Official Eatwell Guide a disaster yet supporters refuse to discuss the obvious low carb alternative

By Jane Feinmann

Three events I have attended in the last month highlight the fact that the Government’s Eatwell Guide is not just clearly unhealthy but indefensibly so. The Guide, based on recommendations from the Scientific Advisory Committee on Nutrition (SACN)’s 2015 Carbohydrates and Health report, says starchy carbohydrates should make up nearly 50 per cent of our daily calorie intake, including for those with Type 2 diabetes (T2D) – a condition involving a chronic carbohydrate intolerance. The official line is that Eatwell is uncontroversial and unchallenged. The meetings I attended suggest this is not the case.

First up, the Guide came under scrutiny from the authoritative All Party Parliamentary Food & Health Forum on March 28.

The Forum had invited the charity, Diabetes UK’s Director of Research, Dr Elizabeth Robertson, to put the case for the Eatwell Guide. The other side was to be covered by Southport GP, Dr David Unwin. He is the Royal College of General Practitioners’ champion for collaborative care and support planning in obesity and diabetes, who has published research showing the benefits of advising those with T2D to eat a low carb diet.

So how did the debate go? Well it didn’t. Rather than an opportunity for their Lords and Ladyships to hear various options for handling the diabetic crisis, it turned into a one-man show. With the press release printed and just days to go before the event, Dr Robertson pulled out and Diabetes UK failed to offer another speaker.

T2D affects four million Brits who the charity is supposed to be helping. This no-show, not the first one by the charity, was probably a PR disaster for them. It clearly annoyed the members there to hear about an official policy and made it look as if the charity’s policy was indefensible.

Case for low carbs impressive, reports BMJ

The event, however, was a success for the low carb side. Dr Unwin spent the hour explaining the benefits for his patients, and for the NHS, of providing advice that contradicts the Eatwell Guide, among them a significant cut in the drug bill as blood glucose levels become more stable. As the BMJ reported Unwin made an impressive case for GPs to be allowed to keep some or all of the savings on T2D medication – in Dr Unwin’s case, around £38,000 for his practice compared to the average spend by other surgeries in his area, while achieving ‘a significantly better quality of diabetes control’ than they did.

Forum members, including Lord Rea, were clearly impressed. Will we soon see the House of Lords lobby for a fees structure to incentivise GPs who tell their T2D patients to ignore the Government’s dietary guidelines? It could well happen.

Just a week later, there was no mention of the Eatwell Guide at my second event, a meeting of NICE at its plush offices just off the Mall, to discuss an update of its 2012 guidelines for people at high risk of T2D. But the Guide was undoubtedly the starchy carb elephant in the room.

Diabetes Prevention Programme: not yet tested in UK

The purpose of the meeting was to compare the cost effectiveness of the new NHS Diabetes Prevention Programme (at £233 for at least 13 sessions providing advice on nutrition, i.e. the Eatwell Guide, plus exercise) with the cost of prescribing metformin, the gold standard diabetes medication that is currently prescribed for people who have pre-diabetes.  .

The results were not at all clear because even after years of a growing diabetes epidemic, the research to support this key plank of the government’s strategy hadn’t been properly done.

So NICE was forced to base its assessment of cost effectiveness on studies of US and Finnish versions of the programme, both of which are more intensive than the, frankly, watered down NHS version.

Secondly, and perhaps more significantly, the evidence-based benefits even of the intensive US and Finnish programmes are not impressive: telling people with pre-diabetes to take more exercise and reduce calories not surprisingly doesn’t work..

DPP not cost-effective for most people at risk of T2D

So as the public part of the meeting drew to a close, NICE was floundering. The only people for whom DPP can be clearly shown to be cost-effective, it appeared, were those under 40 – and then only if there was an assumption that this relatively brief, low cost intervention would bring about changes that would last a lifetime.

Of course that’s nonsense – as GPs on the committee pointed out. Yet the real scandal is that NICE appears to assume that the DPP is the only alternative to medication for people at risk of T2D. There was no mention of the low carb intervention, so wholeheartedly welcomed by an expert group the previous week at the other end of Whitehall.

