Australia's health star ratings farce

The Guardian has published a fantastic report, entitled the Sugar Conspiracy, which argues that sugar, not fat, is behind the world's rising 'diabesity' (diabetes and obesity), and questions how the world's nutritional scientists got it "so wrong for so long":

In 1972, a British scientist [John Yudkin] sounded the alarm that sugar – and not fat – was the greatest danger to our health. But his findings were ridiculed and his reputation ruined. How did the world’s top nutrition scientists get it so wrong for so long?...  

We read almost every week of new research into the deleterious effects of sugar on our bodies...  

This represents a dramatic shift in priority. For at least the last three decades, the dietary arch-villain has been saturated fat. When Yudkin was conducting his research into the effects of sugar, in the 1960s, a new nutritional orthodoxy was in the process of asserting itself. Its central tenet was that a healthy diet is a low-fat diet. Yudkin led a diminishing band of dissenters who believed that sugar, not fat, was the more likely cause of maladies such as obesity, heart disease and diabetes. But by the time he wrote his book, the commanding heights of the field had been seized by proponents of the fat hypothesis. Yudkin found himself fighting a rearguard action, and he was defeated. Not just defeated, in fact, but buried...  

In 1980, after long consultation with some of America’s most senior nutrition scientists, the US government issued its first Dietary Guidelines. The guidelines shaped the diets of hundreds of millions of people. Doctors base their advice on them, food companies develop products to comply with them. Their influence extends beyond the US. In 1983, the UK government issued advice that closely followed the American example.  

The most prominent recommendation of both governments was to cut back on saturated fats and cholesterol (this was the first time that the public had been advised to eat less of something, rather than enough of everything). Consumers dutifully obeyed. We replaced steak and sausages with pasta and rice, butter with margarine and vegetable oils, eggs with muesli, and milk with low-fat milk or orange juice. But instead of becoming healthier, we grew fatter and sicker. 

Look at a graph of postwar obesity rates and it becomes clear that something changed after 1980. In the US, the line rises very gradually until, in the early 1980s, it takes off like an aeroplane. Just 12% of Americans were obese in 1950, 15% in 1980, 35% by 2000. In the UK, the line is flat for decades until the mid-1980s, at which point it also turns towards the sky. Only 6% of Britons were obese in 1980. In the next 20 years that figure more than trebled. Today, two thirds of Britons are either obese or overweight, making this the fattest country in the EU. Type 2 diabetes, closely related to obesity, has risen in tandem in both countries.  

At best, we can conclude that the official guidelines did not achieve their objective; at worst, they led to a decades-long health catastrophe...  

Today, as nutritionists struggle to comprehend a health disaster they did not predict and may have precipitated, the field is undergoing a painful period of re-evaluation. It is edging away from prohibitions on cholesterol and fat, and hardening its warnings on sugar, without going so far as to perform a reverse turn...  

In 2008, researchers from Oxford University undertook a Europe-wide study of the causes of heart disease. Its data shows an inverse correlation between saturated fat and heart disease, across the continent. France, the country with the highest intake of saturated fat, has the lowest rate of heart disease; Ukraine, the country with the lowest intake of saturated fat, has the highest. When the British obesity researcher Zoë Harcombe performed an analysis of the data on cholesterol levels for 192 countries around the world, she found that lower cholesterol correlated with higher rates of death from heart disease.  

In the last 10 years, a theory that had somehow held up unsupported for nearly half a century has been rejected by several comprehensive evidence reviews, even as it staggers on, zombie-like, in our dietary guidelines and medical advice...  

The UN’s Food and Agriculture Organisation, in a 2008 analysis of all studies of the low-fat diet, found “no probable or convincing evidence” that a high level of dietary fat causes heart disease or cancer. Another landmark review, published in 2010, in the American Society for Nutrition, and authored by, among others, Ronald Krauss, a highly respected researcher and physician at the University of California, stated “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD [coronary heart disease and cardiovascular disease]”.  

