Eat Fat Cut the Carbs and Avoid Snacking to Reverse Obesity and Type 2 Diabetes National Obesity...

7/26/2019 Eat Fat Cut the Carbs and Avoid Snacking to Reverse Obesity and Type 2 Diabetes National Obesity Forum Public

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- 1 -www.NationalObesityForum.org.uk www.PHCuk.org

Eat Fat, Cut The Carbs

and Avoid SnackingTo Reverse Obesityand Type 2 Diabetes

In association with


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Introduction

After 250,000 years of evolution, humans became a healthy, well-nourished specieswith a long life expectancy. In only 0 years, things have gone catastrophically

wrong, with epidemics of obesity and type 2 diabetes, unchec!ed by currentpolicies and interventions li!ely to cause reduced life-expectancy, and ban!ruptcy ofhealthcare systems. "his report represents a potential shift in failed policies, andrecommends alternatives which are li!ely to reverse some of the counterproductiveeffects of recent policy.

#olving the obesity epidemic and its associated adverse health conse$uences suchas type 2 diabetes is today%s most important public health challenge. &besitydirectly costs the 'ational (ealth #ervice )'(#* more than + billion per year.irectly and indirectly type 2 diabetes costs +20 billion and without effective action,

this price is li!ely to double over the next 20 years. / In the 1nited #tates the costof diabetes has soared recently, reaching 1# 235 billion in 20/2.

"he roots of obesity and type 2 diabetes are firmly embedded in the foodenvironment. 4egislative efforts to encourage less consumption of processed foodsand sugary drin!s will help significantly reduce the burden of diet related diseasewhich now contributes to more disease and death globally than physical inactivity,smo!ing and alcohol combined. 2 "he role of poor dietary advice has beenignored for too long. #pecifically, thelow fat6andlower cholesterol6message

have had unintended disastrous health conse$uences."he flawed science behind this message and subse$uent change in dietaryguidelines introduced for Americans in /788 followed by the 19 public healthdietary advice issued by the 'ational Advisory :ommittee on 'utritional ;ducationin /7 of the increased calorie inta!e has come from carbohydrates andpolyunsaturated vegetable oils. 5

"he conspicuous rise in obesity immediately following their introduction suggeststhat they are a root cause of the problem. 'utrition science was originally foundedon human correlational studies, which are fre$uently flawed. ?ut that science hasalso been corrupted by commercial influences. "he undue influence of the foodindustry on official guideline bodies and politicians has posed a significant threat topublic health.

@ublic health professor 9elly ?rownell noted that it too! 50 years from the firstpublished scientific evidence lin!ing smo!ing and lung cancer until effectiveregulation was introduced to curb tobacco consumption. ?ig tobacco companies

adopted a strategy of denial, planting doubt, obfuscating, and even buying the



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loyalty of scientists. "he recent similarities with big food companies are nothingshort of chilling.

e understand members of the food industry have a fiduciary responsibility toproduce profit for their shareholders. ?ut the real scandal, at great expense topublic health, is that academics, institutions and =ournals whose primary

responsibility is to patients and scientific integrity have at times colluded withindustry for financial gain.

"he latest ;atwell guide from @ublic (ealth ;ngland is perhaps an example ofcommercial interests trumping independent scientific evidence. "he ma=ority of thegroup established by @ublic (ealth ;ngland to determine the healthy eating rolemodel for the country represented the food and drin! industry. #hould the foodand drin! federation have a say in the design of ;ngland%s healthy eating advice, orshould independent clinicians fulfil that roleB

It is also shoc!ing to suggest that consuming 22 teaspoons of sugar daily can fallwithin recommended guidelines. Cet, this has been true for over a decade. 8 Doroptimum health there is '& dietary or biological re$uirement whatsoever for addedsugar.

"o wind bac! from these harms the 'ational &besity Dorum and @ublic (ealth:ollaboration therefore, based on the most up to date scientific and clinicalevidence, recommend a complete overhaul of dietary advice and public healthmessaging. "he most effective and important changes can be covered in thefollowing ten points.

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1. Eating Fat Does Not Make You Fat

;vidence from multiple randomised controlled trials have revealed that a higher fat,lower carbohydrate diet is superior to a low-fat diet for weight loss andcardiovascular disease ris! reduction


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2. Saturated Fat Does Not Cause Heart Disease.Full fat dairy is likely protective.

