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!