Again, the focus of the ABC story was a former economist who gave up sugar and lost weight. Yes, I know, anecdotal evidence. And yes, if he had given up fat he would have lost weight too, or starch or alcohol. Cutting down on calories does induce weight loss. However, the man’s personal experience was with sugar and having been enlightened he apparently embarked on a mission to rid the Australian diet of the root of all evil.

But he had a problem: Australia’s leading expert on carbohydrates and health, Professor Jennie Brand-Miller from the University of Sydney, was not overly concerned about sugar. Her view was that health effects of carbohydrate-rich foods were related to their blood sugar-raising potential or glycaemic index. Viewed through this perspective, foods rich in refined starch, which strongly raise blood glucose, may be just as bad, or even worse, than foods rich in sugar. Despite considerable scientific support such permissive views on sugar could not be tolerated so a kind of fatwa was issued: Brand-Miller had to be beheaded, in a profession sense. And the ABC and the economist have been after her ever since.

Again, the latest program examined a paper written by Brand-Miller and Dr Alan Barclay called the Australian Paradox in which these authors observed that while obesity rates in Australia have climbed in recent decades, sugar consumption appears to have fallen. But why trawl through this paper again now? For goodness sake, it was published five years ago.

Journalistic deception

Had the public interest been Lateline’s key concern, the producer might have asked a simple question: have any new studies been published that might inform the issue? As it turns out, new studies have been published that relate to all three lines of evidence that Brand-Miller and Barclay relied on in their paper – national dietary surveys, apparent consumption of sugar data and soft drink sales. The results of all three of these new studies are consistent with a fall in per capita sugar consumption in recent decades.

I am very familiar with the two peer-reviewed papers as I co-authored them. If the ABC had been interested in presenting a balanced story they could have given me a ring, but no such luck. They know I exist because Lateline flashed my photo up on the screen on Tuesday night. And at least one of their senior journalists, who featured on the Lateline program, is familiar with the recent soft drink data because I sent it to her the last time the ABC was intent on misleading the general public about sugar. Unfortunately, the data were withheld from the general public on that occasion, as they were this time around.

There is a name for the practice of deliberately withholding information so as to promote a view that a journalist knows to be incorrect. It’s called journalistic deception.

What about the ABS?

If the ABC didn’t want to talk to me at least they could have interviewed someone from the Australian Bureau of Statistics (ABS) which conducted the latest national dietary survey. The top line results from this study indicate a fall in the intake of total sugars since the 1995 survey, though better insight is on the way. The ABS has been busily analysing their data in depth, teasing out ‘added sugar’ from naturally-occurring sugar, and the results are due out in a fortnight.

Why didn’t the ABC interview the ABS? Or just wait a couple of weeks for the release of the in-depth analysis? Why construct a story with stale, 5-year old news that had been covered before when a real story, backed by strong new evidence, will present itself in a couple of weeks? Maybe Lateline got wind of the results.

Furious agreement

In lieu of balance, Lateline interviewed six experts who all agreed with one another – shades of the infamous Catalyst programs on cholesterol. The Australian nutritionists interviewed essentially argued that they just don’t believe the available data on sugar intake. They couldn’t highlight any other sugar consumption studies, it was just a case of ‘spare me the evidence; my mind is made up.’ Such is the parlous state of public health nutrition in Australia that some of its senior players are prepared to advocate policy based on denial of the scientific evidence.

Tellingly, the two authors of the Paradox paper, the editor of the nutrition journal that published it, the professor from the University of New South Wales who reviewed the complaint about the Paradox paper and the Vice Chancellor of the University of Sydney all declined to be interviewed by Lateline. It would appear that the ABC’s reputation for bad nutrition stories had preceded it.

What are the motives?

I suspect those who pitched the story to the ABC were intent on discrediting Brand-Miller and Barclay one more time before the release of the comprehensive ABS analysis of sugar in the Australian diet. These new data will find their way into the updated version of the Australian Paradox paper, which was required as part of the review of the complaint against its authors. With all key lines of evidence likely to show no parallel between sugar intake and obesity trends it would appear that Brand-Miller and Barclay’s argument will prevail. The media strategy seems to have been to hit them while they are still vulnerable.

But why would Lateline accept such a poisonous pitch? What’s in it for the ABC? Surely there is not much journalistic kudos to be gained from recycling old stories.

