Why is the Heart Foundation in Denial over Fat?

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The Queensland Institute of Medical Research (QIMR) last week released the results of a 16 year study that says full-fat dairy reduces the risk of heart-related deaths by sixty-nine per cent. But rather than applauding the new work, the Heart Foundation put up the shutters. Are they worried the emperor has no clothes or is money the real problem?

The study (published in the prestigious European Journal of Clinical Nutrition) followed the dairy consumption of 1,529 adult Australians aged 25-78 years. The participants were asked about their dairy intake on three occasions (1992, 1994 and 1996). The results were then cross-matched to National Death Index data between 1992 and 2007.

The data showed a significant relationship between the consumption of full fat dairy and heart disease deaths. But not the one you might think. The people who consumed full-fat dairy had a sixty-nine per cent lower risk of death by heart attack than those gritting their teeth and gulping down low-fat milk.

The QIMR study comes on the back of a significant US study on heart disease risk published in April. In that study a group of 6,113 average American adults was divided into five groups based on their sugar consumption.

One of the groups was a standout on many of the traditional measures for heart disease risk. They had the lowest fat consumption (just 28.9% of total calories – the Heart Foundation recommends keeping it under 35%). They had the lowest saturated fat consumption (just 9.7% of total calories). And they had the lowest cholesterol intake by a country mile (only 238mg).

This group were poster children for the low-fat lifestyle. There was just one little problem, their blood work was awful. On average the folks in the low-fat group had by far the worst blood cholesterol and triglyceride (blood lipid) readings of all five groups. And they weren’t just bad, they were time-to-order-some-drugs bad.

Just like the QIMR participants, the people doing everything right (from a fat consumption perspective) were the ones most likely to end up dead from a heart attack. Interestingly (in the US study), they were also the one’s eating the most sugar.

It’s all well and good to notice correlations like that, but to have any value as a scientific observation, there has to be plausible explanation for why it might be so. A pair of studies published in 2000 and 2007 may just provide that explanation.

In June 2000, Dr Krauss and his team over at the Lawrence Berkeley National Laboratory, Department of Molecular Medicine at UC-Berkeley published the results of experiments they had been doing on low-fat diets.

LDL cholesterol (or ‘bad cholesterol’) particles come in a range of sizes. People can be divided into two main groups according to which size is most common in their blood. Some people have mostly large LDL particles (Pattern A) while others have mostly small ones (Pattern B). Pattern B are the ones who tend to die from heart disease.

Which pattern you are is largely a matter of genetics. But Dr Krauss found a way to convert a perfectly healthy Pattern A person to Pattern B (heart attack waiting to happen). Just put them on a low-fat diet.

Then in 2007, some researchers in Switzerland found another way to convert Pattern A to Pattern B – have the patient consume sugar. So it seems the two most excellent ways of ensuring a high risk of heart attack is to either be on a low-fat diet or eat lots of sugar.

If that was what you were aiming for, you wouldn’t find it too tricky. The vast majority of low-fat foods are higher in sugar than their full-fat brethren. Eating a low fat diet kills two (fat) birds with the one stone. Slurping up a Diet Yoghurt lowers your fat intake and increases your sugar intake – all at the same time – how efficient.

Faced with the latest evidence from a high quality Australian research team (at QIMR), the Australian Heart Foundation didn’t suggest the issue needed investigation. They didn’t even pretend that they might look at the research and its implications.

No, (rather like the Church of England faced with Darwin’s theory of evolution) they responded to the new evidence with outright denial. In a story about the study which aired last week, a Heart Foundation spokesman said “we strongly recommend to people to have no fat or low fat products in their diet.”

Perhaps the Heart Foundation is in denial because it fears a sudden change of course (after decades of touting the ‘low-fat’ message) might scare the horses (that would be, um, oh that’s right, us). Or perhaps there are more sinister motives leaching out of the stack of money it makes from endorsing low fat (and often high sugar) products with the tick program.

Let’s not forget there are real lives at risk every single day in the battle against heart disease. The Heart Foundation is one of the primary (and most trusted) providers of advice on heart health. For that reason, it receives significant financial support from the Australian public on the understanding that it has our best interests at heart (pun very much intended).

The evidence is mounting that the advice being dispensed is just plain wrong, but the Heart Foundation seems unable see it. If the obvious commercial conflict can’t be resolved then the tick program needs to go. The Australian public needs to hear the truth about what causes heart disease – a low fat diet, lots of sugar or both.

Calorie Labelling is all about making Politicians look good – not you.

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The Victorian government is forcing fast food restaurants to tell us how many calories are in their meals. Premier Brumby says this will “drag back” the “runaway train” of Type II Diabetes. But the science says there isn’t any real point to showing us how many calories are in a burger (or anything else). And the evidence (from places that have already been there, done that and bought the T-shirt) is that it doesn’t make the slightest bit of difference to what we eat anyway.

