A couple of days ago the British Medical Journal published on-line a piece from its editor, Fiona Godlee, wishes urges us to “start the year as we mean to go on—by promoting rational healthcare decisions based on the best available evidence.” In her piece, Dr Godlee highlights a recent assertion by one of the BMJ’s columnists – general practitioner Dr Des Spence – that many ENT operations performed on children such a tonsil removal and insertion of grommets into the eardrum are quite useless and possibly hazardous.
Godlee also points to two pieces published in the BMJ of relevance to good clinical practice. One of these questions the use of aspirin as a preventive medicine for cancer and cardiovascular disease, by highlighting the evidence which suggests this practice does not reduce the risk of death overall. The other piece examines the issue of the widespread practice of prescribing newer, much more costly forms of insulin to diabetics, despite the fact that the evidence suggests they are simply not worth the additional expense. You can read Dr Godlee’s editorial here.
I applaud the BMJ’s apparent desire for medical practice to be based on the best evidence. And this reminded me just how much of conventional nutritional practice lacks any substantial evidence base. This got me thinking that today I might write a Christmas wish-list of my own for humanity. In no particular order, here are some things I wish were more widely recognised.
1. For weight loss, neither ‘eating less’ nor ‘exercising more’ appears to work particularly well in the long term. While the calorie-principle has underpinned weight loss advice for some decades, its application in the real world has, generally speaking, been a crashing failure.
2. Low-fat diets are not effective, overall, for weight loss either (despite what most doctors, dieticians and health agencies would have us believe).
3. Low-carbohydrate diets generally outperform low-fat diets for weight loss, and also lead to greater improvements in a number of disease markers including triglyceride levels, blood sugar levels, blood pressure and measures of inflammation.
4. Low-carb diets have the potential to improve blood sugar control in diabetics, and often lead to much lower requirements for medication, and quite-often, the ability to dispence with medication altogether.
5. Lower-carb diets tend to be more satisfying than higher-carb, low-fat ones, which means individuals quite naturally tend to eat less (sometimes a lot less) without hunger.
6. There is no good evidence that saturated fat (found, for example, in meat and dairy products) causes heart disease.
7. There is no good evidence that eating less saturated fat has benefits for health.
8. There is no good evidence that taking dietary steps to reduce cholesterol has broad benefits for health.
9. There is no good evidence that margarine is healthier than butter (and at least some evidence exists which suggests quite the reverse).
10. There is no good evidence that artificial sweeteners such as aspartame promote weight loss, and considerable evidence exists which suggests they have the potential for adverse effects on health.
11. There is no good evidence that insoluble fibre (e.g. bran) has benefits for health.
12. Fructose is not a ‘healthy sugar’, and despite the fact that it does not raise blood sugar levels in the short term, it nonetheless has the capacity to damage health.
13. The consumption of dairy products is not required for good bone health (we did fine without it for over 2 million years, by the way).
14. Not all of the nutritional information we get is in our best interests, and is often driven by a motivation for profit. That’s one of the reasons why, some of the time, there can be a yawning abyss between what we’ve been told repeatedly for decades and the truth of the matter as revealed in the science.
I’m sure there’s others I’ve forgotten, but that will do for now.
I’d also like to take this opportunity to thank the readers of drbriffa.com for stopping by, and for your kind words of appreciation and support over the last year. Merry Christmas/Happy Holidays!
Dr. Briffa,
I wish you had included a comment about omega-6 lenoleic acid in your wish list. While many are aware of problems associated with excess omega-6 intake, it seems that few fully appreciate the magnitude of the omega-6 seed oils problem. The damage to the public health is way beyond what is currently imagined. Just Google some combination the words lenoleic acid or omega-6 along with any of the major physical or mental disturbances. if you do this enough, you’ll see what I’m getting at.
Examples:
Omega-3 omega-6 balance
omega-6 obesity
lenoleic acid obesity
omega-6 heart disease
etc
I am a Registered Dietitian and I say Amen to that! I have exactly the same wishes for the upcoming years… slowly but surely! Thanks for your amazing work.
Thank you for democratising health by giving us unbiased and uncompromised information, Dr Briffa.
You’ve given us, the patients, an alternative to institutional diktats on health, very many of which, as you continually demonstrate, are based on nothing but ulterior motives.
Have a great Christmas season! And keep up your great work in 2011!
A terrific list that would undoubtedly improve the health of humanity greatly if promoted as assiduously as the standard (and wrong) nutritional advice has been. You do a great job. Thanks again for your effort.
Thanks Dr Briffa, I enjoy your newsletters and wish all doctors thought like you.
I see you are on the butter and bacon bandwagon. Why no mention of fruits or vegetables? Of all types of eating paterns, high fibre has one of the strongest associations with healthier body weights.
Love your list (I’ve been reading for quite awhile so none of it is a surprise) — I’m hoping to persuade my husband to believe it all too.
Enjoy the holidays!