"he rush to condemn saturated fat as a nutrient of concern was premature. A new

meta-analysis of the evidence available prior to the /788 and /7 of calorie inta!e and saturated fat to /0> of calorie inta!e. As the authorsstatedFdietary recommendations were introduced for 220 million 1# and 5 million19 citiGens by /7


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3. Processed foods labelled low fat, lite, lowcholesterol or proven to lower cholesterol

should be avoided.

'o single piece of evidence exists that demonstrates reducing dietary saturated fatreduces cardiovascular events and death. Instead, improvements in hardcardiovascular outcomes are independent of cholesterol lowering. ietary trials thatprovide abundant natural fats such as -linoleic acid, polyphenols and - fatty acids found in nuts, olive oil, oily fish and vegetables rapidly exert positive healtheffects. /8 "he mechanism may include attenuating inflammation, atherosclerosisand thrombosis. Jeplacing saturated fat with omega containing vegetable oilslowers cholesterol but does '&" improve cardiovascular mortality. / of myocardial infarctions, a larger reduction than correctinghypertension )>*, low high-density lipoprotein cholesterol )/>*, body massindex )2/>* or low-density lipoprotein cholesterol )/>*. /7 "he LJI#9 calculator,

used by clinicians to estimate the /0-year ris! of :H, pointedly does '&" use 44cholesterol but total cholesterolE(4 ratio instead.

"he process by which cholesterol lowering foods Mwor!N raises serious concernsfor coronary heart diseaseF (owever there is no evidence that plant sterolsreduce the ris! of :( and much evidence that they are detrimental.6 20



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4. Limit starchy and refined carbohydrates to preventand reverse Type 2 diabetes.

"ype 2 diabetes is a disease of excessive insulin resistance, which manifests itself by

elevated blood glucose levels. @atients demonstrate profound carbohydrateintolerance and public health messages should reflect that. Jefined and starchycarbohydrates are well !nown to increase blood glucose levels, re$uirements formedications and weight gain. It is therefore very disturbing that both iabetes 19and '(# websites prioritise the consumption of starchy carbohydrates for type 2diabetics. #uch diets will potentially lead to progressive worsening of disease withall its attendant complications, such as blindness, !idney failure, nerve damage,peripheral vascular disease, heart disease and stro!e.

A recent comprehensive review concludes that dietary carbohydrate restriction isthe single most effective intervention for reducing all of the features of themetabolic syndrome6 and should be the first approach in diabetes management. A!etogenic diet )one that comprises less than /0 per cent of calorie inta!e fromcarbohydrates* results in the greatest falls in (bA/: and reduction in the use ofmedications. "hese benefits accrue independently of weight loss. 2/

Joyal :ollege of Oeneral @ractitioners clinical expert in diabetes r avid 1nwin,has very recently published profound results by simply recommending the 4:(D

diet to patients. (e was recogniGed as the Innovator of the Cear at the '(#4eadership Jecognition Awards 20/. In addition to dramatically improving hispatients health, r. 1nwin has saved the '(# +35,000 per year for medications fordiabetes compared to the average of his :linical :ommissioning Oroup . 22 If wewere able to replicate these results in the 7,300 surgeries across the 19 we couldpotentially save +32 million a year on drugs for diabetes alone. "he downstreamsavings from reduced end organ damage )heart attac!s, stro!es, cancer etc.* aremany orders of magnitude higher. "his does not even factor in the significantsavings in human suffering.



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5. Optimum Sugar Consumption For Health is ZERO.

Added sugar has no nutritional value whatsoever. "here are no biochemicalreactions in the human body that re$uire dietary fructose. 'o single study existsthat demonstrates benefit associated with its consumption. 2 ;xcess sugarconsumption is strongly associated with increasing ris! of type 2 diabetes,hypertension, and cardiovascular disease, independent of its calories or its effectson body weight 23, 25, 2. hile we welcome the recent orld (ealth&rganisation maximum 4IKI" recommendations, public health messaging shouldemphasiGe the fact that sugar plays '& role in a healthy diet.

#ugar should be relegated to the status of condiment or food additive, rather thanfood. It should return to its role as a decadent unnecessary thing to be consumed

occasionally rather than a daily part of a healthy diet.

In addition we recommend that food labelling on added sugar should be recordedas number of teaspoons. "his enables consumers to ma!e more informed decisionswhen purchasing products in the supermar!et.



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6. Industrial Vegetable Oils Should Be Avoided.

Dor virtually all of the 2-3 million years of human history, pure vegetable oils havenot been part of the diet. 4inoleic acid )the omega- fat in these vegetable oils* isextremely susceptible to oxidation, ma!ing foods rancid, but also oxidiGing in thebody. 28, 2


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7. Stop Counting Calories(Calorie focused thinking has damaged public health.)