Most food contains 4 calories of energy per gram of food. The exceptions are fat (which has 9 calories per gram) and alcohol (which has 7). So a difference in the calorie content of two similar weights (or serves) of food really is just another way of saying one has more fat than the other (or more booze, but I don’t think anyone is worried about that at Macca’s).

We are exceedingly efficient at using our calories. The 150 calories in a glass of apple juice would let us ride a bicycle 8 km, but the same energy (in petrol) would only push a car 250 metres.

Our appetite control is also exceedingly efficient at making sure we don’t consume more calories than we need. Our hormones are so sophisticated they can even tell the difference between fat calories and calories from everything else (and adjust accordingly).

The science says sugar contains an appetite hormone disruptor (called fructose). With sugar in our diet, our bodies can no longer tell when we have had enough calories. Sugar gives our bodies permission to keep on eating and we don’t stop until we are physically restrained by the size of our stomach (or jeans). When that problem, well, passes, our broken appetite control gives us permission to keep eating until we’re stuffed again.

The result is that we are eating way too many calories, but fabulous as they are, our hormones can’t read a calorie sticker slapped on a board out the front of a KFC (even assuming any of us really knew how many we were supposed to be eating anyway). Our broken appetite control is the reason that Diabetes (and obesity) is a run-away train, not a lack of calorie labelling.

Because all a calorie really measures is (relative) fat content, the processed food industry isn’t all that bothered about calorie labelling. They’ll happily slap a calorie count on a can of soft drink (full of appetite hormone disruptor) because they know it comes out looking pretty good next to an equivalent quantity of milk (soft drink – 150 calories v unflavoured milk – 240 calories).

The sugar in the soft drink will make us want to eat more of everything but it’s the milk (which actually fills us up) that comes out looking sorry on a government mandated calorie counting sign. Sugar is effectively invisible on that sign. Indeed they could add more of the addictive substance and not materially affect the calorie count (especially if they use it to replace fat).

The Victorian plan is a straight copy of the calorie labelling laws enacted in New York City in mid 2008. But a Yale and New York University study on the effect of the laws (completed in October last year) showed the effect was exactly – nothing.

The researchers interviewed customers at multiple restaurants in four fast-food chains (McDonald’s, Wendy’s, Burger King and KFC). They collected 1,156 receipts from customers two weeks before the laws were introduced and four weeks afterwards. A similar population in a state without the law was used as the control.

The locations were chosen because of a high proportion of obesity and diabetes among poor minority populations. So if Premier Brumby’s runaway train theory was correct, these were exactly the people who should react to the signs.

In New York and in the control city, the average customer ordered a meal with 825 calories before the laws came into effect. Afterwards the New York customer had bumped their order up to 846 calories but the control customers were still ordering the same.

People were ordering more calories after signs were introduced! While that’s probably just a statistical anomaly, there’s certainly no suggestion the signs had any effect at all on what people ordered.

Never ones to be troubled by evidence of effectiveness, other states are now piling on to the Victorian bandwagon. The South Australian and New South Wales Governments think it’s a terrific idea and are rushing to implement.

Laws like this fit all the criteria for high visibility politics, so our elected representatives are drooling over them. Every time we walk past a Government mandated calorie sign (and ignore it) we can be reminded how much our politicians are looking out for us.

Everybody wins. The Pollie looks like he cares about our welfare and is on the job. The Nutritionists cheer them on because they are being listened to. And the food manufacturers know it won’t affect sales anyway.

The only loser is – well, ah – us. We will still get fatter and still get Type II Diabetes (but everybody knows those fat chickens will come home to roost on someone else’s watch) – bon appétit!

Are Sugar and Palm Oil really part of a “balanced breakfast?”

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Nutella has the nutrition profile of a chocolate bar (and that’s probably an insult to the chocolate bar). But according to their latest advertising, we are supposed to be feeding it to our kids as part of a “balanced breakfast.”

The ad says Nutella contains “premium Hazelnuts, cocoa and the goodness of milk” (cue artistic shots of milk, nuts and cocoa pouring out of the sky). The actual ingredient list looks a little more like this

sugar (50%), palm oil (called “Vegetable Oil” on the label), hazelnuts (13%), skim milk powder (8.7%), fat-reduced cocoa powder (7.4%), emulsifier (soy lecithin), flavouring (vanillin)

I guess a shot showing ribbons of sugar, palm oil and hazelnuts is less artistically appealing (no matter how much more accurate it would be).

In 2008, a remarkably similar advertisement in the UK provoked 53 complaints to the Advertising Standards Authority (ASA). People said that the ad was misleading because it did not make clear that the product was high in sugar and fat.

The ASA agreed and found that as the ad had only mentioned hazelnuts, skimmed milk and cocoa powder (when in fact it had a high sugar and fat content) it was indeed misleading. The Authority decided therefore that the advertisement should no longer be shown on British television.

Of course (when similar complaints were lodged regarding an almost identical commercial here) the Australian equivalent of the ASA decided there was nothing wrong with the ad because it “carefully” used the phrase “balanced breakfast” rather than saying it was a “healthy” breakfast.

