Author Archives: Bill Shrapnel

Catalyst: was the ABC enlisted to sell palm oil?

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The cholesterol controversy featured on the ABC’s Catalyst program had nothing to do with science – it appears to have been designed to sell palm oil. Was the Catalyst team naive or complicit?

ABC television’s science program Catalyst recently ran two programs purporting to expose the myths about cholesterol and cardiovascular disease. In the first program the role of saturated fat in increasing risk was challenged and in the second the efficacy of statin medication for lowering coronary risk was put under the spotlight.

The programs provoked a storm of controversy, even within the ABC, because of their bias and potential to mislead. The ABC’s own health reporter Dr Norman Swan was irate, declaring on Radio National that “People will die as a result of the Catalyst program …”. Swan also conducted an excellent interview with Professor Peter Clifton on The Health Report as a means of countering the mischief caused by his colleagues at Catalyst. It’s well worth a listen.

Catalyst used to be a respected, evidence-based science program. How did it come to this?

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Making a mess of obesity prevention

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Public health advocates have consistently failed to get substantial Government support for their initiatives to tackle the obesity epidemic. And they only have themselves to blame.

Last week on ABC radio’s AM current affairs program the former chair of the National Preventative Health Taskforce lamented that the Government had failed to address obesity. In 2009, the Taskforce released a report titled Obesity in Australia: a need for urgent action which was supposed to be the springboard for Government action on the issue. Instead, the report was tossed onto a large pile of obesity reports and recommendations that have been ignored by our politicians.

What went wrong? Why did the then Government, which was favourably disposed to public health and disease prevention, fail to act? My guess is that it was the appalling quality of the report.

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Jim Mann on carbohydrate quality

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“The problem is that many dietitians around the world are telling people to have wholegrain bread when most wholegrain bread is roughly comparable to eating a bag of glucose.”

Last month Professor Jim Mann** addressed the annual conference of the European Association for the Study of Diabetes (EASD) in Barcelona on the controversial topic of carbohydrate quality. Although he was mainly talking about carbohydrates in the diets of people with diabetes, what’s good for this group is good for most of us.

Sugar

Given the current hysteria about sugar it was interesting that Professor Mann had little to say about it. He indicated that the current EASD recommendation for the general population i.e. that total free sugars be limited to 10% of energy, was appropriate and was likely to be retained when new EASD guidelines are released. He had a lot more to say about starch.

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The decline of breakfast

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Fifteen percent of Australian children head off to school without having had any breakfast and the figure is rising. Among secondary school students it’s closer to 20 percent. What are the implications and what should nutritionists do?

The CensusAtSchool survey

CensusAtSchool is an annual nationwide survey of students’ everyday lives, experiences, opinions and interests conducted by the Australian Bureau of Statistics. Participation is voluntary so the data produced are not necessarily representative of the whole school population, just those who completed questionnaires. Nevertheless, the findings provide insight into the trends, habits, attitudes and lifestyles of Australian students.

According to the latest survey of nearly 24,000 children, about 15 percent do not consume breakfast and the figure has been rising in recent years. There is considerable variation in breakfast skipping across Australia, from 12 percent of Victorian school children to over 22 percent in the Northern Territory.

Earlier reports from the same survey have highlighted how breakfast consumption declines as children get older. Typically about 7-8 percent of primary school children skip breakfast but the figure rises to about 20 percent for children at secondary school.

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Weight loss does not lower cardiovascular risk in people with diabetes

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Surely lowering body weight and maintaining it for 11 years will prevent heart disease and strokes in overweight people with diabetes. Apparently not, according to the findings of a much anticipated trial.

The Look AHEAD Study

People with type 2 diabetes have increased risk for cardiovascular disease. As overweight is often associated with cardiovascular risk factors it has always been assumed that excess body weight contributes to the burden of cardiovascular disease and that weight loss would lower it.

The Look AHEAD Study was conceived to test this hypothesis. This large, multi-centre, randomised controlled trial began 11 years ago in the United States. Over 5000 overweight men and women with type 2 diabetes were recruited – half received active weight loss intervention and the control group received a general program of support and education. The intervention group successfully lost weight. After one year they had lost nearly nine per cent of their initial body weight and at 11 years their average weight was still about five per cent less than baseline.

Over the years the good news started to flow from the Look AHEAD Study. A string of papers showed that weight loss in the intervention group was linked to improvements in fitness, mobility, blood glucose, sleep apnea, urinary incontinence, symptoms of depression, blood clotting and body image. And use of medications was reduced. All very positive, but the real test was yet to come: would weight loss lower rates of cardiovascular disease?

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Old nutrition, new nutrition

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It’s always difficult to capture in a few words the changing state of modern nutrition, the implications of new scientific findings, the wisdom of calls for change to dietary advice and the conservative response. Yet Professor Jennie Brand-Miller from the University of Sydney managed to do it at a recent food labelling conference in a presentation titled ‘Old nutrition, new nutrition’.

Old nutrition

Brand-Miller began by stating: The old nutrition goes like this ….