Hi Doc. John,
please forgive the familiarity, but over this past year or so, I have come to see you as a light in the darkness and (seemingly) total confusion that surrounds diabetes – a friend that imparts sound reasoning and good advice. It certainly seems that diabetes is a matter close to your heart, and I thank you for that.
I would like to ask if you could maybe set up a ‘Peer Forum’ – in which we victims of ignorance and apathy can share our thoughts, experiences and recipes etc., amongst ourselves. I certainly would not expect you to actually run this Forum, as I can well imagine that you do not have too much spare time at all, but would ask if you could simply monitor it and point out things that you, as a doctor, disagree with or feel are wrong and counter-productive – and maybe even encourage or support things that you feel are beneficial to us.
I wish you and your family all the very best for Christmas and the New Year – and please ‘Blog till you drop’.
Thanks again,
Derek Cridland.
“ENT operations performed on children such a tonsil removal and insertion of grommets into the eardrum are quite useless and possibly hazardous.”
I suffered from earache and glue ear 50+ years ago, from infancy to teens. I had my tonsils and adenoids removed at 5 years of age. I had grommets inserted several times. Retrospectively I believe that wheat/gluten/other grains were the root cause of my problems. Which have seriously affected my life and health up until 5 years ago, when I started to avoid, and for the past 3 years completely removed from my diet.
I would suggest that gluten/grains intolerance is missing from your list, and should indeed be up there at the top end. This problem is far more widespread than we know.
couldn’t agree more
definitely add omega6, soy and the food pyramid to the list !!
Great list John! I wholeheartedly agree!
Thank you once again for all your stunning work. You truly are an inspiration to other health professionals like myself. I look forward to hearing more from you in the New Year.
Cheers,
Jamie
Please also add avoiding processed foods; thereby avoiding the majority of your 14 items!
Your Blog is a breath of fresh air and commonsense. Thank you. I look forward to an interesting 2011.
I see no reason here to specifically point out issues regarding dairy products as unnecessary for bone health. If there are no issues per se with saturated fats and protein intake than surely dairy poducts are a fine and satisfying way to obtain these. I noted several times wherein you, Dr. Briffa remark on enjoyng high fat yoghurts for meals and thus, you personally do not have issues with its ingestion. The implication for those that do not read your blog or columns regularly as I do is that perhaps you are not suggesting that those that wish, might very well continue to eat dairy. Furthermore, high protein containing yoghurts are a fine way to lower one’s hunger and is a good substitute I suggest for that bun or piece of pie in the afternnon is it not? As well, high insoluble fibre is a great way to slow down one’s digestion and thus maintain a longer time between meals for those on a weigh control regime. I eat a lot of all those foods mentioned here and have dropped 27 kg in so doing and will continue this regime for life content and enjoying the foods that I now choose to eat..along with a lot of fruits and vegetables by the way.
“For weight loss, neither ‘eating less’ nor ‘exercising more’ appears to work particularly well in the long term. While the calorie-principle has underpinned weight loss advice for some decades, its application in the real world has, generally speaking, been a crashing failure.” For health reasons, ‘move more’ is a necessity. See Physiological and health implications of a sedentary lifestyle.
In practical terms, ‘move more’ can be problematical, as it often results in ‘eat much more’ due to appetite increase and post-exercise bingeing. One solution I’ve found is to exercise (e.g. go for a walk) just after eating a meal.
Adopting a low-carbohydrate diet definitely helps with the ‘eat less’ part.
Merry Christmas from across the pond!
I think the suggestion above about a user thread is a great idea. There are probably other sites that have this element already incorporated. I have seen only one. Marksdailyapple.com. As a result, Mark made a user created cookbook for all to use freely.
I really loved how you spoke about eating less. I’m a fan of fasting and we need to lose the mentally of “eating healthy foods to lose weight.” We need to turn towards the mentality of not eating, but when we do eat, eat healthy foods. That’s one of the major psychological problems people have with losing weight.
You are also right to talk about dairy products. I took a class from a professor at the Harvard School of Public Health and that spoke about this. Milk is not needed for calcium. Osteoporosis is caused by Vitamin D deficiency, not calcium deficiency. We need to take Vitamin D supplements. In addition, milk is high in progesterone and estrogen and she specifically stated “Milk is disease promoting.” It obviously increases the risk of prostate cancer. Anyway great post man! I’m a pre-med student at the Harvard University extension school, I write about health and nutrition too. Sodium intake is a big topic for me… we need to eat way less of it because it causes high blood pressure.
Here’s a post I wrote about how to reduce sodium intake: http://applebananacoconut.com/2010/12/27/tips-for-reducing-sodium-intake/
Hope you have a happy and healthy new year! Im subscribing! Cheers
Dr John,
A very Happy New Year to you and yours. Keep up the good work in providing sound advice on nutrition to the general public.
I would strongly recommend to readers to do themselves a favour and acquire either the True You Diet or Waist Disposal for Men or both as a new years gift and keep as a reference source for a more healthy lifestyle. This will prove a very wise and worthwhile investment. Continuing good health