On the basis of that reasoning, soft drinks could be advertised as a part of a healthy (sorry, I mean balanced) breakfast for children because they contain (quite a lot of) water.

(Australian) Industry self-regulation clearly leaves a little to be desired. So I’ll be putting all my complaints via the ACCC in future. They may take longer but at least they appear to get it right in the end.

I very much doubt that anybody suffers under the impression that a chocolate bar is a healthy breakfast for children (or anybody else). But chocolate bar purveyors are not flooding our screens with ads suggesting they are.

Nutella contains (cumulatively) lethal amounts of sugar and palm oil (which has been implicated in the destruction of Orang-utan habitats). I’m struggling to think of a food less suitable for consumption at all, let alone as part of a ‘balanced’ breakfast for our children.

If they must advertise the stuff then at the very least, Ferrero (the maker of Nutella) should be forced to emphasise the real ingredients rather than a highly selective cherry-picking of the healthier ones (used largely for flavouring).

You can’t blame Ferrero for giving this a go. Clearly (in Australia, at least) they are within their rights. But we need more than a toothless tiger (with a propensity for legalistic interpretation) ‘safeguarding’ our ability to make informed choices.

If Ferrero is allowed to advertise sugar and palm oil as “skimmed milk and (fat reduced) cocoa”, what else is being pushed at us with (legally finetuned) definitions hiding behind the advertising puff? We deserve better.

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The Heart Foundation Tick or the Coles Tick, which is worth less?

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The Heart Foundation is getting its undies in a twist about Coles using a tick in their branding. But consumers might be healthier if they let the Coles tick guide their purchases.

Heart Foundation healthy weight director Susan Anderson complains “we receive many calls and emails from outraged shoppers who have been tricked by phony ticks.” And Senator Nick Xenophon wants to call in the Feds, saying “Coles is being deceptive and the ACCC should investigate.”

Incidentally Nick isn’t worried about the consumer accidentally choosing an unhealthy food. He explains his real concern is that consumers will think the product is Heart Foundation approved and “that is fundamentally unfair to the Heart Foundation. “ Oh, ok, good point. We wouldn’t want to endanger their licensing revenue.

A major study released in April showed definitively that when it comes to Heart Disease (presumably the primary concern of the Heart Foundation), sugar consumption was (by far) the strongest indicator of risk. So how do the products which bear the Heart Foundation Tick stack up in the sugar stakes?

Nestle’s Fruit Fix Bars proudly bear the Heart Foundation tick but are around 72% sugar. However a tick-free Mars Bar is only 58% sugar. I guess they’d need to top it up a bit to earn a ‘tick’?

Other high sugar products proudly bearing the tick include Nestle’s Billabong Ice Blocks (23% sugar), Nestle’s B-Smart Milo (32% Sugar), Kellogg’s K-Time Twist Bars (38% sugar), and Nestle’s Nesquik Plus (60% sugar). It looks like letting the Heart Foundation tick guide you through supermarket aisles could land you in very high sugar territory indeed.

But what of the claim that Coles is leading healthy-food seekers astray with their tick? We all eat breakfast cereals, so the brekkie aisle is a good place to do some comparison shopping.

Coles make a few breakfast cereals emblazoned with their tricky ticks. They are Rolled Oats (no sugar), Wheat Biscuits (less than 1% sugar) and Corn Flakes (10% sugar). Nothing too dreadful there (even if the corn flakes could have less sugar).

But the Heart Foundation endorsed list of breakfast cereals includes Australia’s tenth most sugary cereal (Kellogg’s Just Right – 32% sugar) and the 12th most sugary (Nestle’s Healthwise for Heart Health – 30% sugar). Following the Heart Foundation down the cereal aisle could fill your breakfast bowl with at least three times as much sugar as opting for the Coles tick.

The good news is that if you are prone to ticklexia, you’re in much safer territory from a sugar (and therefore heart health) perspective. Although you probably want to be a little bit careful. Coles have ticks on shaving cream and laundry powder too.

Even when you venture out of the supermarket, the Heart Foundation can be treated as fairly consistent warning of high sugar content. Over at the much-maligned Macca’s the tick approved meals are some of the higher sugar options on (the non-pudding part of) the menu.

A tick-approved Seared Chicken Sweet Chili Wrap, Garden Salad and Italian Dressing will serve you up 4 whole teaspoons of sugar (quite a bit for a salad really). But a plain old Big Mac will add ‘just’ 1.5 teaspoons of sugar to your day. And a Filet-o-Fish, piles on a mere half teaspoon.

The Heart Foundation happily endorses high sugar products because unlike its US counterpart (and in the face of overwhelming science), it considers sugar a harmless (even necessary) addition to our diet. In response to one of my earlier rants, Susan Anderson even told Cardiology Update “Although associated with tooth decay… eating sugar itself is not clearly associated with other health problems.”

I had always believed (like most of us, I suspect) that the Australian Heart Foundation was a powerful force for good in ensuring we all ate well. We trust the Heart Foundation to tell us the truth, not what is commercially convenient for its clients.