My guess is that the ABC shares the interest in ‘food politics’ of many of the more radical public health nutritionists, with its strong anti-corporate sentiment. This requires that the food industry be attacked at every available opportunity – sugar being the current weapon of choice. No doubt the next objective is the imposition of a tax on sugar-sweetened beverages but if this particular battle is to be won sugar has to be seen as a BIG health issue, even though it isn’t. The public relations people call this ‘perception management’.

Personally, I would have thought that the ABC’s role was to report on food politics rather than engage in it.

Disclaimer:
This article reflects my personal views. It was not commissioned or paid for by anyone.

In the United States, the Food and Drug Administration recently announced that partially hydrogenated oils (containing trans fats) were no longer ‘Generally Regarded as Safe’ and gave the fats and oils industry three years to get them out of the food supply. So, begrudgingly, the US industry will be forced to adopt a position that companies in the rest of the developed world adopted 20 years ago.

A brief history of trans fats

Health reviews of trans fats conducted in the 1970s and 1980s found little to be concerned about. The food-health relationship considered important at the time was the effect on the level of total cholesterol in the blood and trans fats seemed to be okay – the effect was similar to that of olive oil.

This all changed in 1990 when researchers broadened their investigations to consider the effects of trans fats on LDL-cholesterol and HDL-cholesterol. Unlike any other class of fatty acids, trans fats raised the ‘bad’ LDL-cholesterol and lowered the ‘good’ HDL-cholesterol – a double negative effect. Trans fats had a worse effect on blood lipids than any other fat or carbohydrate.

Soon afterwards researchers at Harvard found trans fats to be associated with increased risk for coronary heart disease in their large population studies. In Australia, both the National Health and Medical Research Council (1992) and the Heart Foundation (1994) flagged a potential problem with trans fats.

The industry response

To their credit, major fats and oils companies in Europe, the United Kingdom and Australia didn’t wait for their governments to tell them what to do. These companies were abreast of the science, took the initiative, made the necessary investment and began to remove trans fats from their products. In Australia, the process to remove trans fats from margarines began in 1995 and by 1998 almost all of the top brands of margarine in the country were virtually free of trans fats. During the 2000s a second wave of trans fat reduction ensued as major food companies combed through their ingredients lists tracking down any sources of trans fat. As a consequence trans fats now comprise just 0.5% of the calories in the Australian diet, most of which comes from dairy fat and meat fat. This is well below the maximum intake recommended by the World Health Organisation (1.0% of calories).

In Denmark, the trans fat content of the diet has fallen about 85% since the 1970s. Sometimes this fall is wrongly attributed to a regulation imposing a limit on the content of trans fats in food ingredients, which was introduced in Denmark in 2003. By far the majority of the fall in the trans fat content of the Danish diet occurred prior to 2000 as the fats and oils companies fulfilled their social responsibility. Interestingly, the trans fat content of the Danish and Australian diets, one subject to regulation of trans fats and one unregulated, are similar. The Danish diet is actually a little higher, presumably due to the Danes’ love of dairy products.

Ignoring all this, fats and oils companies in the United States maintained their love affair with trans fats. This is hard to comprehend as much of the observational data showing that trans fats were a problem was being generated in United States by American researchers. What were these companies thinking? So, two decades on and many premature deaths from coronary heart disease later, the FDA has had to step in and force the industry’s hand.

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Butter: an interesting anomaly

While the FDA will now expect manufacturers of coffee creamers, crackers, biscuits, cakes and stick margarines to virtually eliminate trans fats from their products there remains an interesting anomaly – butter. The FDA’s consumer information sheet on trans fats states in big letters ‘Selecting foods with even small amounts of trans fat can add up to a significant intake’. Butter has about 3-5% of its fatty acids and therefore 3-5% of its calories as trans fats. Once partially hydrogenated oils are removed from the food supply butter becomes one of the richest sources of trans fats.

The dairy industry likes to tell us that these trans fats are ‘natural’ and therefore not a problem. But the facts of the matter are that at least 10 of the trans fats in butter are the same as those found in partially hydrogenated oils. Not surprisingly, dairy trans fats have similar adverse effects on blood lipids to those in partially hydrogenated oils. Butter is actually made of partially hydrogenated oils – cows eat lots of unsaturated fats from grass and seeds; these fats are then partially hydrogenated in the rumen of the cow to yield lots of saturated fat plus some trans fats, which end up in the meat and milk of the cow. Although this bio-hydrogenation may be considered ‘natural’ its consequences are not good and no amount of public relations spin can make it so.

