Advice against eating fat was wrong. It is time the experts admitted it

Last week the newspapers had a field day — it was the battle of the diet guidelines. A breakaway group of health professionals calling themselves the Public Health Collaboration (PHC) had dared to pick apart and criticise the government’s Eat Well guidelines and produced their own alternative healthy eating guidelines. The medical and governmental establishment — mainly responding to the sensationalist press headlines — retaliated and created their own headlines. Who were these usurpers? Was it not responsible to say to the poor old public: ‘Calories don’t matter and eat as much fat as you want!’ What qualifications did they have and what shadowy agenda and backers? Why didn’t they have more references for their claims? There were personal attacks and claims of foul play by groups who claimed they had not been consulted.

The headlines generated their own story. Few people probably read the PHC new guidelines or the full Eat Well report from the government they were trying to replace. It became a battle of fat vs sugar. Both sides picked on the dodgy science of the other, there was no compromise and there were no winners except the media. The establishment, although critical of the low-carb approach of the newcomers, believed that attack was the best form of defence and didn’t bother to scientifically defend their clearly out of date guidelines — which recommend, for example, that we avoid saturated fats (which means dairy, nuts and olive oil) and that we eat more starchy carbs (rice and pasta).

The low-fat guidelines have been largely inherited from the US. Early studies from the 1970s were based upon correlations between death in different countries and the types of food eaten, and these studies were taken as gospel truth by government diet experts around the world. Recently all of these early studies have been re-analysed and found to be fundamentally biased as well as misleading.

About one per cent of the population have a genetic mutation which means they can’t effectively process fats in their diet and do well to avoid high-fat foods; for the rest of us, however, low-fat diets offer no proven long-term benefits and new evidence in fact shows they may actually be harmful.

For many years fat was the perfect enemy for governments providing a simple public health message and the food industry was happy to go along with it since it benefited financially from low-fat alternatives with added chemicals and cheap protein from soy. But most ‘real’ food is made up of a wide variety of different fats and, if not consumed excessively, may actually be good for us.

The real test of whether fats are good or bad doesn’t come from studies on lab mice or blood samples from humans over a few weeks, or even very large observational population studies. The real test comes from large clinical trials following people for years. There are sadly very few of them, but the Spanish government funded the biggest study of its kind called the PREDIMED study based on 7,000 men and women aged 60 at risk of heart disease. They were randomly allocated to one of two diets: a medically approved low-fat diet without dairy or fatty meats or a high-fat Mediterranean diet with lots of cheese, yoghurt, nuts and extra virgin olive oil. The study was stopped early after five years because one diet group was dying more and had a third more diabetes, heart attacks, strokes and breast cancer — you guessed it: the low-fat group.

This study, published in the New England Journal of Medicine in 2013, has been largely ignored in the UK and in the most recent debate. Despite the adverse health effects of restricting fat at the expense of carbs, it seems there is no stopping the lucrative low-fat food industry. Belief in the benefits of the varied high-fat Mediterranean diet is slowly growing among the informed public, if not yet embraced by the medical profession.

So why do government and NHS experts persist in repeating false dogma about fat and skipping meals and the power of calorie-controlled diets long after their sell-by date? Well, they probably feel that if they back down and admit their mistakes they lose credibility and won’t be believed again.

What about the rebel PHC guidelines? There is certainly plenty of sensible advice in the document and good reasons for them to attack the conventional wisdom on saturated fats — which needs re-writing urgently. However, the authors appear to have become entrenched in their own anti-carb views and make the same mistakes, going a step too far and now basing their new guidelines on fragile short-term evidence of the ‘low-carb diet’ and of healthy extra fats as well as putting emphasis on the dodgy glycaemic index of foods which has never (like saturated fat intake) been convincingly linked to poor health long term.

The battle for the nutritional high ground is too important to be left to evangelical groups defending their positions and measuring how many grams we are allowed. We forget that there are many areas nearly everyone agrees on — avoid processed food, reduced refined carbs, eat more fresh fruit and veg.

As for me, I don’t think we should try and eliminate any real food items to the detriment of our health. We should now accept that most of the advice and guidelines we get are based on flimsy science that deserves to be constructively challenged. The government should issue its guidelines with a warning that the evidence is shaky until big trials prove their worth. Meanwhile, I will continue to enjoy eating both fat and carbs — as long as they are part of a varied, high-fibre, Mediterranean-style diet — with plenty of high-fat unpasteurised cheese and extra virgin olive oil.