The science on sugar says it is lethal. We wouldn’t tolerate our doctor taking payment from sugar manufacturers in return for recommendations. So why should we tolerate it from the Heart Foundation. Whacking a tick on a children’s food product (like Fruit Fix) that has more sugar than a Mars Bar is at best a conflict of interest and at worst, negligent.

So, please Heart Foundation, let’s have less media hype about Coles (using a logo vaguely reminiscent of the tick) and a lot more media hype about the lethal effects of sugar. I know that will hurt your income stream but is that really what’s important here?

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Also published in Crikey (subscription required). You can also read the Heart Foundation’s response here (about half way down the page – no subscription required).

How to spend a fortune on health and achieve nothing (aka the Budget Edition)

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The budget contained a blizzard of announcements on health. And most of them are focused on preventing chronic disease. But the reality is that they will have approximately the same effect on chronic disease (and cost twice as much) as the home insulation program – nada, nil, nothing and nix.

Chronic disease is a priority because (as the budget papers point out) the big three (heart disease, diabetes and cancers) ”account for 70 per cent of health care expenditure … [and] 50 per cent of GP consultations.” And these costs are projected to blow out to (really) unsustainable levels in the next two decades.

And the reason for all this chronic disease trouble? Well, that’s easy, we’re all ‘too fat’. According to the papers, “[the number of fat people] has significantly increased over the last 25 years [with] 68 per cent of adult men 55 per cent of adult women [now being] overweight or obese.”

You’ll no doubt be relieved to discover that the Government knows the cause all this fatitude and (even better) knows what to do about it. You see it’s all down to ‘lifestyle factors’. Translation: we eat too much fat and we don’t do enough exercise.

But the Government’s not just going to sit back and wait for the bills. They’ve got a four (no, not a five) year plan and it goes like this:


  • Grants for “healthy lifestyle programs” in the community
  • “Public Awareness campaigns”


  • Create Medicare Locals (GP centres) for delivery of preventive primary health care
  • More Public Awareness campaigns
  • More grants for healthy lifestyle programs in the community
  • States given money to implement healthy lifestyle programs in workplaces and schools
  • Awards for excellence in promoting healthy lifestyles


  • Finish installing Medicare Locals
  • Money for more nurses and diabetes treatment
  • More Public Awareness campaigns
  • More grants for healthy lifestyle programs in the community
  • States given more money to implement healthy lifestyle programs in workplaces and schools


  • More Public Awareness campaigns
  • More grants for healthy lifestyle programs in the community
  • States given more money to implement healthy lifestyle programs in workplaces and schools
  • Bonus payments for States that show we lost weight

That’s right, the plan is to nag us to death (or more precisely, to nag us to health). If you want to know what a “public awareness” campaign looks like when it’s at home, you need look no further than the recent “Measure Up” ads and posters.

According to a recent evaluation of that campaign, it was wildly successful. Now, by successful they don’t mean that there is any evidence that it had any effect on obesity or chronic disease. No, what they mean is that 91 per cent of us saw it.

The ads successfully told us we are too fat and we should do something about it. And thank goodness we have them because without all that advertising, we’d be forced to well, ah … use a mirror?

The government is backing up these ads with loads of new lifestyle programs and money for GPs to target ‘primary prevention’. You won’t be able to visit a doctor, go to work or enter a school without being nagged about your ‘lifestyle’.

Last September, the Royal Children’s Hospital in Melbourne published the results of a study into exactly how effective that kind of nagging is. The research team asked 66 general practitioners to administer advice “targeting change in nutrition, physical activity, and sedentary behaviour.” The advice was in accordance with the national healthy living guidelines.

In the study, 258 obese Melbourne children were randomly assigned to either an intervention or a control group. The children in the intervention group saw their GP four times over a 12 week period and received all the recommended advice about nutrition and exercise. The kids in the control group lived life as normal without any nagging from their doctor.

Twelve months later, the researchers checked in with the kids to see what difference it made. The result was that the counselling “did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds.” The researchers went on to note that “and it would be very costly if universally implemented.”

In stark contrast, there are over 80 studies (and counting) which show that taking the simple step of reducing the availability of sugar sweetened beverages (soft drinks and juices) has a dramatic effect on obesity and chronic disease. This kind of evidence seems to have escaped the research powers of our health hierarchy. Because even in the face of unequivocal proof that the advice we give our children doesn’t work, we’re lining up for more of the same.

Telling people to exercise more and eat less fat is immensely costly (as the budget has just proven) and the evidence says it doesn’t work. But it appears that we are not about to let those details get in the way of a campaign designed to convince us the Government is doing something about health.

The definition of insanity is doing the same thing over and over and expecting a different outcome. Let’s stop the insanity on health.

Help! We’re running out of Smokers.

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What would we do without smokers? Until last Thursday, their dirty little habit tipped $7 billion a year into Australia’s tax coffers.