So will butter’s ‘Generally Regarded as Safe’ status be withdrawn by the FDA in the near future? Not likely. The dairy lobby is the best in the business. But what will the regulators do when biscuit manufacturers replace their current baking fats (with trans fats) with butter (with trans fats)?

The good news for the Australian public is that current advice to replace saturated fats like dairy and meat fat with unsaturated fats is also the best advice for further lowering trans fat intake.

On 24 and 31 October 2013, ABC television’s Catalyst program aired a two-part series that questioned the link between blood cholesterol and heart disease, and whether current dietary advice or statin medication was effective in lowering heart disease risk. Although the first program on diet was very biased Catalyst may have got away with it as the science around diet and heart disease is considered rather ‘soft’ and is still unfolding.

However, the second program on statins, cholesterol and heart disease was on very firm scientific ground. The last time I looked there were 24 meta-analyses on statin medication and heart disease risk and all showed benefit. But rather than present this perspective Catalyst decided that the public interest would be better served by sowing seeds of doubt.

There were howls of protest. To their credit, other journalists at the ABC took aim at Catalyst. Media Watch presenter Paul Barry said … Catalyst struck us as sensationalist and grossly unbalanced; and some of their so-called ‘experts’ had questionable qualifications.

The ABC’s health guru Dr Norman Swan considered the health implications saying that People will die as a result of the Catalyst program …. It doesn’t get much stronger than that. Was Swan going over the top, or did he just have a good understanding of his subject?

New University of Sydney study

A new study led by researchers at the University of Sydney’s Faculty of Pharmacy has provided some answers. The purpose of the study was to quantify any changes in the dispensing of statins after the airing of the Catalyst program in October 2013. The researchers found significant and sustained changes in statin dispensing following the airing of the program, 60,897 Australians having been affected up to 30 June 2014.

In relation to the health implications the researchers had the following to say:

If the 60,897 individuals we estimated to have been affected continue to be non-adherent, this could result in between 1522 and 2900 preventable, and potentially fatal, major vascular events.

So, unless the situation can be reversed a couple of thousand preventable heart attacks or strokes may occur as a direct result of the Catalyst program. It’s impossible to say how many of these events will be fatal so we can’t accurately answer the question posed at the top of this post. But it would appear that Norman Swan did indeed know what he was talking about when he made the claim that People will die.

Spare a thought for the poor souls working in the ABC’s legal section. Just imagine the litigation to come.

How did the ABC let it happen?

Although current affairs programs on commercial television often present shock-horror health stories, the community expects more from the ABC, especially from its science program. No doubt the credibility of both the ABC and Catalyst led to the high ratings and high impact of the cholesterol programs – people thought it was true. Yet these two programs would have to rate as the most irresponsible and dangerous piece of health journalism ever aired in Australia. Has any other single act of journalism ever put the health and lives of so many people at risk?

What is unclear, however, is why these programs ever saw the light of day? Who pitched the idea to Catalyst? Why would any producer of a reputable science program take it on? Why was the program’s research so bad and so one-sided? Who chose the dodgy ‘experts’ to mount the non-science argument? Why didn’t the ABC’s internal systems start flashing red lights before the program went to air?

The offending Catalyst programs have been removed from the internet so no more damage can be done. How the producer of the cholesterol programs managed to keep her job at Catalyst is a mystery? Wasn’t the casualty rate high enough?

In the meantime the next chapter in the cholesterol story is about to unfold. I’ll cover it in my next post.

That’s an interesting claim but is it true?

Actually, it’s a strange measure to have chosen as it is almost impossible to verify. Most countries in the world simply don’t have good dietary data on teenagers, or adults for that matter. Let’s look at the available data and consider whether the claim is close to being right.

Any global average for sugar intake will be greatly influenced by typical intakes in populous countries such as China, India and Indonesia. Yet sugar intakes in these countries are very low – of the order of 20 grams per day or less, which equates to a miserly 4 teaspoons of sugar per day.