Many nutritionists refused to accept these conclusions...  

Biochemists and endocrinologists are more likely to think of obesity as a hormonal disorder, triggered by the kinds of foods we started eating a lot more of when we cut back on fat: easily digestible starches and sugars...  

Fat takes instruction from insulin, the hormone responsible for regulating blood sugar. Refined carbohydrates break down at speed into glucose in the blood, prompting the pancreas to produce insulin. When insulin levels rise, fat tissue gets a signal to suck energy out of the blood, and to stop releasing it. So when insulin stays high for unnaturally long, a person gains weight, gets hungrier, and feels fatigued...

The article is a brilliant dissection of the nutritional debate - possibly the best that I have read in a newspaper since Gary Taubes wrote "What if It's All Been a Big Fat Lie?" way back in 2002.

The sad thing is that Australia's nutritional science establishment is yet to move on from the "saturated fat is bad, carbohydrate is good" mindset, which is why both the Government's Health Star Rating system and the National Heart Foundation Tick program are fundamentally flawed.

Consider the below farcical examples of these programs. How is it that natural virgin coconut oil receives only a half star health rating (because it contains over 90% saturated fat):





And natural full fat Greek yogurt receives only 1.5 stars:



When highly processed margarine, chock-full of inflammatory omega-6 polyunsaturated fat, receives the Heart Foundation tick:



And sugary low fat yogurt receives a 3-star health rating:



The farce is even worse when it comes to breads and cereals. Somehow crappy processed white bread, which is guaranteed to spike your blood sugars and insulin, receives the Heart Foundation tick:



And do you fancy some sugar with your breakfast? Check-out the below highly processed cereals that receive a healthy 4-star rating and Heart Foundation Tick despite each containing more than 20% sugar:



Or maybe you are too busy to eat cereal? No worries. Just down a processed sugary chocolate-flavoured "Up and Go" milkshake, which receives a farcical 4.5-star health rating:



Or a 26.8 grams per serve of sugar glass of reconstituted apple juice, which receives a 5-star rating:



Or a sugary processed "Roll-up", which contains 26.7% sugar, but somehow still manages a 3-star rating:



Or a couple of sugary muesli bars, which receive a 4-star rating despite containing around 20% sugar:



What should be abundantly clear from the above examples are that the Government's Health Star Rating system and the National Heart Foundation Tick program largely ignore the high amounts of sugar in processed foods, while wrongly demonising saturated fat. According to their own systems, a "healthy" breakfast would look something like the following:

• Two slices of white bread (Heart Foundation Tick - see above);
• One serve of Rice Bubbles Multigrain (4-star rating - see above); and
• One serve of apple juice (5-star rating - see above).

Just by consuming these alone (i.e. ignoring the milk and condiments), someone would ingest:

• 75.5 grams of carbohydrates of which 35.3 grams are sugar (roughly 8 teaspoons worth);
• 9.1 grams of protein; and
• 2.3 grams of fat.

Given the way that the different macro-nutrients affect blood sugar levels and insulin:



Is there any wonder why diabesity is a growing epidemic in Australia?

As long as they continue to view natural saturated fats as inherently bad and refined carbohydrates and sugars as benign, following the advice of the Government's Health Star Rating system and the National Heart Foundation Tick program is very likely to do more harm than good.

Australia needs more than a sugar tax to curb diabetes

A leading Australian expert on diabetes, Professor Stephen Colagiuri, has called on the Australian Government to follow the UK's lead and implement a tax on sugary drinks to help curb the epidemic of Type-2 diabetes. From The ABC:

Professor Stephen Colagiuri was the only Australian contributor to the World Health Organisation's (WHO) inaugural global report on Diabetes.  

According to the report, the number of people worldwide with diabetes has quadrupled since 1980, with an estimated 422 million adults living with the disease in 2014. 

Globally, diabetes and higher-than-optimal blood glucose together caused 3.7 million deaths.  