And now the little nudge Kevin gave the price on Friday will mean that over the next four years smokers will be sending a total of $33 billion to the tax man (go team). In the same time frame, Kevin’s new mining tax will have raised just $12 billion (as long as the resource boom holds up).

Even better than that (as any pollie worth his salt, well knows), whacking smokers is an exceedingly popular blood sport. Almost 90% of Australians are in favour of raising ciggy taxes. So in political terms smoking taxes are as close to free money as you’ll ever get.

In return for their generous contribution to nation building our nicotine addicted brethren ask very little. They cost the health system just $0.3 billion per annum (largely because they have the good grace to die quickly and inexpensively). And they don’t mind being treated like lepers as long as we let them keep smoking somewhere (even if they do have to take a cab to the designated smoking zone).

So it’s a good thing smokers are happy to continue to pay all that moolah because (‘reformed’ or not) by 2033, the Australian health system will be costing up to $295 billion every year (up from the $94 billion it currently costs). To put that in perspective, last year the total tax take for the entire country was a mere $338 billion.

If it weren’t for smokers, the queues at our hospitals would already be a helluva lot longer. Unfortunately smokers are not a renewable resource (for tax dollars). Every time we increase the tax, a few more (clearly less patriotic ones) give up. Since 1980, we’ve mined the revenue base down from 34% to just 19% of adults.

Worse than that, there is a very high likelihood that they swap their expensive (and taxable) addiction for a tax free addiction like sugar. A series of rat studies out of Princeton University over the last six years, have suggested that nicotine and sugar share the same (neurological) addiction pathways. Which might explain why smokers tend to hit the sweets when they give up.

Since people willing to have their brain hacked open while they suck on a lolly have been a little thin on the ground, we’ve had to be happy with animal studies. But advances in scanning technology are meaning that more and more human studies are starting to appear. And these studies are telling us exactly the same thing. Sugar is just as addictive as nicotine in humans.

Getting people addicted to sugar is not a good thing for our ailing health system. Sugar addicts develop lifelong diseases like Type II Diabetes and Heart Disease. These chronic conditions are currently managed (and not cured) with a continuous supply of very expensive medication. And ultimately end with people occupying expensive acute beds for very long periods.

The health budget is a runaway tram because of the accelerating blowout in these chronic (and largely preventable) diseases. By 2033 Type II diabetes alone is likely to cost a billion (or so) more to treat every year than we currently prise out of the smokers.

Taxing smokers until they quit provides a great band-aid for the sugar induced blowout in health. But what happens when we’ve converted them all to sugar addicts? How do we pay for the health system they will desperately need? Who do we tax then?

Ooh here’s a thought, how about we stop feeding people sugar instead? Nah, you’re right, that’s a silly idea, we’ll probably just tax the sugar instead.

Study: Sugar a short-cut to Heart Disease

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Yesterday the US Centers for Disease Control published an interesting study they’d been doing on heart disease risk factors. They divided a group of 6,113 American adults into five groups and measured all the traditional stuff. You know, waist circumference, fat consumption, weight, etc.

The people in all five groups had about the same body mass index (a measure of weight for height where 25-29.9 is considered overweight – they were all about 28) and had about the same waist circumference (95 cm). And I guess those stats are interesting right there, given these were average Americans, not specifically selected for being overweight.

But one of the groups was a standout on many of the measures. They had the lowest fat consumption (just 28.9% of total calories). They had the lowest saturated fat consumption (just 9.7%). And they had the lowest cholesterol intake by a country mile (only 238mg).

This group were poster children for the low-fat lifestyle we are all encouraged to pursue. There was just one little problem, their blood work was awful. On average the folks in the low-fat group had by far the worst blood cholesterol and triglyceride (blood lipid) readings of all five groups. And they weren’t just bad, they were time-to-order-some-drugs bad.

The groupings had been done on the basis of how much added sugar was in each person’s diet (from less than 5% of calories through to 25% or more). The group that had those lousy blood results were the ones who also ate the most sugar. On average, they (1,135 people) were each eating 192 g (46 teaspoons) of added sugar per day. ‘Added sugar’ does not include the sugar in fruit, dried fruit or juices, so total sugar was likely to be appreciably higher than that.

And it wasn’t just a coincidence. As you look down the results, the amount of sugar consumed by each group directly correlated with their cholesterol and triglyceride levels. The group (893 people) that ate the least sugar (13.6 g or 3 teaspoons) had blood work right where it should be for minimal (to non-existent) heart disease risk. The high sugar folks had gained 1.27 kg in the last year. Again, weight gain consistently correlated with sugar (and not fat) consumption.

The researchers discounted the possibility that high sugar intake was just a marker for someone who ate a lot of bad food anyway. The association between sugar intake and blood lipids was independent of the fat and cholesterol components of processed foods. The link also persisted when the researchers took into account smoking, drinking and levels of physical activity. The study leaves no room for doubt that what they were observing was all down to the sugar (and the sugar alone).