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Added sugars or total sugars?

The figure used in That Sugar Film may have been referring to total sugars i.e. the naturally occurring sugars in fruit and milk plus ‘added sugars’. I’m not sure why anyone would be concerned about naturally occurring sugars but let’s push on.

Intakes of total sugar in China, India and Indonesia would be more than twice that of added sugar, maybe 10-12 teaspoons a day. If we assume that teenagers in these countries consume more sugar than everyone else their intake could be about 12-16 teaspoons a day. That’s still a long way from 40.

American sweet-tooths

One populous country stands out from the rest when it comes to sugar intakes – the United States, which fortunately has good dietary data. Sugar intake in the US appears to have peaked in the early 2000s and has been falling since, largely driven by falling intakes of sugary soft drinks.

Currently, adolescents in the US consume about 18 teaspoons of added sugar each day or about 28 teaspoons of total sugars. The makers of That Sugar Film chose to use a level teaspoon (4.2g) as their chosen measure rather than the usual 5g teaspoon, which inflates the intake up to about 33 teaspoons a day – still well short of 40.

So the figure for sugar consumption chosen for That Sugar Film was nothing like ‘just slightly more than the average teenager worldwide’.

Sugar intakes of Australian teenagers

For the record, the average Australian aged 14-18 years consumes about 24 teaspoons of sugar a day, about half of which occurs naturally in fruit and milk.

Had the makers of That Sugar Film consulted with someone who actually knew what they were talking about they would have avoided misleading their audience. Then again, perhaps that was the idea.

Views on the health impact of sugar and carbohydrates more generally differ quite widely and there is plenty of room for debate, but it needs to be informed debate. Wild overstatements don’t help and diminish the credibility of those who make them.

What’s wrong with food processing?

There are three major criticisms of food processing and how it affects the nutritional quality of foods. The first is that processing lowers the nutrient content of a food either by exposing it to heat or by discarding a nutrient-rich portion. Secondly, during processing so-called ‘nutrients of concern’, such as saturated fat, salt and sugar, may be added. A third criticism is that processing may alter the nature of a food unfavourably, for example, by increasing its glycaemic index.

All of these things are true, so processed foods are obviously worse for health than unprocessed foods. Right?

Not so fast.

What’s right with food processing?

If you buy a piece of lean rump steak from your local butcher, do you eat it in its natural raw form or do you toss it into a hot frying pan first? Yes, this heat processing causes some loss of nutrients but we do it because cooked meat tastes so much better than raw meat. Also, cooked meat is much safer to eat than uncooked meat.

The same issues apply when food is processed by a food manufacturer. Safety is the paramount concern and strict regulations must be adhered to. Modern processed foods are so safe that any breakdown in food safety standards usually makes front page news.

Taste versus ‘nutrients of concern’

Taste is one of key things determining whether people buy this food or that. Yet making, say, grain foods taste good inevitably involves adding some ‘nutrients of concern’. Even staple grain foods like bread have added salt, which makes the difference between a palatable product and one that very few people would buy.

Adding fewer ‘nutrients of concern’ to a food may make good sense from a nutritional point of view but if nobody buys the less palatable product the nutritional benefits are never realised.

Processed food is better than no food at all

Some natural products actually require processing to turn them into food for humans. Wheat in its raw, natural state is indigestible and passes straight through the body. But processing wheat turns it into food that feeds millions of people. The same goes for canola seeds. Canola oil certainly has fewer nutrients than the seed from which it came, but some food is better than no food. And besides, the meal from the canola seed isn’t wasted – it’s fed to animals which in turn nourish us.

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Inconsistency

Processed foods are often damned and praised selectively. Take processed milk for example: sweetening milk with sugar to make chocolate milk is generally frowned upon, yet processing milk into cheese is considered okay, despite the higher saturated fat and salt content of cheese. How come? Is it that we like the IDEA of cheese making – a process with a farmhouse tradition, and we don’t like the IDEA of making chocolate milk in a modern factory? Sounds more philosophical that scientific.

In the media we often hear that margarine is more processed than butter and therefore is a less healthy choice. Why? Isn’t the margarine richer in essential nutrients? Doesn’t margarine lower blood cholesterol relative to butter? What has processing got to do with it?