Tim Spector is professor of genetic epidemiology at King’s College London, honorary consultant physician at Guy’s and St Thomas’s Foundation Hospitals and author of The Diet Myth: The Real Science Behind What We Eat

  • Zarniwoop

    I gave up listening to these diet quacks a long time ago.

    Most of their suggestions and guidelines are base quackery and seem only to be designed to gain them fame/notoreity

  • JonathanBagley

    Where, these days, are the best places to buy unpasteurised cheese? Do any of the major supermarket chains stock it?

    • squishbean

      Depends where you are Jonathan. Probably a good farmers market?

  • Anthony Brown

    Well l actually reversed my T2D And lost 4st by following a lowcarb diet, it,s all out there on the Web,why they call it high fat I don,t now ,use butter ,leaving the fat on meat that’s sort if thing,eating loads of nice green leafy veg ,peppers ,why these dietions don,t let there patients give it a try I don’t now ,cost nothing ,if a retired brickie can reverse his diabetes without any help from NHS dietions something is very wrong and needs sorting out

    • Thomas Jones

      Did you read what Tim Spector said about carbs? Do not go low carb, eat sourdough bread, wholegrain carbs, yams, potatoes. Just follow his advice.

      • Tarek

        The advice to eat grains, potatoes etc is to eat high glycemic index carbs which will destabilise blood sugar. Not a problem in non-diabetics, a major issue however in the obese and diabetics.

        • Thomas Jones

          Utter bull! Resistant starch is necessary for a healthy gut environment. Everyone, everyone..needs resistant starch.

          • Tarek

            Resistant starch is present in higher amounts in green bananas. Furthermore fermented foods like sauerkraut contribute to gut health without the glycemic destabilization

            Diabetics have a hard enough time eating right in a carb-heavy society without being advised to eat high glycemic carbs whose other benefits can be found elsewhere

          • Thomas Jones

            Stop trying to be mr knowall. Baked potatoes cold are fantastic sources of resistant starch, as is toast cooled down, and lentils and beans. One need to eat a varied diet with wholefoods playing a very very important part.

          • Great: I love bananas best when they show a hint of green in their skins.

          • So carnivores suffer from chronic digestive issues? Might want to check with the Masai herdsmen on that.

          • Thomas Jones

            Where did I mention chronic digestive issues? Oh the Masai..well they eat tubers, honey, and resistant starch!!

  • George

    When I read the PHC-UK document, I got the impression that it mentioned the GI index in passing, criticised a fault with it (peas have the same GI as sugar), then suggested a more useful alternative, carbohydrate density (CD).
    I have always used CD (%, or grams of carbohydrate per 100g) for solid foods and find it gives a good idea how much they’ll increase my blood sugar.
    It’s also the case that the PHC-UK guidelines come in two parts – low-carb guidelines for those with the challenge of reversing their obesity or T2D, and flexible guidelines for those who want to stay healthy. These latter guidelines are exactly what you’re advocating here – real food items aren’t eliminated (whole rice, fermented bread, and beans are there) but are placed in a context where carbohydrate-dense foods no longer dominate the diet.
    You can check out the full PHC-UK diet recommendations here:
    The low fat, low saturated fat Eatwell type diet was introduced for diabetes without any comparative test to see if it was better than the low-carb diet, which was the existing standard-of-care. This was an act of medical negligence.
    The tests have been done subsequently, and the low carb diet has always outperformed the low fat diet. This mistake should have been corrected long ago.

  • Robert Simms

    Is the ‘one percent’ referring to familial hypercholesterolemia? If so, before the boom in processed foods, FH was associated with longevity.

    • Wikkel Spies

      The really resonates. Many thanks. I am FH and this has caused problems with my doctors throughout my life (now 69). I have now refused further statin treatment because of side effects, because an angiogram is clear AND because the spectacularly beneficial effects of LCHF. TRG ; HDL ratio of 0.41. Have been on aspirin for 30 years and this is what has been the real life saver as revealed in the BMJ article you mention. Again…..many thanks

      • Dr Ravnskov offers his book The Cholesterol Myths for free due to publishing issues. From this page on his site:
        Follow the ‘Smashwords’ link, then click on the PDF button to download it as such.
        See p. 51 for FH specifically.