The American Heart Association (AHA) is no doubt feeling pretty pleased with itself. It came out last August and told Americans they needed to dramatically reduce their sugar intake. This study backs up their advice in spades. People in the study who consume added sugar at the maximum levels recommended by the AHA (9 teaspoons per day for an adult male) ended up in the second lowest group for badness with blood fats. Not perfect, but an awful lot better than the boys and girls slugging down 46 teaspoons a day.

So what is the Australian Heart Foundation’s position on sugar? Well, not much really. They mention that “A high sugar content doesn’t necessarily make a food ‘bad’”, but point out that it isn’t so much the sugar content that’s bad as whether or not the food has other nutrients.

To our Heart Foundation, sugar is just another carbohydrate and not a particularly harmful one at that. In response to one of my earlier rants) Susan Anderson, National Director, Healthy Weight at the Australian Heart Foundation told Cardiology Update “Although associated with tooth decay… eating sugar itself is not clearly associated with other health problems.”

Surely this latest (large cohort) study finally puts a pin in that notion? Yep, sugar will definitely make your swimming togs shrink by the time summer comes around (and the odd tooth fall out), but (much more dangerously) it will also really put you on the path to death-by-heart-attack (with serious symptoms by age 38 according to these figures).

No study on fat has ever produced a result like this – ever! Not even close. So will the message on heart disease be changing here in Australia? Will we stop bagging fat and start going after the real culprit? I’m not a betting man, but I reckon the odds are slightly higher that the Storm will win the grand final – what do you think?

Big Fat Lies

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What do you do when a strategy you’ve been executing for almost 30 years is plainly not working? If you’re the nutrition hierarchy in Australia, apparently the answer is you just keep doing what you’ve always done.

In 1981, the National Health and Medical Research Council (NHMRC) published the very first set of guidelines aimed at making Australians healthier. They had published guides on what to eat since 1954 but these had been focused on the nutrients we need just to stay alive (rather than attempting to improve us).

The 1981 guidelines were different. For the first time they were aimed at preventing chronic diseases. Fat was blamed for the increasing rates of obesity and heart disease, so just like the American version (released a year earlier) our guidelines were focused on fat consumption, recommending we should ‘Avoid eating too much fat’.

And that’s pretty much how the guide has read for the last three decades. In short, fat makes you fat and sick and you should eat a lot less of it.

I very much doubt that anyone actually pores over the guidelines while they fill their shopping trolley, but many of us use them without realising it. They are the basis for the nutrition (daily intake) recommendations on every packaged food we buy. They form the foundation for every piece of advice any government agency or nutritionist gives us (from school canteens to hospitals). And every meal for our military forces is created using a policy based on the guidelines.

Because of this, the eat-less-fat message got through to us loud and clear. Between 1980 and 1995, the average Australian successfully decreased the amount of fat they were eating by 5% and the amount of cholesterol by a whopping 18%. We replaced the fat with carbohydrates (bread, cereals and sugar), increasing our consumption by 16.5%.

Unfortunately the obesity statistics went in exactly the opposite direction to our fat consumption. In 1980, two in five (39%) Australian Adults were either overweight or obese. By 2008, only two in five weren’t (62% were overweight or obese). In just 28 years, all that low-fat eating (or was it the high-carbohydrate eating?) had managed to increase the number people with a weight problem by 58 percent!

Heart disease sufferers didn’t fare much better. The number of people afflicted increased by 12% between 1989 and 1995 (despite significant advances in health care for heart patients in that period).

Evidence that fat makes you fat and sick was suspiciously lacking by the time the revised guidelines came out in 1992. And the proof that the theory was nonsense was there in spades by the time the third release hit the streets in 2003.

A comprehensive review of the evidence had been published in the British Medical Journal in 2001. It concluded that despite decades of research (and thousands of people participating in randomized trials), there was “still only limited and inconclusive evidence” that the amount or type of fat you eat makes any difference to your chances of death by heart attack.

The guidelines are currently being reviewed ahead of publication of new version (hopefully next year). So can we expect a sudden change of heart from the nutrition elite? The US experience suggests pigs may be approaching the runway before that happens.

The US guidelines are being reviewed this year as well, but they won’t be changing much because (according to Meir Stampfer, a Harvard professor of nutrition and epidemiology who worked on the 2000 guidelines) scientists on this year’s committee know perfectly well what the evidence says, but few researchers want to shake the status quo or risk confusing the public.

Here in Australia, status quo is definitely the name of the game as well. The draft update to the new NHMRC dietary guideline released this week takes 678 pages to tell us that not much will be changing.

And you don’t have to look too far to see why. The NHMRC is heavily dependent on the Australian Heart Foundation for scientific review of the evidence on fat and heart health.

Despite the fact that Heart foundation researchers have been publishing scientific reviews since 2003 that say things like:

  • “Dietary fat is not an independent risk factor for the development and progression of overweight and obesity”;
  • “Eating patterns low in fat and high in carbohydrate may not be beneficial for lowering [heart disease] risk”; and
  • “There is no direct relationship between total fat intake and the incidence of [heart disease]”,

none of that science has stopped them plastering their website with messages imploring us to eat less fat (or stopped them jumping into bed with margarine manufacturers and sugary snack makers). Maybe they’re scared the public (yep, you) will get confused by all that science?