If processing fats is a concern, why aren’t we concerned about how cows process fats? Cows eat lots of essential polyunsaturated fats in grass and grain but then convert most of them to saturated and trans fats – bad fats – which end up in the milk and meat. But the adverse effects of this bovine processing seem to pass without comment.

The logic seems to be that if a cow processes fat, that’s a good thing, even if the outcome is bad. But if humans process fat, that’s a bad thing, even if the outcome is good.

Objective criteria required

Whether a food is processed or not is simply a very poor way of determining whether it’s a healthy choice. More objective criteria that are actually relevant to human health are required, such as whether a food is nutrient-rich or nutrient poor, low or high in fibre, low or high in glycaemic index, low or high in saturated and trans fats, and so on.

The trouble is, when you take this objective approach many processed foods actually appear to be healthy choices.

The changing science

The science relating to how much of what we should eat for good health has certainly evolved in recent decades, but it’s not a simple story.

• In the early 1980s, most health authorities recommended that saturated fat in the diet should be limited to lower heart disease risk.

• At that time trans fats were thought to be neutral but by the 1990s they were considered be as bad as saturated fats. And by the 2000s trans fats were thought to be worse than saturated fat.

• Three decades ago carbohydrate was thought to be the ideal replacement for saturated fat, which led to widespread support for low fat diets. But by the late 2000s scientific support for low fat diets had dropped away.

• Although the early science indicated that unsaturated fats may be the best option to replace saturated fat in the diet somehow they were less preferred to carbohydrate. Their time has now come.

The Willett Model

Harvard nutrition guru Professor Walter Willett has developed a simple model for explaining the current state of the science. His model puts saturated fat at the centre of our attention and then shows how heart disease risk is affected when other nutrients replace it in the diet.

Key points to note are:

If trans fats replace saturated fats in the diet, heart disease risk goes up. So trans fats should be minimised in the diet, which has been successfully achieved in Australia.

If unsaturated fats replace saturated fat, heart disease risk goes down. The resulting Mediterranean-type diet is moderate in total fat but enriched in unsaturated fats. This is now the preferred foundation for a heart-healthy diet.

Which brings us to the third point: there is no advantage in replacing saturated fat with carbohydrate, or vice versa. Heart disease risk is unchanged. The big lesson for nutritionists from this was to stop advocating low fat diets for heart disease prevention. The other lesson – for the general public in particular – is to ignore all the rhubarb from low carbohydrate advocates who argue that we should all eat more saturated fat, in general, and more coconut oil in particular. It has no basis in science.

Dubious motives

The motives of the saturated fat enthusiasts are particularly dubious. Not content with pushing the myth that saturated fat is better for health than carbohydrates they further muddy the waters by demonising ‘seed oils’, which is code for unsaturated fats. So we are asked to believe that carbohydrate and unsaturated fats are both evil and therefore the only safe thing for us to eat is saturated fat. Claptrap of the highest order.

Needless to say, all of the world’s leading nutrition authorities do not support these arguments.

If your suspicions were not already fully aroused, ask yourself why these dietary myths are pushed by non-nutritionists via social media. Hmmm, you don’t think it could be a thinly-veiled marketing campaign for coconut oil, do you?

Yikes! Why are our so-called health authorities putting this dreadful toxin in our drinking water?

Fluoridation: the pollution of our precious bodily fluids

An enlightened few have known about the dangers of water fluoridation for decades and have tried to warn us. In Stanley Kubrick’s 1964 film, Dr Strangelove, there is a telling scene in which General Jack D. Ripper, played by Sterling Hayden, ignores a hail of bullets from his own troops and asks a cowering colleague whether he has ever heard about water fluoridation.

Ripper then explains that “… fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face … I can no longer sit back and allow Communist infiltration, Communist indoctrination, Communist subversion and the international Communist conspiracy to sap and impurify all of our precious bodily fluids”.

Of course, General Ripper has totally lost it. Prior to the fluoridation scene he ordered the 34 B52 bombers under his command to make an unprovoked nuclear strike on Russia.

Early anti-fluoridation campaigner General Jack D. Ripper (source)

The crazification factor

Why does anyone listen to the modern day General Rippers and their bizarre claims about fluoridation? Dentist and public health epidemiologist Michael Foley puts it down to the crazification factor i.e. ‘the percentage of the population with a tenuous grasp on rational thought and an eagerness to embrace the conspiracy theory de jour’. Although willing to accept many conspiracy theories as harmless nonsense, Foley draws the line at those things that have the potential to adversely affect public health.