A calorie is only a calorie if it is incinerated, and the heat given off measuredP indeed

that is the definition. (owever, calories from different foods have entirely differentmetabolic effects on the human body rendering that definition useless. "herefore,the effect on our health differs substantially depending upon where that calorie isderived from. Dor example, e$ual calorie portions of sugar, alcohol, meat or olive oilhave widely differing effects on hormonal systems such as insulin, and satietysignals such as cholecysto!inin or peptide CC. It is highly irrelevant how manycalories a portion of food on a plate contains. hat matters is how our bodyresponds to the ingestion and absorption of those calories, and how they aremetabolised, depending upon the specific food in $uestion.

:urrent caloric reduction strategies for weight loss are highly ineffective. ata fromthe 19 :linical @ractice Jesearch atalin! from 2003-20/3 estimates the probabilityof attaining a normal weight at / in /8 3. "his e$uals a failure rate greater than77>. "his is easily confirmed by the experiences of virtually all people attempting adiet, the ma=ority of which are calorie-based methods.

It is often assumed that excessive caloric inta!e is the root cause of obesity, but thisis untrue. A calorie of food energy can have different metabolic fates depending

upon the hormonal stimulation. Dor example, that same calorie of food may be usedto generate body heat or stored as body fat. &besity is a disease of energypartitioning, not one of total energy inta!e. "he primary driver of this partitioning isthe hormone insulin.

:alorie-focused thin!ing is inherently biased against high-fat foods, many of whichmay be protective against obesity and related diseases, and supportive of starchyand sugary replacements, which are particularly detrimental for those with insulinresistance.

#hifting focus away from calories and emphasising a dietary pattern that focuses onfood $uality rather than $uantity will help to rapidly reduce obesity, related diseasesand cardiovascular ris!. 5 Japid weight loss and regain from fad dieting isdetrimental to health. #uch Mweight cyclingN contributes to hypertension, insulinresistance and dyslipidaemia resulting in increased mortality ris! and worsecardiovascular outcomes. "he loo! A(;A )Action for (ealth in iabetes* trialfound no cardiovascular benefits with a low calorie diet combined with increasedphysical activity in type 2 diabetic patients. espite significant weight loss even up

to the maximum follow-up of /.5 years, no health benefits could be found. 8



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@ublic health should wor! primarily to support the consumption of whole foods thathelp protect against obesity-promoting energy imbalance and metabolicdysfunction rather than continue to promote calorie-directed messages that maycreate and blame victims and possibly exacerbate epidemics of obesity and relateddiseases.



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8. You cannot outrun a bad diet.

It is widely accepted amongst the public and media that consuming more caloriesthan we burn is the cause of the obesity epidemic, and thus the solution is to domore exercise. "his is not correct. &besity is a hormonal disorder leading toabnormal energy partitioning, which cannot be solely fixed by increasing exercise.

Dor many years, food and drin! companies have pushed the physical activitymessage to exonerate themselves of their own role. Indeed, companies promotingprocessed and highly refined foods lin!ed to the obesity epidemic have sponsoredma=or sporting events e.g. the &lympics. Jegular physical activity does indeed havea multitude of beneficial health effects but weight loss is not one of them. "here hasbeen little change in our levels of physical activity in the past three decades, whilst

levels of obesity has increased.


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9. Snacking will make you fat (Grandma was right!)

"here have been two ma=or changes in our dietary habits since the /780s, prior tothe onset of the obesity epidemic. "he change to a high carbohydrate, low fat diethas been well documented and has played an important role in causing obesity. "heother change, the increase in meal fre$uency plays an e$ual if not larger role andhas been largely ignored. In the /780s, the average number of eating opportunitieswas three brea!fast, lunch and dinner. Dast-forward to 2005 and that number hasalmost doubled. 30 'ow we eat brea!fast, snac!, lunch, snac!, dinner and snac!.And each of these are more often refined carbohydrate containing than not.

;ating continuously from the moment we arise to the moment we go to sleep doesnot allow our body to digest and use some of the foods that we eat. "he entire day

becomes an opportunity to store food energy without a chance to burn it. ;ating sixtimes a day does not result in weight loss )3/*, but tends to increase overallconsumption of food.