For the last three decades the NHMRC and the Heart Foundation have been spending our hard earned tax dollars telling us to eat less fat (and by implication, more carbohydrate). For at least the last 10 years, that message has been demonstrably wrong.

Now I guess that would be merely irritating if they’d been telling us that parting your hair on the left caused bad breath (it doesn’t). But millions of real people have made daily decisions about what to shove in their mouth based on this advice (whether they knew it or not) with the direct result that they are significantly fatter and sicker than they were the day before.

Its time those we trust with our health stopped worrying about confusing our pretty little heads and started worrying about the fact that their advice is killing us. I’d rather be confused than dead. How about you?

Type II Diabetes is not inevitable

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One of the primary motivators for Kevin and Nicola’s proposed ‘reform’ of the health system is the explosion in health costs predicted in the Intergenerational Report released in February.

Kevin explains “If we do not change the system, the state and territory budgets will be overwhelmed entirely by health costs over the next 20 or 30 years to the point that their ability to do anything else would be removed,” and Nicola backs him up by pointing out that the direct cost of treating diabetes alone is projected to increase 436 percent (!) from $1.6 billion to $8.6 billion by 2032-33.

According to Diabetes Australia, those numbers are likely to be a vast underestimate. They reckon almost 15 percent of the population already suffer from diabetes (or pre-diabetes). Worse still, those numbers are going in only one direction – up, big time – because according to them, “there is no cure for diabetes”.

Diabetes is currently the sixth biggest killer of Australians, but headed for number one with a bullet. And before it kills us (and this is why Kevin and Nicola are worried), we will each probably consume hundreds of thousands of public health dollars (primarily as drugs) being treated (and not being cured).

There are three main types of diabetes (Type I, Type II and Gestational) and they are all on the increase, but the one everyone is worried about (when it comes to health dollars) is Type II Diabetes.

Type II Diabetes is variously called Non-insulin Dependent, Lifestyle or (less and less now) Late Onset, Diabetes and it currently accounts for around 95 percent of all diabetes diagnosed in Australia. It’s been a national health priority since 1996. Since then, the prevalence of the disease has doubled, so whatever we’ve been doing it aint been working too well so far.

Type II Diabetes is the end stage of a disease which starts out as failure of our ability to process carbohydrates (about 60 percent of our food). Our bodies convert most carbohydrates to glucose. In healthy people that glucose is pumped out to the cells that need energy via our bloodstream. Cells that need energy, signal their desires by moving glucose receptors to the cell surface (kinda like hanging out the “this room needs servicing” sign in a hotel).

In people who ultimately become (Type II) diabetic, something goes wrong with the “room needs servicing sign”. The receptors never get to the cell surface (or if they do, it’s in smaller numbers). The result is that the glucose goes sailing by. The maid doesn’t know the room needs her.

Because the glucose doesn’t get used by the cells (or not as many of them), it stays in the bloodstream longer and the result is a longer than normal high blood sugar concentration. People in this early stage fail 2-hour after-meal blood sugar tests but do ok on fasting blood sugar tests. If they’ve been fasting (haven’t eaten) for a while then blood sugar will have returned to normal. These people are often diagnosed as being “pre-diabetic”.

We can be pre-diabetic for decades. Eventually though, we lose the ability to clear the glucose at all and that’s when we officially have Type II Diabetes. It’s the point where we can no longer get our blood sugar levels back to normal even after fasting.

Doctors will tell you that there are all sorts of risk factors associated with Type II Diabetes. If you’ve got a high BMI, thick waist or high total body fat (all different ways of saying you’re fat), you’re in the gun. But one symptom has a much higher correlation than any of those, yet strangely it is never spoken of (probably because it’s a tad bit hard to measure). The one thing that almost always means you are on your way to Type II Diabetes is the amount of fat stored in your muscles (whether you look fat or not).

That accumulated fat in the muscles is an indication of persistent high levels of circulating fat. And it has been shown to directly interfere with the ability of cells (that need energy) to get the receptors to the cell surface. It’s like some fat guy is standing between you and the door when you want to hang out the ‘room needs a service’ sign.

So if you want to do some experiments on diabetic rats and you don’t have any handy, you can give normal rats diabetes by increasing the amount of circulating fat in their bloodstream. And the best way to do that is to feed the rats sugar. The fructose half of sugar (sugar is a 50/50 mix of glucose and fructose) is converted directly to the kinds of fats necessary to create diabetes as soon as it is eaten.

The latest in a line of studies that have tried this on humans got the expected results last year. The researchers at the University of California fed volunteers diets supplemented with fructose (at around twice the level consumed by the average American). The result was a 20 percent decrease in the effectiveness of clearing the glucose out of the bloodstream – step one on the Type II Diabetes treadmill. Other recent studies have shown that when carbohydrates (including sugar) are pulled out of the diet, Type II Diabetes symptoms are reversed.

