Pill-pop nation

They're not sweeties

One of the big news stories last week featured reports of a study by Imperial College, London, showing that statins have almost no side-effects.

It came hot on the heels of a report from NICE – the National Institute for Health and Excellence, which among other things, provides guidelines on medical treatments in the UK – announcing that, in order to reduce death from heart disease further, the threshold for prescribing statins should be lowered from a 20% risk over 10 years to a 10% risk over the same time.

Now: a disclaimer. I am not now nor ever have been a scientist or medical expert. So what follows are merely the personal conclusions of someone who might be judged to fall within the latest category that NICE is talking of.

And after the disclaimer, a statement.

I have never had a cholesterol test (I haven’t been near a doctor in years) and, on the basis of what I have read, I do not believe that cholesterol is the big problem or that high cholesterol is the cause of the UK’s rates of heart disease – and I would not willingly take statins myself.

Cholesterol is a vital building block in the body. Evidence suggests it is actually dangerous to drive it down – especially after the age of 50.

Mind most doctors have big doubts about the latest NICE announcements. According to other research by Pulse, the GPs’ magazine, of 511 GPs polled on a variety of issues, 57% opposed the NICE proposal, and 55% would not take a statin or prescribe one for a family member based on the new NICE-proposed lower threshold.

What we seem to be seeing is what Dr Phil Hammond – GP and comedian (and do see him if you get the chance: he’s very good) – has described as the “medicalisation” of society.

Statins have made vast profits for Big Pharma over the years – due to patents and stuff running out, those have reduced of late, so the NICE advice must be, err, nice for these same corporates.

However, it’s worth noting that eight out of the 12 members of the NICE panel that recommended the change have declared ties to the manufacturers, including Pfizer and AstraZeneca.

On only a very slightly different note, a quick glance at thelist of the NHS website’s partners-in-public-health list – (hat tip to Zoë Harcombe o Zoë Harcombe) – gives an indicator of just how much the country’s health has become utterly tied in with corporate interests and, therefore, with the search for profits.

As I explained three years ago, the current government decided to involve more Big Food representatives in making public health policy – and one of the earliest examples of this sawgovernment health ‘advice’ effectively providing free advertising for branded, processed foods.

It’s not difficult to begin to see where problems lie – or where they can be seen or suspected.

Last week’s research from Imperial College was a meta-analysis: in other words, a meticulous survey of previous surveys – in this case, 29 different studies.

But while the meta-analysis itself had no corporate backers, who knows who backed all those other studies?

Not only do we know that research is often produced that has been financially supported by the industry, but it’s also known that Big Pharma is most secretive with trial data – it doesn’t like sharing it with anyone, even in the medical profession – and there are plenty of people around who will assert that the same companies skew trials to start with by using ‘pre-trial trials’ to weed out anyone who obviously shows signs of side effects.

So the ordinary GP has little chance themselves of knowing all the details of any drug – they have to rely on the companies who sell them, just as we have to rely on our doctors.

The thing with statins, though, is that there is no substantial evidence for the big claim that levels of cholesterol cause heart disease.

That myth came into being because of the American researcher, Ancel Keyes.

After WWII, heart disease among men in the US reached epidemic proportions.

Keyes thought he knew why – that a diet rich in saturated fat caused high cholesterol caused heart disease – and he set out to prove it.

After a small study in the US, using men only, he looked further abroad and eventually produced what has become known as the Seven Countries Study, which bore out his great theory.

The trouble is, Keyes didn’t study seven countries. He studied 22 – and ditched most of the findings because they did not tally with what he wanted to find.

This is not a natural product

It ignores the French ‘Paradox’ – only a paradox if you believe Keyes – that sees the French eat more dairy produce than anyone else on Earth, never mind all that foie gras and duck confit, and yet still have far lower rates of heart disease than exist in the UK or US where the low-fat mantra has been so willingly churned out and gobbled up.

Yet Keyes’s work became the foundation for the health and diet advice of the last 40 years: cut out fat and fill up with starchy carbs.

It’s almost certainly been a contributory factor in the rise of obesity, but on a positive note, it’s provided Big Food with wonderful opportunities for creating and marketing as healthy, artificial fats and fat substitutes.

We now have a position where the British Heart Foundation has links not just with the NHS – see that previous link – but also directly with Unilever, which produced Flora.