And it’s not the only occasion that this has happened. In February, the Lancet published a Seminar on T2D outlining the impact of, and potential remedies for this global epidemic, currently affecting 415 million people. It thoroughly assesss the efficacy and safety of diabetic medication and includes a brief reference to very low calorie diets and bariatric surgery as alternatives but no makes no mention at all of low carb diets..

When I asked the lead author, Dr Sudesna Chatterjee of Leicester University’s Diabetes Research Centre, why low carb had been ignored she said the evidence showed that patients wouldn’t adhere to it. This statement, so frequently made, cannot continue unchallenged. A growing number of trials demonstrate the effectiveness and acceptability of a low carb diet when combined with a program of education.

Dr Unwin has published results from his practice in the BMJ on which I posted a report about for HealthInsightUK 18 months ago.

As he recently told the Lords Health and Food Forum, the diet resulted in weight loss, improvement in blood sugar control and a reduced need for medication. Last month an American study, published in JHR Diabetes, involving 262 patients with T2D obtained similar results (10.2196/diabetes.6981). The key finding of this trial, however, was that the crucial accompanying education program was equally effective when delivered in person or on-line.

Eatwell Guide dairy advice is challenged by The Dairy Council

A third recent meeting I attended gave some cause for hope that change is in sight. On April 5, the Dairy Council held a meeting for journalists to launch its monograph: ‘Dairy and Obesity: What the Science Says’. It wasn’t about T2D as such, but the analysis by leading scientists showed exactly how nutrient-rich dairy foods, notably butter, cheese and full fat milk and butter, are both highly protective of health and able to cut the risk of obesity for all ages.  

‘There are many potential mechanisms by which dairy can modulate fat balance and there is a good rationale for including dairy products in the diet to assist with fat loss whilst also maintaining lean body mass,’ explained leading researcher, Dr Javier Gonzalez of the University of Bath.  In other words, dietary fat doesn’t make you fat.

This was no political rally. It was a well-mannered, low-key event. But there was no doubting the serious intent of the Dairy Council in highlighting the sheer wrongness of what many see as the infamous Eatwell plate – where butter is shunned in favour of a ‘low fat’ spread and a sliver of cheese and mini tub of ‘low fat’ yoghurt, an option that looks pathetically small and unappealing compared to the glory of the starchy carb section.

‘Let’s start by telling people how many portions of dairy they should be eating every day in the same way as they are told how many portions of fruit and veg to eat,’ Dr Anne Mullen, Director of Nutrition at The Dairy Council told journalists.

She was speaking at the panel stage of the meeting and invited a comment from fellow-panelist, Dr Sheela Reddy, described by the Dairy Council’s programme as ‘formerly of the Department of Health, making her almost someone prepared to be publicly accountable for the Eatwell Guide. And surprisingly Dr Reddy agreed. ‘Yes’, she said. ‘I agree we need to tell the public how many portions of dairy they should eat every day.’

So why are the clear benefits of low carb being ignored?

Straws in the wind? On the one hand, there’s a huge interest in low carb. At the same time, important ongoing discussions that will decide policy for years are ignoring evidence that it could dramatically improve people’s health and save NHS funds.  Such willful blindness is not only unscientific; it is not hard to identify plausible and unedifying reasons. One, professional pride, is understandable. Admitting 40 years of advice was wrong is hard. Another is less forgivable. The links between the diabetes profession and the large food companies has already been described in detail here.

Dietitians often defend their position by saying that it’s excess calories and lack of exercise that make you put on the weight that can lead to diabetes. This is a claim that chimes perfectly with the line taken by food and drink companies. Research published earlier this month in the BMJ found that: ‘Industry money was used to covertly influence journalists with the message that exercise is a bigger problem than sugar consumption in the obesity epidemic’. (BMJ 2017;357:j1638  It’s this advice that many believe has led to the current epidemic of both obesity and T2D.