The Californian study lasted just 10 weeks (and clearly longer term studies are needed) but red flags are waving all over the place. Sugar consumption creates exactly the kind of fat needed to turn us all into Type II Diabetics. It shouldn’t come as much of a surprise then that as our per person sugar consumption soars past 1 kg per week, Type II Diabetics are being minted at the rate of 275 per day (and counting).

But you won’t find any warnings about not eating fructose on the Diabetes Australia website. In the face of a deadly epidemic (accelerating at epic proportions) why are we not being told what the research says about sugar? Why is the government response restricted to rearranging the funding deckchairs on the titanic? And why do our healthy eating guidelines persist in advising that there’s nothing wrong with a diet that’s 20 percent sugar?

Unlike death and taxes, Type II Diabetes is not inevitable. It can be stamped out and it can probably be done easily by eliminating added fructose (sugar) from our diet. But first, those we trust with our health need to stop fighting about who pays for the amputation of our gangrenous limbs and start reading the research on sugar.

How sick do we have to get?

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A study published this week says that we are 87 percent more likely to contract pancreatic cancer if we have two cans of soft drink a week (about 10 grams of sugar a day on average). But the current Australian healthy eating guidelines say it’s perfectly fine to slurp up more than ten times that much sugar. Is there a problem here?

In the study, 60,524 Singapore Chinese were followed for 14 years (not literally, they were surveyed on their dietary habits). Their names were cross-matched with health records. Those that drank two or more soft drinks a week were much more likely to be among the 140 that had contracted pancreatic cancer in the intervening years.

Clearly the study doesn’t prove anything. You could drive a truck through it with questions like “What else did they eat?” “Did they smoke as well?” and so on. But it’s not the only recent study coming up with similar results.

A 2006 study published by the Karolinska Institute in Sweden also decided soft drinkers were in significant jeopardy, and had warnings for anyone eating sugar at all. The Swedish study began in 1997 when scientists ran a dietary survey of almost 80,000 healthy people, who were subsequently monitored until June 2005. According to the cancer registry, 131 people from this group had developed cancer of the pancreas.

The researchers were able to demonstrate that the risk of developing pancreatic cancer was directly related to the amount of sugar in the diet. The people who said that they drank soft drinks twice a day or more were 90 per cent more likely to develop pancreatic cancer than those who never drank them.

It won’t shock you to discover soft drinks are not health food, but the study went on to report that people who added sugar to food or drinks (like tea and coffee) at least five times a day were at 70 per cent greater risk than those who did not. People who ate fruit jams at least once a day also ran a higher risk – they developed the disease 50 per cent more often than those who never ate them.

As far as our bodies are concerned, a soft drink is a combination of just three things, water, glucose and fructose (the two halves of sugar). If water or glucose is the problem then we should all give up now. Water is critical to survival (if you like living more than three days) and if we were cars then glucose would be our petrol. A 2002 a study tried to tease out which food element had the greatest association with pancreatic cancer, and fructose got first prize.

The study conducted by the US National Cancer Institute identified 180 cases of pancreatic cancer from among 88,802 women who were monitored for 18 years as part of the Nurses’ Health Study. Women who were overweight and sedentary and had a high fructose intake were shown to have a 317 percent greater chance of developing pancreatic cancer.

Big Sugar’s response to the most recent study was as predictable as death and taxes. Richard Adamson, a consultant to the American Beverage Association (ABA) said in a statement “… soft drinks do not cause cancer … You can be a healthy person and enjoy soft drinks. The key to a healthy lifestyle is balance — eating a variety of foods and beverages in moderation along with getting regular physical activity.”

Well, he would say that wouldn’t he. You canna blame a man for trying (it on). After all, the ABA is in the business of selling soft drinks. The fact that he could have been reading from the current Dietary Guidelines for Australian Adults is of much more concern.

The Australian guidelines say “Consume only moderate amounts of sugars and foods containing added sugars.” They go on to explain that what that means is up to 20 percent of energy intake. For an adult male eating a 2,200 calorie diet, that is 110 grams of sugar (about three cans of soft drink) a day.

In Australia, pancreatic cancer is the fifth most lethal cancer for both men and women. Every year it kills almost twice as many Australians as Melanoma and the numbers are steadily increasing. It is also the least treatable cancer. More than 95 percent of sufferers are dead within five years of diagnosis (compared with just 7 percent for Melanoma).

None of the studies on sugar and pancreatic cancer are conclusive on their own. But taken together, there is cause for serious concern. Sugar consumption is clearly implicated in a disease which (every year) kills almost one and a half times the number of Australians as die on the nation’s highways. And yet the people we rely on for nutrition advice tell us that it’s perfectly fine to consume sugar at ten times the level which was a problem in the most recent study.

It’s time to wake up, smell the (unsweetened) coffee and act on sugar before we sentence even more Australians to death by pancreatic cancer.