And Flora is now able to be marketed as ‘heart healthy’ – watch out for the link between the foundation and the product in advertising. Unilever is also on that list of NHS ‘partners’.

In recent months, an increasingly desperate-sounding British Heart Foundation has taken to making statements on health stories that have the ring of a siege mentality about them.

When Sweden become the first country in the West to ditch the low fat diet advice last October, the foundation was sticking its fingers in its ears and claiming that low fat was still best.

With each new piece of research that is slowly rehabilitating natural saturated fats, it does the same.

The cynic might speculate on how, were it to do otherwise, that relationship with Unilever could become strained.

An increasing number of doctors are voicing concerns about medicalisation, just as increasing numbers of doctors are also stepping away from the diet mantras of the last four decades.

We’re starting to see the issue of sugar being raised much more, in terms of the serious damage that high consumption can do.

And it’s worth noting that, in the case of sugar, much of it is hidden.

I was in M&S a few weeks ago, looking for a yogurt for breakfast. I couldn’t find one that didn’t have sugar in it – not least the ones that are sold on the basis that they are ‘low fat’; healthy, in other words.

This IS a natural product – and it will not harm you

And then there’s high-fructose corn syrup that manufacturers have taken to shoving into all manner of processed foods to make them more palatable and to make the consumer buy them again and again.

Again, this is not obviously sweet foods we’re talking about. High-fructose corn syrup is used in breads, cereals, breakfast bars, yogurts again and soups.

Who thinks of sugar in soup or in bread? Cereals have been sold to the public for decades as a healthy breakfast, and breakfast bars come into the same category.

This is what hidden sugars means.

As an increasing number of people raise the issue of these hidden sugars, and as an increasing number of comparisons are made between the attitude of Big Food and that of Big Tobacco, the industry is fighting back.

Those links with the likes of the NHS and the British Heart Foundation should make us skeptical of any defences of what has become the status quo on health and diet advice.

Just as those links between NICE members and Big Pharma, and between Big Pharma and disease, should make us equally skeptical.

What is needed is far greater transparency in all these cases – and far better regulation, properly enforced.

There’s nothing inherently wrong with profits. But when the search for profits trumps people, then it’s a sign that something is very wrong.

And what is also needed is an honest and thorough approach to dealing with the problems caused by a national approach to food that includes using takeaways and ping food to the extent that the UK does, not taking time to eat properly, constant snacking, the demise of cooking skills, a prevailing attitude of food as fuel, vast amounts of media space given over to faddy diets, new homes built without proper kitchens etc etc – and not just a rather lame sense of correcting it all my medicalising the populace.

That won’t be as easy as sticking fingers in ears and endlessly intoning the low-fat mantra, irrespective of the body of evidence against it, but it would be a damned sight more effective than the equivalent of the three little pigs inviting the wolf to join them for dinner.

Further reading:

The Great Cholesterol Con by Dr Malcolm Kendrick

Although now dead the Cholesterolosaurus will march on by Dr Malcolm Kenderick

Bad Pharma by Dr Ben Goldacre

Bad Food Britain by Joanna Blythman

Worth following on Twitter:

@KailashChandOBE

@JoannaBlythman

@bengoldacre

@DrAseemMalhotra

@zoeharcombe

@drbriffa

The above-mentioned may not agree with all I have written here, but are all very much worth reading and following on the matter raised in this post.

Cereal offenders

A toothless tiger? Is that all the sugar?

However, over the weekend, I admit to actually being shocked to the point of total gobsmackedness.

No, not by the news that the Labour Party is considering the issue of a cap on sugar in breakfast cereals, but the mere fact that, on the basis that the suggested cap is 30%, it seems that some cereals currently consist of more than 30% sugar.

Now I’m well aware that such products do include sugar – no matter how much they're marketed as a healthy product – but to contain more that 30% sugar?

Labour, being terrified of the corporate lobby, is only floating the idea of a cap. And it seems that cereals that are particularly targeted at children are the man concern.

Mind, you can guarantee that this soon became all about whether the party would ban Tony the Tiger and the grrrrrrrrrreat start to the day that is a bowl of Frosties.

Say you’re a dedicated enough shopper that you check labels before putting a product in your basket. Now okay, you’ll know that Frosties and many other cereals have sugar in them.

You’ll possibly also be aware that, ingredients are listed in order of quantity, so if it lists sugar second, then that’s because it’s the second biggest ingredient.