#nac!s tend to be highly insulinogenic )or fattening* since we demand theconvenience and shelf stability of refined carbohydrates. It is simple to eat somecrac!ers as a snac!, but not a small piece of grilled salmon.

e must balance the time that we spend eating, and the time we spent '&" eating,

or fasting. "he very word Mbrea! fastN, which denotes the meal that brea!s ourfast implicitly ac!nowledges that we must spend some part of the day fasting, evenif it is only /2-/3 hours in the evening and night while we are mostly sleeping.Jeducing the fre$uency of our meals will pay enormous dividends in weight lossefforts. ;liminating snac!ing )especially after dinner* and adding bac! periods offasting are simple ideas practiced widely before the obesity epidemic. "his is notli!ely coincidental.



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10. Evidence Based Nutrition Should Be Incorporated Into Education Curricula For All Healthcare Professionals.

Oiven the immediate health threat posed by diet related disease we believe that it is

imperative that education curricula for undergraduate, postgraduate and continuingmedical education incorporate up to date evidence based nutrition. A global surveycarried out by investment ban! :redit #uisse worryingly revealed a substantial levelof misinformation that exists amongst doctors with 72> believing that fatconsumption could lead to cardiovascular issues, suggesting obesity as aconse$uence with nutritionists coming up with broadly similar conclusions.Incorrectly 53> of doctors and 30> of nutritionists thought that eating cholesterolrich foods raises blood cholesterol. Kost shoc!ing6 in the report was that of doctors thought butter was worse than margarine and > believed vegetable

oils are beneficial to health. 32

"his is not only about preventing disease, but involves nutritional interventions thataddress and eliminate the root causes of chronic disease as opposed to a limitedmodel of treating symptoms and ris! factors with pharmacotherapy. "he fact thatprescription medications are now the third most common cause of death globallyafter heart disease and cancer should be a wa!e up call that the future of healthcarewill re$uire a strategy that incorporates evidence based lifestyle changes to treatillness in addition or often as an alternative to medical treatments which come with

side effects. e support the Academy of Kedical Joyal :olleges and the ?KQ who=ointly provide a blueprint to reduce the harms of too much medicine6 as part ofthe :hoosing isely campaign. &ne of their recommendations encourageseducating the public to as! medical professionals whether there are simpler orsafer options6 to ta!ing medications. 3



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Healthy Eating Guidelines & Weight Loss AdviceFor The United Kingdom

As well as helping write this document the @ublic (ealth :ollaboration )@(:* have

also written a more extensive report on healthy eating guidelines and weight lossadvice for the 1nited 9ingdom. "his report can be downloaded from the @(:website at www.@(:u!.orgEhealthy-eating-guidelines-weight-loss-advice-for-the-u!Ewhere you can also find out more information.

https://www.phcuk.org/healthy-eating-guidelines-weight-loss-advice-for-the-uk/https://www.phcuk.org/healthy-eating-guidelines-weight-loss-advice-for-the-uk/https://www.phcuk.org/healthy-eating-guidelines-weight-loss-advice-for-the-uk/https://www.phcuk.org/healthy-eating-guidelines-weight-loss-advice-for-the-uk/


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References

/. (ex ', ?artlett :, right , et al. ;stimating the current and future costs of"ype / and "ype 2 diabetes in the 1nited 9ingdom, including direct healthcosts and indirect societal and productivity costs. iabetic Kedicine20/2P27F


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/.de #ouGa JQ, Kente A, Karoleanu A, et al. Inta!e of saturated and transunsaturated fatty acids and ris! of all cause mortality, cardiovascular disease,and type 2 diabetesF systematic review and meta-analysis of observationalstudies. ?KQ 20/5P5/ doiF /0.//Ebm=.h78


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2.Added sugar inta!e and cardiovascular diseases mortality among 1# adults.Cang L, Shang S, Oregg ;, Dlanders , Kerritt J, (u D?. QAKA InternKed. 20/3 AprP/83)3*F5/-23. doiF /0./00/E=amainternmed.20/./5.

28.Dree Jadic ?iol Ked. 200/ ec /P/)//*F/


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7. It is time to bust the myth of physical inactivity and obesityF you cannotoutrun a bad diet . A Kalhotra, " 'oa!es, # @hinney ?r Q #ports Ked b=sports-20/5-0737//@ublished &nline DirstF 22 April 20/5 doiF/0.//Eb=sports-20/5-

0737//

30.@op!in ?K. oes hunger and satiety drive eating anymoreB Am Q :lin 'utr

20/0P7/F/3283/.:ameron Q. meals per day does not result in greater weight loss. ?r Q 'utr.

20/0 AprP/0)

Eat Fat Cut the Carbs and Avoid Snacking to Reverse Obesity and Type 2 Diabetes National Obesity...

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