Now is a time when openness about the evidence base on diet and health is essential

A review of the evidence on saturated fat and health by the government advisory committee SACN is due to appear sometime this year, which perhaps explains the timing of the Dairy Council’s latest monograph. It was one of the scandals of SACN’s carbohydrate and health report two years ago that the Committee refused to consider evidence on fat as an alternative to carbohydrate.

This new SACN report should lead to major shift in UK’s nutritional advice. A new Eatwell Guide might, for instance, encourage the population to consume a minimum of five (or even between five and ten?) portions of healthy dairy daily – instead of a Plate that gives the impression that nutritious dairy food is something best avoided.

Above all it’s time for public debate. Those who are in position to provide influential advice to people with T2D or pre-diabetes must be prepared to discuss their policy publicly. They cannot be allowed to carry on hiding behind cancelled appearances in order to keep the lid on such a critical debate.

Jane Feinmann

Jane Feinmann

Jane Feinmann is an award-winning medical journalist with a special interest in investigating safe and effective healthcare. She belongs to Imperial College Health Partners’ Patient Safety Champion Network. Her website is janefeinmann.com.

30 Comments

  • This is just an advertisement for dairy. Every meeting, every study funded by the Dairy Council.

    How can you claim to be honestly investigating.

    How about some unbiased information Jane Feinmann.

    • Ah yes, John McDougall ‘unbiased’ – a bit like calling Trump or BoJo ‘diplomatic’.

      • Ah yes, John McDougall ‘unbiased’ – a bit like calling Trump or BoJo ‘diplomatic’.

        One liners are not my forte, Kevin, so truly I admire a well placed and succinct put-down packaged in a single sentence when I see one.

        Another thing I have come to admire is people willing to post comments under their full name (or at least forename and surname together). Almost invariably they talk more sense, are less fixated, show more humility, are more willing to learn, and seem less troubled by insecurities, in general, than people who cast bigger veils over their identity through the use of ‘lesser’ names or pseudonyms. Naturally exceptions can, and do, arise.

        • I really hope that Jerome Burne will devote some time to discussing the above video. My instinct is that deprecating traditional foods, such as milk (setting aside the issue of use of growth hormones), is not good advice.

          I’d love to hear the other side of this argument – is milk really sufficiently acidic to pose a threat to bones? The reason that Parmesan cheese is very acidic (mentioned in the video) is obviously that it contains quite a lot of free fatty acids of small molecular weight – but I mean is vinegar dangerous for the same reason?

          • The alkalising diet may be a slippery and wriggly concept, David, and its’ supposed evidential basis is a matter of contention [1]. My view on it is a work in progress; I have yet to finalize my mind. The stage I am at is that I am inclined to think that it shines a light upon some important questions pertaining to biophysics – but does so from the wrong angle.

            The notion of alkalising foods can be a bit misleading. It is not the pH of the food that is the prime concern, instead it is the effect upon the body after the food has been digested, the food reduced to metabolites, and those metabolites metabolised. The queer thing here is that certain foods that we would say are acidic can have an alkalising effect upon the body.

            In order to establish whether a food is alkalising or not persons wearing white lab coats and wrap around spectacles burn foods, gather the ash, and then measure the pH of the ash. Burning you see is regarded as surrogate method to replicate the business of metabolism. Nullis in verba, are the watchwords at the Royal Society; is ‘burning’ a sound surrogate means to replicate the effects of metabolism? [Dunno. D'you?]

            Anyway never mind the somewhat confusing affair that a food that is actually acidic can actually have an alkalising effect I think I think the alkalising diet is a primitive concept that could be improved for shining a light upon the same question (the pH balance of blood) but from the angle of oxidation stress, oxidative stress, and antioxidants. And just to confound matters there may be a profound source of antioxidants which has hitherto been overlooked. This overlooked source may amount to a lack of understanding that is a confounding factor in the reasoning behind the alkalising diet and any promoting of it.

            The above is not to suggest the alkalising diet is complete baloney, I think there may be some merits to the idea, but those merits may be enhanced by dressing ‘em up slightly differently and describing them differently.