But it’s less likely that you’ll spot, further down the list, high fructose corn syrup – or whatever other term it’s listed as – and yet many cereals do include this.

Even a cereal such as Bran Flakes has sugar as the third ingredient – plus salt. And honey. And this is a cereal that, to read the blurb, you would believe was a gift to better health.

Don’t get me wrong: I’m not suggesting anyone cut out sugar altogether. But one aspect of the overall problem is hidden sugar and disingenuous marketing in products that are sold on the basis of ‘healthiness’.

You might buy a pizza, opting for what you think is a pretty healthy topping, but some companies use high fructose corn syrup to glaze the base. Is that somewhere that people really expect to find sugar? I doubt it, personally.

“Enjoy regularly within a healthy diet and lifestyle” adds the blurb for Müller’s low-fat, fruity yogurts. Yet have a guess what the third ingredient is- yup: sugar.

So why does the food industry behave like this?

Well, it’s obvious: money.

Even though there is an increasing understanding of the problems caused by the hidden sugars in processed foods, most people still believe that the really big demon is fat – and big food is more than happy to play along with that.

The trouble is, when you strip all the fat out of something, you need then to find a way of making it palatable. That’s what they have to do with margarine – as well as adding artificial colour, since removing the fat renders the product grey. And nobody is going to want to spread a grey substance on their toast, no matter how healthy its manufacturers claim it is.

Labour’s ideas are merely tinkering around the edges. The problem in this situation is that big food is a hugely powerful lobby and can get away with a great deal that many people would view as downright immoral. And I never use that word lightly.

There are commentators who believe that the entire added sugar approach is going to come down on the head of manufacturers very soon – in much the same way that tobacco companies have been hit.

Let's face it – it's a very long time since anyone was claiming that tobacco was good for you – yet companies are still claiming that products that contain sugar are specifically healthy, as we've seen.

Ancel Keyes and the whole ‘fat-is-evil’ farce have a great deal to answer for.

But more than 30% sugar in breakfast cereals for children? Grrrrrrrr.

A counterintuitive way to eat

Ladies and gentlemen, today, I’d like to introduce you to David T Breaker.

Mr Breaker is a self-described “Conservative Home blogger. Liberty defender. Jeffersonian. Goldwater Reagan type. Winner Britain's Most Boring 2012.”

He doesn’t explain what “most boring” aspect of his existence this year has been accorded such an honour, but then it’s not easy to do such things within the limits of Twitter.

However, in the midst of an online exchange the other day about the NHS (he hates it, unsurprisingly) he objected to the idea of obesity as ‘a disease’, even though at least some medical practitioners describe it as exactly that.

“You can't catch obesity!” He tweeted, shrilly. “You cause it yourself. It’s self harm.”

Not, quite apart from the fact that you can’t “catch” cancer either, the rest of his comment is utter, simplistic nonsense.

Not, I hasten to add, that he is the only one to believe such rubbish.

Quite coincidentally, I have just finished reading Escape the Diet Trap by Dr John Briffa.

In it, the author (a British doctor) starts by detailing what, for many people, has been their experience of trying to lose weight.

In effect, it has meant going on a calorie-controlled diet, with exercise. Seeing some weight loss – then putting it back on. With interest.

The popular view – presumably believed by the likes of Breaker – is that the eventual outcome is doubtless down to a lack of self-discipline, laziness, greed and probably a few other similar failings.

It is quite something to read a doctor saying that this is not necessarily the case.

Briffa highlights the way that diet advice has centred on a mantra of combining calorie reduction with cutting fat and increasing complex carbs (bread, rice, pasta, potatoes etc).

Yet as he shows, this is counterproductive to weight loss.

What the book does is not lay out a ‘diet’ (“this is not a diet book’, says the subtitle), but explains in some detail, and with recourse to countless studies, what happens when we eat different foods and the effect of those foods on us.

So he explains, for instance, about insulin and what this and other hormones do.

He doesn’t limit this weight alone, but also tackles the major health concerns like diabetes and heart disease (which is something else you don’t “catch”).

In essence, Briffa explains that, over some years, he has seen considerable benefits for patients moving to a different way of eating.

He stresses low carbohydrate, high protein – for all sorts of scientific reasons, but also because it sates hunger better than starchy carbs – and higher fat than is usually recommended.