The NHMRC position on fluoridation

And public health is what fluoridation is all about. The National Health and Medical Research Council states that ‘… water fluoridation is the adjustment of the natural fluoride concentration in fluoride-deficient water to that recommended for optimal dental health.

Most of the world’s water naturally contains between 0.2 -10 mg/litre of fluoride, Australian water supplies being at the lower end of the scale i.e. fluoride-deficient. The fluoridation levels in Australian states vary between 0.6 and 1.0 mg/litre, the aim being to provide the Australian people with the Goldilocks level of fluoride – enough to prevent tooth decay but not enough to cause ‘fluorosis of aesthetic concern’ i.e. the mottling of the teeth that can occur at higher intakes of fluoride intake.

New review by NHMRC

The NHMRC is currently reviewing its policy on fluoridation but don’t expect any radical changes – the cool, calm world of science is a far cry from the hysteria on the internet. In a recent media release an NHMRC spokesman said “Based on the work already conducted in the review, NHMRC is expected to maintain its support for the fluoridation of water supplies.”

Better grab your gun! Our precious bodily fluids remain under threat!

WHO’s record on sugar

The World Health Organization (WHO) is a leading global health agency with a proud history of sound dietary advice, including advice about sugar. In a 1990 report, WHO recommended a limit on intake of ‘free sugars’ of no more than 10% of daily calories, which is about the current average intake of Australian adults. Free sugars means all sugars added to foods by the manufacturer, cook or consumer, plus sugars in honey, fruit juices and syrups.

WHO’s rationale for limiting sugar intake was to lower the risk for tooth decay. No lower limit on intake of free sugars was recommended.

Thirteen years later WHO again looked at the science of sugar and health and found ‘convincing’ evidence that both the amount of free sugars and the frequency of sugar consumption increased the risk for tooth decay. And again WHO recommended a limit of 10% of daily calories.

The 2015 WHO report

In its latest report WHO found … wait for it … that eating too much sugar causes tooth decay and that the intake of free sugars should be limited to … wait for it … less than 10% of daily calories.

Interestingly, WHO also made a ‘conditional recommendation’ that the intake of free sugars could to be lowered to below 5% of daily calories for better prevention of tooth decay. But then WHO stated that this recommendation was based on ‘very low quality evidence’.

In this day and age it is a mystery why any health organisation would make a recommendation based on ‘very low quality evidence’. If the evidence is so poor, why didn’t WHO just stick with the old advice that there was no recommended lower limit on intake of free sugars?

WHO also reviewed the evidence in relation to whether sugar intake is related to body weight. Its recommendations are cautious e.g. WHO states that the evidence ‘suggests’ an association between reduction of free sugars intake and lower body weight in adults. There was no association in children. The quality of the evidence varied between moderate to low.

Perhaps the reason for the soft recommendation was WHO’s desire to maintain advice about free sugars, whereas other organisations have tended to focus more on sugar-sweetened beverages where there is more persuasive evidence. WHO found that substituting sugar for other carbohydrates (starch) had no effect on body weight, so there is nothing inherently fattening about sugar – it all depends on how many calories you eat.

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The myths: what WHO doesn’t say

The latest WHO report is notable for what it doesn’t say about sugar. It doesn’t say sugar is addictive, toxic, uniquely fattening, or that it gives you fatty liver, heart disease or diabetes. That’s because these are all just myths peddled by attention-seeking, non-nutritionists to boost their celebrity, sell books and make money.

Too much sugar is bad for your teeth. And sugar contains calories, which cause weight gain when consumed in excess of the body’s needs.

It’s not rocket science; it’s nutrition science.

The origins of the low fat diet

The low fat diet had its origins in 1980 with the publication of the first Dietary Guidelines for Americans. The recommendation to ‘Avoid too much fat, saturated fat and cholesterol’ was intended to lower blood cholesterol and reduce the risk for heart disease. Although the focus was really on lowering saturated fat, it was thought that lowering total fat intake may help prevent some cancers and obesity.

In Australia, the simpler guideline ‘Avoid eating too much fat’ was adopted to aid its communication.

