Dr. Zoë Harcombe on the Mess: The Money vs. the Evidence

thank you very much a few thank-yous to
start off with first of all thank you Greg as Pat said without Greg we all
wouldn’t be here so thank you for who you are and for what you do and thank
you very much for inviting me to be with you today I they want to thank Karen
because the direct invite came from Karen I’ve known Karen since the South
African conference that was put together for Professor Tim notes and she is quite
simply amazing I think everybody would agree with that
and I’d also like to thank Brad and T on their logistics in getting us here and
getting us ready work quite superb so thank you to all of those people
especially alright so I want to talk about the money versus the evidence in
the context of the mess and you’ve seen this great graphic outside this room if
any of you haven’t heard me speak before I tend not to clutter up my slides with
references but there are a lot of references so if you want to go to my
site forward slash CF for CrossFit 19 all the references are on there and I
recommend the very first reference highly because it’s an article called
the mess written by Greg and to sum up the mess it’s basically the escalating
disease the escalating medical costs which many people are profiting from but
none are combatting effectively and that sums up what the mess is all about so
imagine you’re a multi-million dollar food company advice that supports your
products would obviously be very helpful public health advisors who promote your
products would be very helpful too and those public health advisors having a
monopoly on promoting your products now that would be super really helpful but
that is exactly what is going on in the u.s. then when I wrote my obesity book
it was back in 2010 it’s one of the books out in reception there’s passages
I look at and I think I would really love to update those especially the
dietary fat stuff and those passages I’m pleased that I was writing about ten
years ago and in the conflicts of interest chapter I looked at the
sponsors that were partnered with the American Dietetic Association
as it was known then and those were some of the household names now behind those
organizations at the time I was doing this research ten years ago four hundred
and sixty seven billion dollars behind the American Dietetic Association now
wind forward to today they now call themselves the Academy how arrogant is
that of nutrition and dietetics they have a different set of sponsors
and they only now have about a hundred billion in back in now if you go to the
most recent Dietetic report for the Academy of Nutrition and Dietetics their
revenue amounts to 2.8 million so they are doing a shared load of stuff on very
very little money and I suspect because it’s got this kind of back in behind
that organization now where does the monopoly come in well there was an
organization called the Commission on Dietetic registration that was set up in
1969 and as of this month a hundred and four thousand dietitians and
nutritionists are registered with this organization and there are legislative
bills in almost all the states in the US so where you’ve got the red states those
have the full monty of protection for the dietitians and the nutritionists who
had given out in essence the fake food company advice and so there are 27 of
those and the District of Columbia you’ve then got seventeen in green
they’re the next level down they’ve got a protected title situation but it has
the same effect if you’re not a registered nutritionist or registered
dietitian according to their advice you can’t practice in those states you’ve
got three in the yellow that have a degree of protection but you’ll still
find it difficult to have a carte blanche advice consultation operation in
those three states and then let’s hear it for the three rebels because you’ve
got Michigan Arizona and New Jersey beautifully positioned there in white
who’ve said so far and they’ve held out we’re just not having this and you can
see the organization behind that on these sides but it creates a conflict
because we’ve basically got the law because on the left hand side you’ve got
a very typical extract from those acts that operate in
those states this one just happens to be from Illinois but it’s basically saying
if you’re trying to practice without being licensed under this act
then you’re committing I think it’s a class 1 misdemeanor in most states you
can be prosecuted you can’t be fined I don’t think they go as far as throwing
you in jail but every time you offend you can be fined so if you ignore the
ban and and offend again you get fined again but that clashes right up with
your fabulous First Amendment because your First Amendment which is not shared
by other countries in the world we’re fighting for free speech at the moment
you’ve got a First Amendment that says you’ve got a right to say what you feel
and what you believe and where does that stack up well before I even knew some of
the things that were going on with CrossFit I’d prepared this presentation
when I was back in Wales and there were a couple of cases that really really
caught my eye I had no idea that CrossFit are actually involved in these
cases that this is a guy called Steve Cooksey and Steve Cooksey was
catastrophic ill so he was chronically obese he was a couch potato these are
his own words he was really an unhealthy guy and he was rushed to hospital almost
into a coma and they said to him you’ve got type-2 diabetes and so therefore
you’re now going to be on insulin and drugs for the rest of your life and you
now need to eat a low-fat high-carb diet a cook sees quite a challenging kind of