On the latter, he points out that the ‘link’ between a diet rich in saturated fat and heart disease is overstated.

Indeed, in a blog post only last week, he showed some recent statistics to illustrate that the ‘French Paradox’ is really no paradox at all.

For those who aren’t familiar with that idea, the French experience appears to contradict the conventional ‘wisdom’ that a diet high in saturated fat leads to ‘high cholesterol’ leads to heart disease.

Not only do the French consume more dairy produce than anyone else on Earth, they’re hardly reluctant to eat meat – and that’s before we mention the south west, where they create wonderful things such as foie gras and duck confit. And still don’t have the heart disease we and the US do.

Briffa does, incidentally use foie gras to reinforce one of his key arguments: to fatten the duck or goose liver, the bird is not fed fat – but grain.

He also notes the benefits of cutting bread and other starchy carbs from your diet in terms of feeling less bloated.

Now, as I mentioned here, for a few weeks now I’ve been experimenting with lowering carbs – and cutting out bread. It started, as it happened, before I’d read Briffa.

The strangest thing – because however much you read, the opposite has been drummed into our minds – is that I feel lighter.

If I were to attempt to analyse it more closely, I would also add that I frequently feel as though my belly is flatter. I’m not hungry, so I can only assume this is a lack of bloatedness.

Have I really been feeling bloated, on at least a minimal level, for some years?

So, if nothing else comes of this, I currently feel that bit ‘better’.

Back to Breaker: Briffa’s experience with his own patients illustrates just how wrong he is.

But he patently forgets or brushes over other issues that are contributors to the wider issue that the UK as a whole faces today.

Briffa has no time for processed food, and slates cereals as readily as bread.

But just look at cereals: portrayed as a generally healthy breakfast staple, even many of the so-called really healthy ones are laden with sugar and salt.

Advertising is then combined with that conventional wisdom to say that complex carbohydrates are so good you need more of them – and people eat them who are trying to lead a healthy life and eat healthily and maintain their desired weight.

The medical profession and government public health bodies do not have brilliant form in this area: as in the US, the advice has hugely been influenced by the lies of Ancel Keyes about saturated fat and heart disease (he hid more than half the results of his survey because they didn’t tally with what he wanted to ‘prove’).

But it perhaps says something that, for his stance, Briffa received what he described as “an abusive and invective-laden email from the head of communications of the trade organisation the Flour Advisory Bureau”.

Such bodies have a vested interest in people continuing to believe that starchy carbs are the foundation of a healthy diet.

Perhaps Breaker would like to consider that sort of abuse for a change.

And in the meantime, Briffa’s book is well worth a read.

No king ever breakfasted on Cornflakes

I hate breakfast. Seriously, I do. I know it's not very foodiefied or on trend of me, but it really is my least favourite meal of the day.

Actually, that oversells my relationship with breakfast – it goes way beyond 'least favourite' status.

Now some of this possibly goes back to all my years of dieting, when skipping breakfast was an easy way to avoid calories, so the habit was broken.

But it’s also far, far more than that.

Is there any other meal that has become so restrictive in terms of what is readily available?

I mean, when I get up at about 6.30am, I am not ready to eat. Frankly, it’s unusual for me to even drink anything at that stage except the occasional glug of fruit juice. I usually start feeling ready to break my fast around 90 minutes later.

So I grab something on the way into work or slip to the canteen for something once I’ve arrived.

The former means a sandwich or roll from one of a couple of places or possibly a warm pastry with filling from Pret or something ‘healthy’ from the same place, like a pot of fruit. Or a pot of yogurt. Or a pot of fruit and yogurt if I’m feeling spectacularly flash.

The latter means a toasted bread product (Chorleywood sliced bread or crumpets) and butter, with occasional jam when pushing out the boat. Cereal is available. Or you can have a pot of fruit. Or a pot of yogurt. Or a pot of fruit and yogurt.

There is some semblance of a cooked breakfast available at the latter, but even if you get there as the canteen is opening for business, the bacon is already tougher than an old boot and the scrambled egg has been sunning itself for so long under a lamp that it needs manually scrambling again with a fork.

Perhaps if I started getting up at 5am, I’d be ready to eat by 6.30am and could prepare something that I actually fancied before leaving home . Although then I’d have to contend with The Other Half objecting to whatever I chose to rustle up.

