Nina’s challenge to the USA food guideline team

Nina Teicholz’s article How dietary guidelines are out of step with science has provoked online furore since it made front page headlines on the BMJ 26 September 2015.

Nina, a journalist who took ten years to research and write her bestselling and highly acclaimed book Big Fat Surprise, has been attacked for having the temerity to explain how bias on the part of the expert panel who decide what should be published in this year’s Dietary Guidelines for Americans, is making people fatter and  sicker, instead of improving their health.

Her opponents claim that as a mere journalist she has no business criticising scientists and doctors who know what is good for patients. They claim that their guidelines are scientifically sound and just because they have missed out studies on low carbohydrate diets that show improvements in weight, diabetes control and cardiovascular risk factors, and also failed to evaluate  studies that show that saturated fat does not cause any health related problem, does not mean that their recommendations are unsound.

Nina is concerned that anything that goes against the low fat/high carbohydrate “healthy eating” advice of the last 35 years is being systematically suppressed.  The committee comprises of only 11-15 “experts” yet the recommendations have ramifications for millions of people, not only in the USA, but worldwide.  A congressional hearing will be set in October to discuss the guidelines, hence the importance of signing Professor Jeff Volek’s petition for clarity over the scientific basis for the guidelines.

The USA government set up the Nutrition Evidence Library in 2010 in order that systematic reviews on nutrition could be comprehensive and standardised. Yet, the current expert team did not use this resource for over 70% of the topics on their review, instead choosing to rely in the opinions of the American Heart Association and American College of Cardiology, both of whom have significant funding by food and drug companies.

Among other inconsistencies Nina points out that the Women’s Health Initiative, in which 49,000 women took part, that the lower saturated fat intervention group had no benefit in heart attacks or strokes. Three meta-analyses concluded that saturated fat did not increase cardiovascular mortality, and yet the recommendation of the group has been to limit saturated fat to less than 10% of calories, saying that the evidence basis for this is “strong”…..Stretching the truth a bit?

Low carbohydrate diet research was also not systematically reviewed.  A meta-analysis and critical review concluded that a low carb diet was the best type of diet to control type two diabetes. Two other meta-analyses showed that low carbing was the best diet for weight loss, and improving cardiovascular risk factors. Despite the evidence that would have been revealed, had it been actually looked for, the guidelines went ahead without it. About the only positive message to come out of the guidelines are that a cap on dietary sugar is being proposed.

The three diets that are endorsed by the new guidelines are the “healthy vegetarian diet”, the “healthy US diet” and the “healthy Mediteranean diet”.  Systematic NEL reviews were done on these diets and the evidence base was given as “limited” which means that the evidence quality was low. Despite this the committee decided to boost the evidence rank to “moderate”. Despite at least three National Institutes of Health funded trials on 50,000 people that show that a low fat and low saturated fat diet is ineffective in combating heart disease, obesity, diabetes or cancer, this is the main thrust of the 2015 guidelines, just like all the other guidelines published in the last 35 years.

Nina thinks that many experts, institutions and industries have an interest in keeping the status quo and that these interests create bias. The potential conflicts of interest in some of the committee members is discussed. This subject has also been discussed regarding our UK guidelines by Hannah Sutter in her book Big Fat Lie.

Nina concludes: Given the ever increasing toll of obesity, diabetes and heart disease, and the failure of existing strategies to make inroads in fighting these diseases, there is an urgent need to provide nutritional advice based on sound science. It may be time to convene an unbiased and balanced panel of scientists to undertake a comprehensive review. There needs to be transparency, disclosure of conflicts of interest, and rigorous scientific evidence that is reliably analysed to produce the best possible nutrition policy.

Well…..Nina, you are quite right, and since Jeff Volek’s petition was launched 4 days ago, at least 4,000 people agree with you. So just how important is having a good food guideline for diabetics?

Take the NICE 2015 type two guideline. A main trust is the promotion of structured education for all types of diabetics. “This should be evidence based ….nutritional advice should be given by a health care professional with specific expertise and competencies in nutrition…emphasise “healthy eating” (also known as the high carb / low fat diet)…limit saturated and trans fats to 5-10% of calories…..reducing hypoglycaemia should be a particular aim for those on insulin or a sulphonylurea…Type two diabetes consists of insulin resistance and insulin deficiency…. Insulin resistance is characterised by increased body weight and is worsened by overeating and lack of exercise…commonly associated with high blood pressure, lipid disturbance and a tendency to thrombosis, fatty liver and abdominal adiposity.”

Surely NICE are kidding? Despite also having a distinct lack in worthwhile evidence for their dietary guidelines, they are pushing all diabetics into nutrition classes led by NHS dieticians. They want them to continue teaching a diet that is well known to increase insulin resistance, burn out the pancreatic beta cells that produce insulin and make hypoglycaemia more likely if you are an injected insulin user who aims for good blood sugar control.

NICE conclude their impossible wish list, ”Aims of education are to improve outcomes by addressing health beliefs, optimising metabolic control, addressing cardiovascular risk factors, facilitating behaviour change, reducing complications,  improving quality of life and reducing depression. The relationship between the person with diabetes and healthcare professionals should be enhanced thereby providing the basis of true partnership in diabetes management.”

Hypocritical or what?

Dr Unwin’s winning formula for fitness and health

Dr Unwin
Proof that you can eat low-carb AND run…

Hello, I am David Unwin, another GP interested in the low-carb approach to helping my patients with type two diabetes.

My work formed the basis of an article published in the March 2014 edition of Practical Diabetes. ‘Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice’.

I am not a diabetic, but have been on the diet for about two years now. I started it as a gesture of support for my patients but find I am more alert and need less sleep on it. Surprisingly it seems to help me run faster too! I recently finished a 10 K road run in less than 46 minutes, my best time for years.

Since writing the article in March, my practice has been given a small grant which means we have now helped 37 people with type two diabetes. Interestingly, the results are very similar to our original cohort including improvements to cholesterol, despite a diet higher in fat which makes one wonder…


Diabetics have long been exhorted to give up sugar and encouraged to take in complex carbohydrate in the form of the starch found in bread and pasta (especially if ‘wholemeal’). In fact, bread should be seen as concentrated sugar which explains why it has a higher glycaemic index than table sugar itself.

As there are no essential nutrients in starchy foods and diabetics struggle to deal with the glycaemic load they bring, we question why they need form a major part of their diet at all.

The recent increase in screening in general practice along with epidemic of ‘central obesity’ is revealing large numbers of pre-diabetics and diabetics (diabesity). At a time when there are questions about drug safety, which diet is best is of particular importance.

Many patients are already experimenting with the ‘low carb’ approach as it is so widely advocated on the internet. We wanted to see how effective and well tolerated it was.

A series of 19 type 2 diabetics and pre-diabetics volunteered to go on a low carbohydrate diet backed up with ten-minute one to one sessions with a GP or practice nurse, and regular group education.

After seven months only one had dropped out, of the rest all had significant weight loss (average 8.63 Kg) and the average HbA1c was down from 50.68 to 39.9 mmol/mol (6.7% to 5.7%).

Despite the higher fat intake on this diet the cholesterol dropped and liver function improved for nearly all participants.

We conclude this approach is easy to implement, brings rapid weight loss and improvement in HbA1c using a diet that the great majority of patients find easy to live with.

You can find the full article at Practical Diabetes.