guys so he said this doesn’t really make sense I’ve got a condition whereby I
can’t handle glucose and they’re telling me effectively to eat glucose so he did
the opposite and he lost 78 pounds and he put his type 2 diabetes into
remission and he looks like he does now but that’s when he came across the
legislative powers of the dietitians and the nutritionists who are protected so
he started his blog sharing his own story because he wanted to inspire other
people you don’t have to take this advice that you’re being given and his
blog started in 2010 but it was when he started an advice column on his site and
it was called Dear Abby just a fictitious person send in your queries
I’ll give you back my opinion and that’s when the dietitians kicked into touch
so by January 2012 off he had notifications from the North
Carolina Board of Dietetics and nutrition that he was essentially
practicing without a license now in May 2012 this organization here the
institute of justice helped him with his lawsuit and CrossFit are helping both of
them so they took on the case on the basis of the First Amendment and in June
2013 and if you look at the references for this slide seven
there is a fabulous judgment there which is well worth a read because some of the
statements in that Fourth Circuit opinion are really interesting how they
talk about the law coming up against the First Amendment and they actually come
to the conclusion that they cannot allow cook cease appeal to go forward without
actually saying that there is a direct clash so the outcome of that case was a
victory for Cooksey the Institute of Justice and I now know CrossFit because
three things came from that case first of all North Carolina board needed to
change their acts because it was recognized it was breaching the First
Amendment the second key thing to come out from that case was that cook C was
allowed to continue to give his free advice and the third observation was
that there is a problem not just in North Carolina but there’s a problem
globally across the states where we’ve got these acts rubbing up against the
First Amendment and online was the key word that they used and I do wonder if
there’s a difference between online and perhaps one-to-one consultations so the
final statement that came from cook C’s lawyer was that North Carolina can no
more require him to be a state registered dietitian then they can
require his fictitious Dear Abby to become a state licensed psychologist so
that’s where that case ended so right up to date July this year just a week ago
Heather delcostello was an unlicensed health coach according to this article
well yeah she started her company in 2015 in California which if you remember
was one of those yellow states so it’s not quite as bad as the green or the red
ones she was offering a six-month program where you’d have 13
one to one consultation but in 2017 she moved to Florida and Florida was one of
those red states and Florida then issued her very very quickly with a case saying
you are unlicensed and you are practicing in effect as a dietitian so
enter again the Institute for justice and the July ruling that has just come
out has actually supported the Florida Dietetics Board to say we don’t think
Heather should be allowed to practice ongoing as a nutritionist and the
Institute of Justice are arguing both on the First Amendment principle and also
one that I think may have even more success the monopolistic practice
principles because this is outright monopolistic practice and when you
realize the monopolistic practice is backed by the who’s who of the fake food
industry it makes you realize this is even more outrageous so the law the
lawyers for Heather this was their summary statement they
are going to be appealing they’re basically saying for decades since 1969
when this credentialing agency was formed it has been knocking up against
the First Amendment and they’ve been breaking that amendment in the view of
the lawyers so this case is not finished yet now for practitioners out there and
I came to realize this for my involvement in the Professor Tim Noakes
case because of course we had that crazy situation was a tweet and advice are you
actually in a consultation if you’re on Twitter of course you’re not but I think
the really safe areas for any practitioners are in giving out
information and in giving opinions and if you don’t call it advice it’s very
difficult for somebody to say you’re not allowed to give information and you’re
not allowed to give your opinion particularly in this country with an
amendment that you’ve got so what is the advice that these guys are dishing out
well it’s the absolute classic Dietary Guidelines for Americans my plate and
food labels so I’m just gonna whiz through what they think we should be
eating so I’ll start with food labels because it’s probably going to be the
quickest but you go on their website that’s the kind of advice you get on a
food label how to read a food label what to do if you see X Y Z n on a food label
this is what the policy should be on food labels if you don’t know what
something is without reading the label then don’t put it in your mouth what are
you doing so that’s that one dealt with then we have my plate I must admit when
I saw my plate come out I thought how can people be so nutritionally ignorant
so if my ladies I’m not sure it’s working very well here but if you can
see the protein down on the right hand side what they’re trying to do here is
to say these are the food groups that we should be eating protein is not a food
group protein is a macro nutrient how dull do you have to be to not know the