            More to come, maybe. . . . I need two tumblers, some vinegar, a couple of make-shift electrodes, a voltmeter, and some-data, before I report back. Thanks for the nudge, David. ‘Had it in mind to do this for several weeks and never got around . . .

            1, https://en.wikipedia.org/wiki/Alkaline_diet

    • Where inflammation is concerned, diary seems to be less of a problem than lean meat. How so? Because dairy contains less arachidonic acid (AA) than meat and beef contains less AA than pork and poultry. For example:

      The highest level of AA in lean meat was in duck (99 mg/100 g), whereas pork fat had the highest concentration for the visible fats (180 mg/100 g). The lean portions of beef and lamb contained the higher levels of n-3 polyunsaturated fatty acids (PUFA) compared with white meats which were high in AA and low in n-3 PUFA. The present data indicate that the visible meat fat can make a contribution to dietary intake of AA, particularly for consumers with high intakes of fat from pork or poultry meat. https://www.ncbi.nlm.nih.gov/pubmed/9590632

    • Matthew, please grow up. Posting videos that you happen to like isn’t any form of argument or contribution.

      Are we supposed to just watch and believe these evangelical vegetarians, as you’ve clearly done? The same people who tell us that every disease known to man is caused by eating meat or animal products. Your friends even tell us that type 2 diabetes is caused by eating meat. According to these propogandists, out of control blood glucose isn’t caused by eating excessive glucose (carbohydrates). In the last thirty years as diabetes has risen nine-fold, meat consumption has fallen, but facts are inconvenient and posting propoganda videos is easy.

    • We would not have evolved the ability to digest milk if there were no evolutionary advantage to it. If we have the mutated gene that allows it, then it is crazy not to take advantage of the high quality nutrition it provides. Can you make a compelling case for cereal grains? The food that takes out more than it puts in?

  • Dr Elizabeth Robertson clearly didn’t feel like defending the indefensible in front of an informed audience. Diabetes UK’s credibility is seeping away and it’s now an obstacle to helping people with this terrible but preventable disease.

    This resistance to change is what you get when you involve the food industry in ‘helping’ to produce SACN guidelines. No wonder people get ever more sceptical about official advice. Got a problem with high blood glucose? Well, eat more glucose and take drugs. It’s good advice if you have shares in junk food or pharma.

    These Lords and ladies need to be having a meeting with the Prime Minister, a diabetic herself.

  • Thank you for sharing these insights. As a practicing nutritional therapist I find it hard to understand what goes on inside these committees. How can they be so unaware of the building evidence for a higher fat lower carb diet? People on the Eatwell diet get sicker year on year, switch them to a low carb nutrient dense diet and they visibly improve within weeks with blood results to match. There’s no problem ‘sticking to it’: clients are delighted to eat foods that they haven’t eaten without guilt for decades. It’s a win-win.

    • Explain how this recipe on your website is fundamentally different from what you see in the chart on the Eatwell guide.

      https://dinnerwithdawn.com/2017/03/04/warm-salads-the-easy-way-to-ten-a-day/

      http://www.nhs.uk/Livewell/Goodfood/Pages/the-eatwell-guide.aspx

      • Well, Matthew, it’s free from grains and starches which knocks out the yellow part (38%) of the plate. Higher in both protein and fat than the Eatwell Guide recommends and packed with more vegetables and less fruit than the eat well guide suggests for balance. It also avoids the higher carb options (grapes, bananas) on the green side of the plate. Overall the macronutrient balance is tipped strongly towards fats and protein and the glycemic load (for want of a better short phrase) of this meal is significantly different from the Eatwell Guide.

        • Again, but you seem to have missed out in your template section for the salad,

          ‘beluga lentils, butter beans, chickpeas, broad beans or peas, warm or cold. Quinoa and sweetcorn work too.’

          Now if you are a Bant qualified nutritionist are they not starches.

        • Your salad is pretty much the entire Eat Well guide on a plate.
          You forgot the wafer-thin mint on top to finish it off.