I don’t mind pastries occasionally, but seriously, where do you get a proper croissant outside of France – the sort of confection that is utterly fresh and so rich in butter that it flakes at the merest reverberation of lips smacked in anticipation.

When I give in to temptation and buy one here, it’s always to be reminded of the triumph of optimism over experience.

Staying in Brighton last month for work, I genuinely enjoyed having poached eggs on toast in the morning. And indeed, at a weekend, when I manage to discipline myself enough to eat before doing something else (like doing the shopping on a Saturday), it’s likely to be a couple of soft-boiled eggs.

Eggs, it’s worth stressing, that are free range and organic and from a farmer I trust. Eggs that are a glory and make such simple eating utterly worthwhile.

When I was a child, my mother would equip us for school with a small glass of fruit juice, an eminently sensible bowl of cereal (Rice Krispies or Cornflakes), followed by a piece of toast with marmalade and a glass of milk.

And therein lies part of the problem.

Why do people eat cereals? Doesn’t it say something that Cornflakes were jointly invented by a man who was three stops short of Upminster and believed that a diet of two bland meals a day was essential to control nasty sexual urges?

The world’s two biggest markets of breakfast cereals are the US and UK – is it a total coincidence that both these mass consumers of such starchy carb-laden fodder have particularly high levels of obesity?

But set that aside: the taste, just think of the taste! It’s largely like eating cardboard – unless you drown it in milk and add sugar to give it some interest. And that’s the healthy ones, as opposed to those that arrive complete with tons of salt and sugar, plus a veritable cornucopia of additives and gimmicks, like chocolate or marshmallows, just to get the children to eat this ‘healthy’ breakfast.

Look at the aisles in a supermarket and see how many different cereals there are; take a look at the ingredient lists and see how many don’t have added sugar, salt and god alone knows what else.

The variety is as great as that of ‘potato’ snacks – in the same places that you’ll struggle to find more than one variety of English apple.

Which might also say something.

There is, of course, porridge, but that needs things added to it to make it less boring and bland.

But all this raises another question: if you read a story about a man who ate Christmas dinner every day, you’d think he was bonkers.

Yet vast numbers of people eat exactly the same every day for breakfast and apparently think that’s entirely sane.

And personally, the lack of variety is one of the things that most peeves me about breakfast.

Occasionally, if I’m at home on my own (and therefore won’t have to suffer outraged complaints about the smell), then once I’m ready to eat, I’ll rustle up some nice, traditional fried bread and fried egg – cooked in lard, of course – or, if really feeling the pangs of hunger, a bowl of basmati rice, served with seasoning and a dollop of good butter.

‘Rice for breakfast’, you say in shock. Well why not? Indeed, it’s a central component of kedgeree, that wonderful dish created by cooks for those returned from the Raj and missing India.

Y’see, while I have no desire to go all Gosford Park on you, those country house types had some good ideas about breakfast – a wonderful array of options and none of them involving sugared cardboard.

Kippers, for instance, or devilled kidneys.

I’m making my own mouth water, contemplating such delicacies. Now obviously such things demand time – and that’s something that few of us have on a regular basis when it comes to breakfast, but come on – even bread and dripping would be welcome.

Or if you had the ingredients, pan amb tomàquet, the Catalan bread that’s toasted and then rubbed with a cut clove of garlic and half a really ripe tomato.

Hotels usually make it worse rather than better: most cooked breakfasts are far from great – not least because they’re almost never actually fresh; the cheeses and cooked meats on offer for those wanting a more ‘continental’ approach are mass produced and bland.

And whoever invented those bloody awful rotary ‘toasters’ that take an hour to give a slice of bread little more than the merest blush should be force fed Special K until they burst.

Not that it’s much better at hotels across the Channel. Which is why we never eat breakfast in hotels but go and find a local café. It usually works out cheaper too and you can watch the world go by while consuming good coffee and pastries or bread that’s rather better than what I’ve described here.

Now I know that breakfast is important and these days, I not only understand the reasons, but can see the affect on my appetite if I skip breakfast.

But given that breakfast is when you’re supposed to dine like a king, then how come we have such a deadly dull range of easily available choices? And the mere absence of meaningful choice, seen against the number of available cereals, shows how much breakfast has become, rather than something fit for a king, the most mass-produced meal of the day, driven massively by claims that it’s healthy!