difference between a food group and a macronutrient so they’ve missed out all
of these food groups all the ones in bold the reference on this slide is a
blog that I wrote on what I think the food groups are and I’m happy to debate
them I think there are nine you can separate out nuts and seeds if you want
you can separate out beans and lentils for all I care but I’m going with nine
so they didn’t include meat fish eggs legumes nuts and seeds because of course
they lump them all together in protein and we’ll come on to a great little
graphic in a second which shows how dull they are because they don’t know where
the protein is so clearly I haven’t got a lot of time for my plate because it’s
so nutritionally ignorant and then in the Dietary Guidelines for Americans
essentially what they’re saying is eat the usual stuff aged through healthy
whole grains protein is back in there again dairy and of course vegetable oils
but don’t eat saturated fat salt and sugar so I want to go back to food
nutrition 101 and I hope there’s probably some doctors and nutritionists
whatever in the audience I hope there’s still something to take away for each of
you because when you study nutrition rather than being taught nutrition and
there is a very very important difference because if you taught
nutrition you’re taught the usual nonsense if you study it you can work it
out for yourself so go back to the basics of what food is why do we need to
eat because we seem to have forgotten why we’re eating food is mostly water
and then of course food is macronutrients and we have three
macronutrients and from protein we have essential amino acids we have essential
fats that we need to consume but there is no essential carbohydrate this is one
of my favorite quotes in the literature is from the
2005 panel on macronutrients and American government documents provided
you eat enough fat and protein the lower limit of carbohydrate is 0 there is no
essential carbohydrate but there are essential proteins and there are
essential fats and obviously in nutrition essential means something that
we must consume my cholesterol is essential for life but we don’t need to
consume it we make it so those are the macronutrients and we then have
micronutrients things that we need in smaller quantities and they are 13
vitamins 8 of the B water vitamins vitamin C which is another water soluble
vitamin and then the fourth fat soluble vitamins and then approximately 15 16 we
could have some debate on the minerals but everybody knows zinc calcium copper
magnesium iron and so on those are the things that we need in our diet so this
graphic that I’ve put together I really still can’t see if this is working but
over on this side what we’re doing is looking at the three macronutrients so
over on the left hand side you’ve got pure carbohydrate there is only one pure
carbohydrate on the planet and it is chakras 100% carbohydrate arguably not a
food because it brings no nutritional value whatsoever and the definition of
food is pretty much something that provides nutrition in some form over the
other extreme you’ve got pure fats which would obviously be olive or coconut oil
lard is a pure fat butter isn’t butter does have some water and some protein
and then you can see with the yellow bar over the top protein is in absolutely
everything else it’s in lettuce is in fruit it’s in legumes and steak and all
the stuff that you would expect now what I think is really interesting about real
food is that nature tends to provide us with either car proteins or fat proteins
now think of car proteins as things that come from the trees and the ground
they’re the things that vegans do eat think of the fat proteins as things that
vegans don’t eat they’re the animals that’s your meat fish eggs and dairy and
then there’s some really interesting foods in the middle because nature
really rarely puts carved fat and protein in good measure in the same
foods and the exceptions are things like nuts seeds and avocado and it’s probably
why because I work more with people trying to lose weight
than I do with super-fit people I’m more reticent about nuts than CrossFit is
because they’re what I call Moorish so if I’m working with overweight people if
I let people go into that fat carb combo section open a bag of hashes or
macadamias you just can’t stop eating the damn packets and the fake food
companies have worked that out because that’s where all their food is so think
about muffins or ice cream or McDonald’s and the ban or the hotdogs and the ban
on the ketchup everything in the fake food world is that fat carb combo which
we humans cannot resist we have no appetite restriction when it comes to
that area now the other interesting thing is if you’re going back to those
essential proteins and those essential fats they’re found in the animal foods
sure you’ve got protein in lettuce and apples and legumes and all the rest of
it but it’s not complete protein complete protein comes in animal foods
the essential facts particular Omega 3 comes in the form that the body needs it
which is EPA and DHA in animal foods yes flax seeds have got ala that’s not
the form in which the body wants Omega 3 so that’s my favorite chart on what food
is all about if we wish through carbohydrates 101 we start off with
monosaccharides which we know is glucose fructose and galactose and let’s call
them what they are straight away because monosaccharide just means a single sugar
and I think every time we think about carbohydrates we’ve got to remember that
we’re talking about sugar so we then have disaccharides or two sugars and you
can see how uh krause is just a molecule of glucose and a molecule of fructose
