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The first major study to look at all-cause mortality and cardiovascular disease and nutrition across all 5 continents of the world may have arrived just in time. The study findings have just been published in one of the world’s leading scientific and medical journals, The Lancet and were presented yesterday at the European Cardiology Society conference in Barcelona.

With this study now published, it’s going to be very difficult for governments to continue to tell us to get most of our energy from carbohydrates when there’s now clear evidence that that advice is killing us. The new study out of McMaster University, Canada, gives credence to those of us, including cardiologists, who have long advocated lower carb and higher fat diets. And if that wasn’t enough, it shows that raw and cooked vegetables aren’t equivalent, a difference that’s never distinguished in government guidelines.

In the Acknowledgments section of the paper, the study is claimed to be investigator-initiated and over 50 sources including the Population Health Research Institute (PHRI) at McMaster University, the Heart and Stroke Foundation of Ontario and Canada, the Canadian Institutes of Health Research, "and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi-Aventis [France and Canada], Boehringer Ingelheim [Germany and Canada], Servier, and GlaxoSmithKline), and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries."

The sheer diversity and number of the funding sources, the fact that Big Pharma grants were 'unrestricted' and that it was investigator-initiated reduces the risk of vested interest bias or conflicts of interest. The study does however have weaknesses, among the most evident being the reliance on self-reported intake data from questionnaires which tend to vary in accuracy.

Since it’s now almost universally accepted that what we eat and what lifestyles we choose are for most of us the single most important determinants of our health, we have to take government advice seriously. That’s because so many people rely on it, from health professionals through to consumers. It’s of course not as simple as that, as layered on top of what governments tell us are a complex of other factors, linked to preferences or addictions, and a minefield of interacting social, cultural and economic determinants.

The low fat farce

Governments, along with Big Food, have for over 3 decades been locked into the notion that low fat diets are healthy, despite an absence of ‘gold standard’ evidence from randomised controlled trials.

The Lancet study blows this into the long grass. The study, referred to as the Prospective Urban Rural Epidemiology (PURE) study is one of a series. The present one looked at reported dietary intakes, via questionnaires, of 135,335 individuals, across 18 countries (reflecting low, middle and high incomes) on all 5 continents, over a 10-year period. Follow-up continues and will result in further publications.

The researchers found that people between the ages of 35 and 70 on low fat/high carb diets had an increased risk of early death compared with those on a lower carb/higher fat diet. This emphasises that government advice over recent decades to switch out saturated fats and replace them with carbs has been killing people. Interestingly, the apparent protective effect of higher fat intakes occurred whatever the type of fat, whether saturated, monounsaturated or polyunsaturated.

Dietary fat intakes amounting to around 35% of total energy intake had a drug-busting 23% lower all-cause mortality risk. By contrast, diets high in carbs (60% of total energy intake), around the amount consumed when following government guidelines like the UK’s Eatwell or US Myplate guidance, were associated with a higher risk of death.

How long can health authorities and governments hold out before updating their advice on optimal fat/carb intakes?

Optimal veg and fruit intakes

The current PURE study also found that an intake of veg, fruit and legumes of 3-4 servings a day, equating to 375-500 grams, was associated with a lower total mortality and non-cardiovascular mortality.

The researchers found no evidence of benefit for consumption above this level, possibly because it was offset by excessive carbohydrate intake. The authors commented that in some developing countries where vegetables and fruit are expensive, recommending say 3 instead of 5 servings daily, around 400 grams, might be more achievable.

Lead author, Dr Mahshid Dehghan, said in a podcast accessible from The Lancet website that In higher income countries the study findings shouldn’t be looked on as a suggestion to eat less veg, legumes or fruit.

Another important finding was that the study showed that consumption of raw vegetable sources was more protective against cardiovascular diseases than cooked veg. We have long known that many phytochemicals, vitamins and other nutrients are heat sensitive and may be damaged by heat, and we also know that certain forms of cooking can introduce new, harmful chemicals and byproducts, especially when starches, sugars, fats and proteins are subjected to high temperatures. These range from carcinogenic heterocyclic amines (HCAs) formed in high temperature cooked meats, to advanced glycation end products (AGEs) that contribute to inflammation and oxidative stress in the body.

Astonishingly, government guidelines simply don’t distinguish between cooked and uncooked foods despite a wealth of evidence showing many are as different as chalk and cheese, including the latest from this PURE study.

Recently, we’ve raised the question with governments in the European Union over whether they can move to force manufacturers of processed meats to include cancer risk warnings. This would reflect the 2015 classification by the International Agency for Research on Cancer (itself an organ of the World Health Organization) of processed meats as proven human carcinogens. Governments might be aware of this, but the majority of the public isn’t and this type of nitrite-preserved processed meat is fast becoming a staple of kids and adults alike.

Would that change if it had a cancer warning on it? We think so.

It’s refreshing that that as more evidence is released, there is ever more scientific support for our own Food4Health guidelines that we believe properly reflect the available scientific and clinical evidence.

Join our campaign

In the coming weeks, we’ll be unfolding a campaign targeting a number of governments with a view to making significant adjustments to their guidelines. Among the hit list of changes to dietary guidelines we will be pushing for are the following:

  • Removal of any recommendation to consume low fat foods
  • Removal of any recommendation to limit saturated fats
  • Total carbohydrate consumption should not exceed 50% of energy intake
  • Recommending at least 3 portions a day of fresh uncooked and unprocessed vegetables or fruit
  • Minimise consumption of refined carbohydrates (e.g. sugar, white bread, white pasta, pizza bases)
  • Minimise consumption of savoury snacks
  • Minimise consumption of charred or high temperature cooked meats
  • Minimise consumption of processed meats containing nitrite preservatives

We’ll keep you posted on progress of the campaign. In the meantime, if you want generalised dietary guidance, whether for adults or children, that’s based on solid scientific and clinical evidence, please refer to the ANH Food4Health guidelines.

Given that your government won’t be telling your friends and contacts about their defective advice, do them a favour and forward this widely.