          Mr Creosote would be very appy with it.
          https://www.youtube.com/watch?v=aczPDGC3f8U

          “Thats’ great. Ay! Are you about a size 14?“

    • Q: “How can they be so unaware of the building evidence for a higher fat lower carb diet?”
      A: they can’t. The real reason is massive financial pressure from Big Ag and Big Pharm.

      What would happen to the wheat,sugar, and pharmaceutical industries if the truth were known? How much do they contribute to political funds? Cui bono?

  • Now you’d be telling the whole truth (after all it is Good Friday) Stephen T, if you included all the food industry alongside that medical industry.

    Dr Harcombe also claims the guidelines are bad as they promote industry not public health, but then hypocritically supports all meat, dairy, eggs, fish, oil, lard etc

    http://www.huffingtonpost.co.uk/entry/eatwell-guide-criticism-dr-zoe-harcombe_uk_575ecbb3e4b014b4f25432d9

    The National Obesity Forum are in cahoots with all of it as explained here.
    http://www.youtube.com/watch?v=eE0gfHTTkHE&t=7m34s

    https://www.biblegateway.com/passage/?search=John+8:32

    Here is that truth.
    https://www.drmcdougall.com/misc/2012nl/oct/mcgovern.htm

    • It is no accident that Dr John McDougall has an entry in the Encyclopedia of Diet Fads.

    • 10 companies control almost every large food and beverage brand in the world.

      These companies — Nestlé, PepsiCo, Coca-Cola, Unilever, Danone, General Mills, Kellogg’s, Mars, Associated British Foods, and Mondelez — each employ thousands and make billions of dollars in revenue every year.

      http://www.independent.co.uk/life-style/companies-control-everything-you-buy-kelloggs-nestle-unilever-a7666731.html

      I’m am not at all sure what Good Friday has to do with ‘truth’. Matthew. Just how confused are you?

      As for John; 8:32: . . . . Erm, well, ahem, there are another 1439 minutes in every day.

    • Matthew, once agin you don’t deal with the points I make, but just post more propoganda. It makes you look credulous and immature. It adds nothing and harms whatever argument you’re struggling to make. Watching this stuff is like being in North Korean and listening to the ‘Great Leader’.

      We’ve been eating meat, dairy, eggs, fish and lard since we evolved. Zoe Harcombe believes these natural, unprocessed foods are healthy and increasing numbers in the medical world agree with her. She produces evidence and that’s a lot more impressive than wasting people’s time with worthless attachments.

  • I am tempted to try to reduce starches in my diet. So, perhaps, a couple of my favourite potato dishes will survive, but no more routine mashed or boiled potatoes. Crisps will be allowed occasionally. Much less bread but still some walnut bread and oatcakes. No sweetcorn as a vegetable; seasonal corn-on-the-cob from the garden still to be enjoyed. Rice to be reserved for accompanying Asian food.

    Is such moderation likely to do good?

    • Editorial

      Matthew I’m puzzled as to where you are coming from. It seems to me, forgive me if I’m wrong, that you have convinced yourself that there is only one way to eat – the McDougal way, which is very keen on carbs and, as the establishment has been doing for 50 years, demonises saturate fat especially from animals. What’s more you have taken upon yourself to harass and challenge anyone who strays from this one true dietary faith.

      You have done this in a way that has often been hostile and insulting. A little while ago you claimed that one contributor who had posted a detailed and carefully researched article about the role of carbohydrates and blood sugar levels in cancer was killing people, without a shred of evidence. Last week you implied that the author of another careful and thorough report on the confused response of the dietary establishment to the low carb challenge was simply regurgitating Dairy Council propaganda.This was demonstrably wrong. In neither case did you show any understanding of the points they were making nor the evidence for them.

      This blog was set up with the aim of encouraging debate and discussion around the the largely ignored (in practice) potential for lifestyle changes to prevent and treat chronic lifestyle disorders. See the statement at the top of the opening page. One of the areas we have concentrated on is the benefits of the low carb diet, not because anyone here holds it as an article of faith nor because no other dietary approach could possibly have any benefit, but because there is growing evidence of its benefit in a surprisingly wide range of medical areas and because it has been shamefully ignored by establishment dietitians.