and then molto’s which is not one we hear about so often is two molecules of
glucose so you can immediately see because of the blue that every time you
put something in your mouth that’s a carbohydrate you’re putting glucose into
the bloodstream so why would carbohydrates be good for diabetes then
we have polysaccharides which are many sugars and we have the digestible form
so implants that comes in the form of starch and in humans it comes in the
form of glycogen and of course we’re told to eat starchy foods so that we can
replenish our glycogen storage room and of course if we’ve got full
mikage installs we’re never going to be losing weight because the body’s got the
ready supply of fuel that it can tap into anytime it needs it and then you’ve
got the many sugars of the indigestible kind so we have soluble indigestible
carbohydrates that’s things like beans and oats
we have insoluble carbohydrates which are things like bran and whole grains
and of course collectively that is what we call fiber so when people say that
fiber is essential fiber clearly isn’t essential because we already know that
carbohydrates are not essential and fiber is a subset of carbohydrate so
fiber is not essential and plus anything that ends up down the toilet how good
can it really be for you fats 101 there are three fats
we know them as saturated monounsaturated and polyunsaturated and
I’d love to call them stable fats mono unstable fats and poly unstable fats
because that is what we should be calling them because the saturated fat
is the most stable when you’ve got the carbon atoms in the middle you’ve got
the hydrogen atoms on either side of the carbon you can see it from the top
picture over there and it’s just forming a perfect stable chain which is why it
will be solid at room temperature so you then move to something that’s more
heavily monounsaturated fat and it will be liquid at room temperature and it
might well go solid in the fridge and then the polyunsaturated fats where
you’ve got more than one area where the hydrogen atoms are missing and that will
be liquid at fridge temperature now a couple of fascinating facts about fat
every single food that contains fat contains all three fats there are no
exceptions and one of the things I’ve come to realize it’s discovering that is
you will struggle to find a food that doesn’t contain at least a trace of fat
in fact it may only be a krause that one over on the left-hand side if you find a
nutrition label on the next packet of blueberries you buy there may well be a
trace of fat which means there’s all three fats in the blueberries and the
second interesting factoid about fat is only dairy products have more saturated
than unsaturated fat not the saturated fat is bad and unsaturated fat is good
but just to set the record straight so you will now be able to
answer this question I don’t worry I won’t pick on any but which of these
foods has more saturated than unsaturated fat it is the low-fat milk
because it’s only dairy that has more saturated than unsaturated fat so what
you’ve got on this slide and we’ve got some post cars I’ve got some one a
website they’re not with us but I’ve got a website with this picture on there and
we can always get some cars sent over to Greg if some of you want to hand these
out because these are just great to have in your handbag to have a bit of a laugh
with people because what we’ve got on this slide is the first number is the
total fat in that item so you’ve got steak you’ve got eggs you’ve got an oily
fish mackerel lard I love the lard one almonds olive oil
and of course that low-fat milk first number is the total fat out of a hundred
grams so it’s immediately also a percentage the second number is the
saturated fat content of each of those products so come down to the lard lard
is mostly monounsaturated fat eggs are mostly monounsaturated fats take ditto
so then our super powers that be will tell us to eat oily fish but they’ll
tell us not to eat red meat in the name of fat well oily fish has got twice the
total fat and one and a half times the saturated fat of the red meat steak that
I pulled out of the USDA database so how does that work and then look at olive
oil which is supposed to be the elixir of the Mediterranean diet well we’ve got
fourteen times the total fat in olive oil and seven times the saturated fat
and the people say yes but you wouldn’t have a hundred grams of olive oil you
might have a hundred grams of steak okay but one tablespoon of olive oil has got
more saturated fat than a 100 gram pork chop so how crazy is our diet advice
when you start looking into nutrition and just while we’re sticking with steak
because I know we love our steak and we’ve been very generously given a lot
of steak since we arrived on Sunday they say some really really really dull
things about steaks and the to dullest things that they say about steak is one
it’s going to clog your arteries and I think there’s probably only one way in
which that could happen that would be if you intravenously injected it other than
that I can’t work out a mechanism and then the
second thing that they say is it’s full of saturated fat well it isn’t the first
thing it’s full of is water before you cook it almost all food is the main
ingredient is water vegetables of course are upper at about 90% then it’s full of
protein complete protein that’s gonna make us healthy and strong then you’ve
got a little bit of ash and minerals then you’ve got the fat which remember
from the previous slide amounts to 7% and of that just a couple of the percent
are saturated fat so saturated in fact literally is the last thing that steak