  • Foods can be dissected into macronutrients
  • Saturated fat is the main dietary risk factor for cardiovascular disease
  • A low fat diet is best for prevention of obesity, diabetes and cardiovascular disease
  • “Eat a diet that is low in fat and high in complex carbohydrate”
  • “Eat plenty of cereals, breads, rice, pasta and noodles, preferably wholegrain”

And then she took old nutrition apart, highlighting how the nutrition landscape had changed over the past decade or so:

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Gluten-free diets: who’s spreading the bulldust?

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Gluten-free diets are good for people with coeliac disease but nobody else, yet going gluten-free has become a major international food trend driven along by celebrity endorsement. Hocus-pocus like this doesn’t just happen; it’s sophisticated food marketing on a global scale.

Coeliac disease

All dietitians and nutritionists are familiar with coeliac disease – the gastrointestinal disorder suffered by about one percent of the population. It’s due to an inflammatory response to gluten, a protein found in wheat, rye and barley, which damages the gut wall resulting in malabsorption of nutrients leading to gas, distension, diarrhoea and weight loss. Adopting a gluten-free diet provides great benefits to those with coeliac disease but it has long been thought that such a diet offers no benefit to people without the condition.

What about gluten sensitivity?

More recently, a hypothesis has emerged that there is a spectrum of reactions to gluten with full-blown coeliac disease at one end and mildly irritable bowel at the other. The term gluten sensitivity has been coined to describe the “no man’s land” in the middle. If it’s true, millions of people could be affected. But gluten sensitivity is almost impossible to diagnose as the gut wall is not damaged and there is no diagnostic biomarker. So, if you have tummy troubles and they seem improve when you go on a gluten free diet, well, maybe, perhaps you have gluten sensitivity.

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Salt debate hots up

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Arguments over salt and health have broken out on both sides of the Atlantic, with dissenting opinions among individual experts and even professional societies. What’s going on?

New IOM report

The latest round of the salt controversy was triggered by the Institute of Medicine (IOM) in the United States, a very conservative and scientific organisation. Their latest report had two key messages, the first confirming the positive association between high sodium intakes, high blood pressure and the risk for heart disease. No drama there. The contentious finding was that there was not a strong scientific case for shifting from moderate to low salt intake.

Just to get your bearings, a high sodium intake is considered to be about 5000 mg/day – the average intake in China. Intakes in many western countries are moderate by comparison, about 3300-3700 mg/day. However, the upper limit of sodium intake recommended in Australia’s Nutrient Reference Values is only 2300mg/day, the same figure recommended in the Dietary Guidelines for Americans. Just last week the European Society of Hypertension and the European Society of Cardiology published new guidelines for the management of hypertension, recommending sodium intakes in the range of approximately 2000-2300 mg/day. The American Heart Association goes even further, recommending just 1500 mg/day.

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Debunking the paleo diet

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Paleo diets are the flavour of the month. Their premise is that our hunter-gatherer genes are out of kilter with our modern agriculture-driven diet and this disconnect is making us all sick. Adopting the diet of our ancestors is considered to be the pathway to health. Sounds plausible enough, yet critics say it’s based on false assumptions.

What are paleo diets?

Although paleo diets come in several guises they are all based on a similar theme. Throughout most of our time on planet Earth humans were hunter-gatherers eating game meats and wild plant foods and this shaped our genetic make-up. The development of agriculture during the last 10,000 years radically changed the human diet yet, as human evolution is slow, we have essentially retained our ancient genes. The mismatch between new diet and old genes is the root cause of high rates of obesity and other chronic diseases in the modern era.

The proposed solution is to eat like a caveman. Modern day paleo diets rely on meat, fish and seafood as staple foods. Fresh fruits and vegetables, nuts and seeds, eggs and healthful oils are all recommended. Sugar and many processed foods are restricted, though paleo diets also restrict grains, legumes, potatoes and dairy foods, which are fixtures in many healthy eating guides. The argument goes that these foods were all recently introduced into the human diet and are deleterious to health.

That’s the theory but critics of paleo diets are now coming out in force.

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Coconut oil: health or hype?

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Coconut oil is not usually recommended in healthy diets because of its high saturated fat content yet the media is awash with reports about the wonderful health benefits of coconut oil. Is this new science or marketing hype?

Among vegetable oils, coconut oil is one of the richest in saturated fat – about 86-87% of all its fatty acids are saturated. Given the latest advice to replace saturated fat with unsaturated fat it would appear that coconut oil is the last vegetable oil a credible nutritionist would recommend. Wouldn’t all that saturated fat just raise blood cholesterol and increase heart disease risk?

The case for coconut oil

Coconut oil advocates argue that not all saturated fat is the same and that the health effects of coconut oil are better than might be expected. It is true that saturated fat is not a single entity – it’s a collection of different saturated fatty acids, each with its own effect on blood lipids. Medium-chain length saturated fatty acids (6-10 carbons) appear to have little effect, whereas the longer-chain saturated fatty acids (12-16 carbons) all raise total blood cholesterol. Stearic acid, which has 18 carbons, is cholesterol neutral but continues to be treated with suspicion (see below).

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