Professor Colagiuri said Australia was about average in the total number of people with diabetes. 

"We are also regrettably average in the increasing rates of diabetes that we see in Australia," he said.  

"And we're fairly high up on the list of countries with regard to overweight and obesity, which is a major driver of diabetes."  

Professor Colagiuri said a sugar tax was one way the Government could tackle the problem...  

"A sugar tax will clearly not be the only solution to the problem, but there has never been a successful public health intervention which has not involved some form of legislation and regulation, and leaving the changes to be made on a voluntary basis simply doesn't work," he said.

Placing a tax on sugary soft drinks would be a great start but no panacea.

Australia has one of the highest sugar consumption rates, along with the USA, Brazil, Argentina and Mexico. These countries each clock in at more than double the world’s average sugar consumption:




Australia is also one of the most obese nations on earth:



There are several channels in which sugar drives obesity.

First, sugar is a simple carbohydrate made up of two molecules, glucose and fructose. This bond is split-up in the stomach before being absorbed. Research shows that glucose primarily drives fat storage under the skin, whereas fructose deposits visceral fat around organs, such as the liver.

Worse, excess sugar intake can accelerate the development of Type 2 diabetes. When extra liver fat is made, that ends up obstructing the workings of the liver, and you can end up with 'insulin resistance', which is a precursor to Type 2 diabetes. Basically, the liver doesn't work effectively, so the pancreas has to excrete extra insulin in order to shift blood glucose into your cells. This insulin also tells your body not to burn fat for energy, thus making your body store fat.

Second, sugar manipulates the hormones insulin and leptin, thus turning-off the receptors that make us feel full. It is particularly dangerous when disolved in things like soft drinks, since it is instantly and easily absorbed.

Type 2 diabetes is growing quickly in Australia. According to Roy Morgan Research, people diagnosed with some form of diabetes increased from 915,000 to more than 1.2 million between 2007 and 2015, a growth driven primarily by the rise in Type 2 diabetes, which accounts for just over 90% (1.1 million) of cases.

Therefore, given sugar's unquestionable role in 'diabesity' (diabetes and obesity) in Australia, there is strong justification for curbing its consumption, including via a sugar tax.

That said, the epidemic of Type 2 diabetes extends beyond just sugar to the over-consumption of refined carbohydrates in general.

Since the Australian food pyramid was first introduced in 1982, it has told Australians to consume large quantities of high glycemic foods, such as breads and cereals:



This food pyramid remained largely unchanged for 33 years until the pyramid was improved in 2015 to promote the importance of unrefined carbohydrates like vegetables and lessen the importance of refined carbohydrates like breads and cereals:



Common amongst both pyramids, however, is the recommendation to consume large quantities of carbohydrates and minimise the consumption of fats.

The problem with this recommendation is that consuming carbohydrates generally elicits a strong glycemic response (i.e. raises blood sugars quickly) whereas consuming fats elicits almost no glycemic response (i.e. keeps blood sugars stable):



Therefore, if the government truly wants to prevent diabesity, the logical answer is to encourage people to cut-out refined carbohydrates (including sugar) and replace them with unprocessed natural foods that are high in fat (including saturated fats).

This way of eating makes you feel full, keeps blood sugars low, lowers the body's insulin response, and prevents insulin resistance and diabetes.

It's also interesting to note that the Roy Morgan Research study on diabetes showed that diabetics are far more wedded to a low fat lifestyle than ordinary Australians:



Here's a thought. If they shifted their food consumption away from refined carbohydrates towards natural fats, then their blood sugars would be lowered as would their requirement for insulin.

The message is simple. To reduce the epidemic of Type 2 diabetes and obestity across the population, the dietary guidelines should be shifted towards a natural foods based diet that minimises the consumption of refined carbohydrates and maximises the consumption of natural fats.

This article first appeared at MacroBusiness.com.au. You can read it here.