is and yet they’re running around telling us not to eat red meat in the
name of saturated fat so we’re now going to look at the evidence because we
looked at what they’re telling us to eat and we’ve looked at nutrition 101 so we
know what’s going on with food and carbohydrates and fat so if we want to
look at the evidence for what they’re telling us to eat and then the evidence
for what we think they that we should be eating then let’s have a look at this
now this is commonly viewed as the evidence pyramid so right down at the
bottom you’ve got test-tube research you might have animal research moving up the
pyramid you get to things like case reports or opinion pieces you’ve got to
be coming in at the top of the pyramid to be having some seriously credible
evidence and over recent years and this is debatable
it is generally seen that a systematic review when you go through all the
literature and look at all the studies you don’t cherry-pick and then pulling
those together in something that we call meta analysis that’s generally regarded
to be the top of the evidence tree and if you can pull together randomized
controlled trials where there was actually an intervention so you can
establish causation that’s supposed to be at the top of the tree they will then
try to pull together things that we call epidemiological studies and we’ll come
on to those in a minute because they are nowhere near as good so we’re trying to
get stuff up at the top of that evidence pyramid and so I’ll start off with the
meta-analysis of randomized control trials evidence for the Dietary
Guidelines for Americans and the Academy for Nutrition and Dietetics and I didn’t
forget to put anything on that slide because that is the meta-analysis
evidence of randomized control trials for their diets there is none there is
arguably only one RCT that is large enough and long enough that is actually
tested this diet which is rich in veg and fruit and grains protein of course
in everything dairy oils etc and it was of course the Women’s Health Initiative
which was the main paper was published in 2006 and those were the key findings
so you’ve got large enough and long enough you’ve got 48 nearly 49 thousand
women over 8 years the intervention was to have more vegetables more fruit more
grains less fat and it made no difference whatsoever now some really
interesting things that we need to note before we move on from this Women’s
Health Initiative so immediately every man in the room can ignore it it was
conducted on postmenopausal women I haven’t seen a woman in the audience yet
who looks over 30 so it also doesn’t apply to any of you it’s a very very
select group it’s what we call non generalizable you can’t then apply it to
the general population even if they had found something and the next thing that
is so important because we’re trying to talk about evidence base here remember
that the first Dietary Guidelines for Americans came in in 1980 and in 1977
they were being put together by Senator McGovern so back in 1977 we had the
fruit veggies low-fat high-carb advice coming in women were recruited they were
enrolled into this study between 1993 and 1998 that’s 20 years after the
advice has already been given so we can categorically say it is not
evidence-based because for something to be evidence-based the evidence must come
first and it never can be evidence-based because the evidence wasn’t there first
so what I’m hearing now is at a conference in London in May and there
was a Cambridge academic and they’re starting to talk about evidence informed
because they know they’re never going to win the evidence base because it wasn’t
there at the time so then we turned to the epidemiological evidence and there
are three fundamental thought floors with epidemiology and I’m going to be
glancing at Gary quite a lot here because Gary hates epidemiology more
than possibly anyone else in the world quite rightly first floor
obviously with epidemiology is that it can only ever establish Association and
not causation so what I’ve got here is some data or some studies from the fiber
wholegrains world so this one came out in January of this year by Reynolds and
they were claiming that there would be a 15% difference in all cause mortality if
you’ve got people having 30 grams of fiber a day versus 5 grams of fiber a
day I mean seriously how bad is your diet have to be that you’re not even
having 5 grams of fiber a day you’re not even having a vegetable or not from what
I can work out so anyway they established the Association they then
look at relative not absolute risk so that 15 percent number is relative not
absolute risk now with a meta-analysis you don’t have the detail of the studies
in that top level paper so to understand what’s going on with absolute risk you
have to go down a level so I went to yang which was one of the most important
papers in an umbrella review that had been done on fiber at the time and yang
very helpfully came up with the 16% difference in all cause mortality so I
know that I’m looking in in roughly the right area and the absolute risk in this
case was 0.68% over the duration of the studies so when you apply that 16
percent difference it comes down to the difference between point six three and
point seven three so that’s the difference between six in a thousand and
seven in a thousand and that’s if it were causal and it isn’t because you
don’t get into causation unless that top number is a hundred percent you’ve got
to have something like double the Association before Bradford Hill
criteria would kick in so who cares even if it were causal you’re going to go out
