’s review builds on growing evidence of those consequences. It extends the findings of her earlier research, a meta-analysis in the BMJ Open Heart in 2015. That study showed that no randomised controlled trials (RCTs, the so-called “gold standard” of scientific research) supported dietary guidelines introduced first in the US in 1977 and then the UK in 1983.
The US guidelines are the most influential globally and have affected millions. Experts with no links to Big Food and Big Pharma now say the guidelines are the “single biggest experiment in modern medical history” – one that went horribly wrong.
US officials first introduced the guidelines to reduce rising mortality (death rates) from heart disease in the US. That was based on the so-called “diet-heart hypothesis”, which holds that saturated fat causes heart disease. The UK followed the guidelines first; most other English-speaking countries followed suit.
Harcombe’s review is the first to investigate whether there was any epidemiological research to support the guidelines at the time. It turns out there wasn’t any. Among the review findings:
- Dietary recommendations were introduced in the US (1977) and in the UK (1983) to reduce overall fat consumption to 30% of total energy intake and reduce saturated fat consumption to 10% of total energy intake. RCT evidence at the time did not support the introduction of these dietary fat guidelines. Epidemiological evidence at the time did not support the introduced dietary fat guidelines.
- No prospective cohort study available to dietary guideline committees found any association between total fat intake and deaths from heart disease;
- No prospective cohort study available to dietary guideline committees found any association between saturated fat intake and deaths from heart disease in the same population;
- One study alone provided support for the “diet-heart hypothesis” (the one that says saturated fat causes heart disease). This study “suffered the most serious limitations” and introduced many confounders;
- All RCT and epidemiological evidence available for dietary guideline committees to consider at the time had been undertaken only on men. Thus, evidence available could not be generalised to women.
When Harcombe’s meta-analysis appeared in the BMJ Open Heart in February 2015, PHE quickly conceded that there was no RCT evidence to support the guidelines when US and UK introduced them. However, PHE also claimed that epidemiological evidence at the time was “strong”, and RCT evidence available today is “overwhelming”.
Harcombe’s BJSM study shows that PHE’s contention on strong epidemiological evidence is terminally weak. She will be publishing two studies soon evaluating currently available RCT and epidemiological evidence.
How might all this affect clinical practice in future? Harcombe and colleagues say dietary advice in the UK and the US “at least, needs re-examination”.
They say the revised US 2015 dietary guidelines have for the first time excluded recommendations for total fat for the first time. However, they have maintained the advice to restrict saturated fat. The “pool of evidence does not support this recommendation”. Public health advice on dietary fat in the UK has “prevailed in the absence of supporting evidence”.
In an earlier editorial in the BJSM titled Designed by the food industry for wealth, not health: the ‘Eatwell Guide’, Harcombe eviscerates the Eatwell Guide with her usual sharpened research knife.
She says the guide “promotes industry wealth not public health”. A group appointed by PHE consisting primarily of members of the food and drink industry formulated it, not independent experts.
Its primary flaw, “as with its predecessors, is that it is not evidence-based. There has been no randomised controlled trial of a diet based on the Eatwell Plate or Guide, “let alone one large enough, long enough, with whole population generalisability”.
The guide’s emphasis on carbs is “the result of dietary advice to restrict fat”, she says. This is not based on the evidence, while the advice on carbs has never been tested”, she says. “Not even the hydration message (to drink 6-8 glasses of sugar-free fluid) holds water.”
Another view: WHY SO MANY DIETITIANS HAVE ‘HITS’ SYNDROME
Not surprisingly, Harcombe’s editorial infuriated PHE and its allies. A hastily cobbled rebuttal post popped up on the Science Media Centre website. Titled Expert reaction to editorial on the revised UK Eatwell Plate, it quotes several experts at length. All are critical of Harcombe’s views. That shouldn’t be surprising, given the Science Media Centre’s funding by drug and food companies. It’s an unedifying spectacle of a global phenomenon and the usual suspects – heart foundations, dietitians associations, academics and doctors – rallying to support paymasters and vested interests in food and drug industries and shooting the messenger again.
The experts who attack Harcombe’s editorial appear oblivious – by default or design – of the evidence stacked against the US dietary guidelines and their UK incarnations.
Among those quoted is King’s College London professor emeritus of nutrition and dietetics Dr Tom Sanders. Sanders is also the BNF scientific governor and has received £4.5m in funding from the sugar industry for his research.
He calls the editorial “a piece of provocative journalism not backed by science”. He says the headline is “totally unjustified”. He says Harcombe makes ” a number of flimsy claims and insinuates a malign influence of the food industry”.
He defends food industry involvement in the Eatwell Guide saying it is “only proper that (the industry) is consulted in the process as a stakeholder”. He says there’s “not a shred of evidence to support the central claim that current dietary guidelines are responsible for the current obesity epidemic”.
Sanders also seems to support the CICO (calories in, calories out) model which holds that obesity is from gluttony and sloth. He says the obesity and subsequent diabetes epidemics are simply from “changes in human behaviour, notably a more sedentary lifestyle and changes in eating habits, which have nothing to do with the dietary guidelines. For example, increased consumption of food eaten outside the home and larger portion sizes.”
British Dietetic Association spokesperson Catherine Collins is also quoted. Collins, who is principal dietitian at London Teaching Hospital, doesn’t believe there was any industry involvement. She dismisses Harcombe’s claim as “ludicrous”
Victoria Taylor, a senior dietitian at the British Heart Foundation (BHF), says the guidelines follow “a rigorous and independent process of review of the best evidence available by the scientific advisory committee on nutrition”. Taylor says “randomised controlled trials alone won’t give us a full picture as carefully controlling the diets of thousands of people over many years would be impossible”.
In the end, as Harcombe says the Eatwell Guide’s greatest flaw is likely to be a “missed opportunity to deliver a simple and powerful message to return people to the diets we enjoyed before carbohydrate conditions convened. But when the who’s who of the food industry were represented on the group, ‘Eat Real Food!’ was never a likely outcome.”