Keys versus Yudkin

The low fat diet had a low key launch. Yet these humble origins are now being re-imagined as the disastrous consequences of a fight to the (professional) death of two of the great nutritionists their era – Ancel Keys and John Yudkin. As an epidemic of heart disease raged in the post-war years Yudkin pointed his finger at sugar. But Keys argued that the effect of different fats on blood cholesterol was the key mechanism affecting heart disease risk, and he won the day.

Yet Keys’ victory is now being portrayed as the fateful moment when nutrition science careered off course for four decades. Fortunately for humankind, ‘the truth’ that the problem was sugar all along has now been revealed by various journalists, lawyers, economists and B-list celebrities, all of whom seem to have made a packet in doing so.

Not content with challenging Ancel Keys’s views, the myth-makers have set out to destroy his reputation, arguing that he fudged his data – that Keys was a fraud. In contrast, Yudkin is now portrayed as a prophet, whereas he was discredited in his day.

The mythical fork in the road

Why the myth-makers need to construct this fanciful sugar or fat fork in the road is a mystery. After all, both the Australian and the American dietary guidelines published in the early 1980s discussed fat and sugar. The relevant sugar guideline in Australia was ‘Avoid eating too much sugar’ and the American guideline simply said ‘Avoid too much sugar’. And the advice to limit sugar intake has stayed in place ever since.

In contrast, as new scientific evidence about fat became available the cancer link was dismissed and recommendations steadily evolved to have more focus on fat type and less on lowering total fat. All the recent research is ignored by the myth-makers.

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Mistakes were made

Certainly, mistakes were made by some of our health authorities. By the mid-90s the ‘eat less fat’ message should have been disappearing into history. However, it was given a new lease of life when obesity experts latched onto it, based on insufficient evidence which soon fell away.

According to the myth-makers, this wasn’t a policy failure. No, it was the work of the sugar barons conspiring with their operatives in academia to prop up the low fat diet to further their commercial interests!

Fraud? Conspiracy?

Alternatively, maybe nutrition experts have just been gradually refining their dietary recommendations as new scientific evidence becomes available.

Fat in your liver

Most of the carbohydrate we eat ends up in the bloodstream as either glucose or fructose. The myth goes that glucose is the good sugar as it is used to power the brain, the muscles and most of the cells in the body. And the fructose is the bad sugar which is quickly taken up by the liver and turned into fat, giving rise to fatty liver.

Unfortunately for the myth-makers, no reputable health authority in the world agrees. Fatty liver is certainly a common problem but the experts see it as part of the metabolic syndrome – a cluster of abnormalities linked to central obesity and insulin resistance, where the cells of the body become less sensitive to insulin.

There is no recommended diet for fatty liver. Instead, health authorities encourage people with fatty liver to lose some weight and increase their physical activity, both of which improve insulin resistance.

Fat in your blood

Our liver certainly has the ability to turn both glucose and fructose into fat – it’s the perfect way to turn any excess carbohydrate calories into a form that can be stored for later use. And sooner or later this fat appears in the blood as ‘triglycerides’.

However, the idea that all the fructose we eat turns to fat pushing up the level of triglycerides in the blood is just plain wrong. If you are a healthy, normal weight person eating enough food to maintain your body weight your liver only turns a tiny fraction of fructose into fat, about 1-3%. Most of the fructose taken up by the liver is actually turned into glucose – supposedly the good sugar, so it’s much more accurate to say ‘fructose turns to glucose’ than it is to say ‘fructose turns to fat’.

It’s a different story if you overeat thereby forcing the body to turn excess sugars into fat. But the underlying problem here is not fructose; it’s overeating.

The best ways to lower the level of triglycerides in the blood are to lose some excess weight, increase physical activity and limit alcohol intake.

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Fat on your body

The silliest myth about fructose is that it is uniquely fattening. You would have thought that we would all have learned something from the fat-makes-you-fat fiasco, where the blame for the obesity epidemic was laid at the feet of just one nutrient – fat. This focussed everyone’s attention on the third of our calories that came from fat and allowed us to ignore the rest. And the nation got fatter.

Does it make any sense to target fructose, which typically provides just 10% of calories? Do the other 90% of calories not count?

None of the nutrients is uniquely fattening. People put on weight when they regularly eat more calories than their bodies need.