        He co-authored this 2015 paper, which is how I first heard of him
        ‘How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease’

        • Wikkel Spies

          This is great. Thank you

  • Leo Pemberton RD

    The healthy eating guidelines DO NOT recommend the exclusion of olive oil, dairy or nuts. The predominant fatty acid in olive oil is mono-unsaturated, NOT saturated. A hastily written article methinks.

  • Erik Arnesen

    Please… in that PREDIMED trial, the “low-fat” group ate 37 % fat, only about 4 % less than the “high-fat” group. Hence, they compared two high-fat diets, but one was a Mediterranean high-fat diet, the other was a western diet. The latter was NOT a low-fat diet. Anyway, at no time has there been an official recommendation to “avoid fats”. The premise of this article is false.

  • You ought to be able to recognize that the demonizing principle jumps ship – such that we grow to become the thing we hate – unless of course we recognize the hate as the driver of the demonizing device and choose not to use it.
    I’m glad you are focusing on real food as opposed to the adulterated or heavily processed ‘food’ that suits the logistical and distribution needs of corporate cartels. The kind of carbs makes a big difference as with fats. But also the effects of many pesticides and herbicides on our gut bioflora affects the ability of the body to metabolize particularly refined carbs.
    There are positive synergies of benign influence as there are negative and isolating co factors to assign magical healing or demonic powers is part of the attempt to validate and reinforce identity based in conflict – or it would not be driven so.
    Our gut biogenome is unique – regardless being an identical twin – and so the effects of diet are unique. General guidelines with accommodation for diversity within them – for some thrive on what others cannot survive – and they do not need demonizing or invalidating for being ‘different’ to a church of technocracy in which the one true diet or any other freedom of discovery and association – is used to conform or negate all else to its model.
    The corruption of science is the same patterning as any other – involving institutional ego as an investment in fear of loss. A diet of persistent fear makes hollow of Life – reducing consciousness such that only the impending breakdown of the model can catalyse awakening from a false investment.
    A good teacher makes themselves obsolete – and healthcare is not about generating and ever larger capture of addiction to sickness management – so as to prove and justify investment in the model!
    But addiction to power operates beneath the masks of social or even personally accepted ‘reality’.
    Our environment includes our thought – and the tacitly agreed definitions or model of reality that we operate – largely unknowingly – generates the feelings and perceptions from which we tend to grow our personality strategies for surviving WITHIN such conditioned parameters.
    The influence of cartels of wealth and power in key moments can and does direct perception of reality. The lobbies that promoted the mistaken or fraudulent vilification of cholesterol and saturated fat found a key moment in Ancel Keys – who was an economist making associations that are like blaming fire appliances for causing fires because they are found at the scene. But note the investment in demonizing anything is inversely proportional to the power that is then assumed and identified in self righteousness. Power in this sense is corruption from the outset. Science does not need engage in fighting un-truth so much as sharing in true communication – that is in honesty and transparency. This is a tall order for human beings – because we are human beings and not dis-embodied minds untainted by power struggle of conflicted identity seeking reinforcement in validation.
    But honesty is our bedrock – for without it insanity runs unchecked. War is the condition in which truth is the first casualty. And so honesty is uncovering the truth of what seems irreconcilably conflicted or un-resolvable.
    Joy of appreciation and gratitude for being is a primal contextual diet. Anxiety is toxic if not immediately brought to light and transformed. Fear feeds fear to grow monstrous in the dark. Reason is also Light.

  • Callipygian

    Even ‘Mediterranean’ diet is hardly realistic: what does it mean? As one or two journalists have pointed out, there is no one ‘Mediterranean’ cuisine. But there IS a way of eating, which tends to stress whole, fresh, and naturally pickled foods. But then, so did the pre-war British way of eating. The use of ‘Mediterranean’ as a term is a glamour sell. It means ‘eat much as British people used to do, only substitute olive oil for butter’. Guess what? Butter is arguably as good as olive oil for most people and in most cooking contexts. The only thing you can’t do is drizzle it on salads.