      Anyone one who knows anything about nutrition knows it is an imprecise science – not really amenable to RCTS, relying on observational data, heavily influenced by commercial interests and so on. The idea that your guru McDougal has some some kind of lock on the truth – you have claimed his position is “irrefutable” – puts a big question mark over your grip on nutrition. Despite the uncertainties there have been some remarkable developments with the low carb approach such as the benefits reported by literally tens of thousands of people with diabetes and fascinating discoveries about its impact on the metabolic changes underlying the rising tide of chronic disorders.

      There are plenty of areas of uncertainty such as the interaction with very low calorie diets or the amount of fruit and vegetables necessary to maintain a healthy microbiome. But you seem, again apologies if I’ve got it wrong, uninterested in any of this. Instead you prefer to issue challenges on minor points – do you dare debate the issue with my guru, a diet recommended here is similar to one on the EatWell plate. You have just had a very informed and polite explanation on precisely how that diet does differ significantly from the EatWell plate. I expect you to ignore it and skip on to a fresh challenge.

      You have every right to believe wholeheartedly in the low fat Eatwell plate school but please stop putting this blog up as a kind of rival sect and endlessly attempt to point out heretical views.

      • Well said.

        Matthew has found his Great Leader McDougall and reacts with disbelief and accusations when people are unimpressed by his leader’s views. His response to any discussion or contribution is to attack and then attach videos from McDougall. He doesn’t understand that this approach convinces no one and quickly turns off people from ‘veg’ science, as my vegetarian friends call it. He’s bad mannered, gullible and immature. Sect members like him tolerate no debate and merely wish to crush or abuse those who want to look at evidence and who remain unconvinced by his shrill and rather desperate entries. Enough is enough.

        • Four excellent links above of info that you have completely ignored, including The Lancet Stephen T.

          You even ignored the research from this esteemed bunch of people
          https://www.drmcdougall.com/wp/wp-content/uploads/Carbohydrate-and-Human-Evolution.pdf

          It answered your question “what do you think our pre-agriculture ancestors were eating? Again, ‘Cooked Starch’ Stephen T!

          Try harder.

          • Matthew, once again you don’t deal with points raised but add more ‘thoughts’ from McDougall. You esteem him, but that’s a view held only in parts of your sect.

            You’ve so completely bought into the thoughts of the Great Leader that you cannot accept that others honestly hold different views. You constantly state or imply dishonesty about people who hold views that are much more common and better respected than yours. When not implying dishonesty you state or imply that people are being paid to promote meat, fish, eggs and other ancient foods.

            So, all that archaeology and anthropology that finds a mass of animal bones and animal protein in ancient food is wrong. We just let the animals walk on by and ate cooked starch instead.

            Comments such as “try harder” are for children on Facebook. Once again it shows the lack of respect you show to people who haven’t joined your sect and prefer evidence to cooked starch.

      • Perhaps a little active moderation of the comments here would help. When people start to harass others, I don’t think it is unreasonable to exclude them from the debate.

  • The problem is bigger than just diabetes. If the Eatwell guide is cr*p for diabetes, it is cr*p for everyone. The Eatwell guide could be designed to create diabetes. It is as corrupted by big business as the so-called “climate science” crowd are.

    Never in my 64 years did I ever expect to have to consider that I should have to do exactly the opposite from what was proposed by government “scientists”. My health has vastly improved by ignoring medical advise and doing the opposite.

    • I almost agree, Brian,

      But the strange thing is that there are whole cultures that are based on eating rice. The starch breaks down into 100% glucose, so it totally makes sense for diabetics not to eat carbs, but how do those cultures survive?

      I wonder if sucrose is different because it breaks down into 50% fructose.

  • “The official line is that Eatwell is uncontroversial and unchallenged”.

    Well, apart from scientists and conscientious doctors.

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