and eat 30 grams of beans just to avoid that kind of risk
and then possibly the most important aspect the healthy person confounder
because every time you look at epidemiology there’s a characteristics
table and you look at the people in the 30 grams today of fiber and you look at
the people in the 5 grams a day of fiber and I just picked up one study here to
give you the exact figure so this is the zoo study which was key in that Reynolds
paper twice the alcohol intake for the lower fiber guys one and a half times as
likely to be obese one and a half times as likely to be in the
lowest activity category one and a half times as likely to be in the lowest
education every time you see an epidemiological study or a meta-analysis
of all of those studies those are three things going on and the healthy person
can founder I think is one of the most important a Gary said in the Denver
conference earlier on this year what they’re doing with epidemiology is
they’re taking that super healthy person who doesn’t smoke and doesn’t drink and
is super active and well educated and high income and they just happen to eat
in this way and what they’re saying is if everybody else in that way they would
be as healthy as that super healthy person which of course is madness
because they’ve got every other advantage on top of that going on so
that then drives you and you can insert any words you like for the word fiber so
when you spot that healthy person when you see that epidemiological study is
the thing that they’re talking about a marker of the fact that the person is
healthy or is it what makes them healthy I think somebody who eats whole grains
and beans and pulses is a healthy type of person I don’t think giving those
beans and pulses to another person who’s going to make them healthy maker market
is a really important thing so it got me thinking why let’s explore this healthy
person just a little bit more why do they even find a 15 percent difference
even though it’s relative race why do they find a difference so I came up with
this 2×2 matrix because at the same time they were trying to say you’ve got to
eat your healthy whole grains because you’ve got to be having loads of fiber
so I split the food groups there’s a nine food groups from earlier on and I
put them into this thing that I’ve called the carb fiber matrix up in box
say you’ve got a lot of stuff that we so it’s high fiber but low in carbohydrate
and then in box C you’ve got stuff that’s low carbohydrate low fiber over
in box B’s where they want us to be living so it’s high fiber high
carbohydrate and then I think we’ve got agreement if we could get the conflict
of the fake food companies out of the way we should please have agreement that
we shouldn’t be occupying box D which is low fiber high carbohydrate just pure
junk so what kind of person is occupying box B well because we’re in America I
think it’s the kind of Gwyneth Paltrow kind of person now Gwyneth Paltrow loves
fruit and vegetables so much she actually named her children
Falls and muesli no I jest she actually named her children Apple and Moses but
he’s pretty close don’t you think so she’s up there now she’s healthy if she
eats legumes it’s not gonna make a difference to her health and then down
in box D and remember when they’re doing these fiber studies they’re not
comparing box B with box C or with box a they’re comparing that dreadful dreadful
diet down in box D and love him or hate him you’ve got to admit he doesn’t eat
well but that that’s what you’re comparing so that sure healthy person
confounder think Donald and think Gwyneth and you’ll be just about there
so the latest meat bashing that we had this was only six weeks ago or so so
another study came out this one was from the UK makes it slightly different a
rasher of bacon a day and you’re all gonna die it came from this article in
the Journal of Epidemiology and I’m far more interested in non significant
findings than I am in significant findings because non significant
findings tell you a lot so in this study there were a shedload of non significant
findings but they didn’t report them they just reported the one where they
found something for a rush of bacon we’ll come on to that in just a second
so the non significant findings they found were for bowel cancer and poultry
and for fish and for dairy interestingly if you ever want a study to say that
dairy is not gonna be a problem for bowel cancer believe it or not this
vegan study is gonna help you out cheese and even bowel count some red meats
because of course the headline was about red meat but as soon as you get into the
detail of the paper they drop the red meat bit and they’re into red and
processed meat and then really interestingly because we’re told that
all this fruit and veg and fiber etc is gonna save us from bowel cancer there
was not an inverse association with all of those or tea or coffee and bowel
cancer so they found nothing protective among the things that they liked to tell
us to eat so in their association not causation they were claiming there’s a
19% difference if you have 25 grams of bacon a day which is basically a rusher
of bacon this is what the absolute risk boiled down to it boiled down to eight
cases intense hour some people in six years so one in
10,000 person years and that got headlines around the world
that’s epidemiology for you and of course the healthy person confounder was
absolutely in full swing in this paper the meat eaters processed meat in the
Maine were much more likely to be older and smokers and drinkers with a higher
BMI higher body fat higher non-steroidal anti-inflammatory
users which is not great for the bowel and lower vegetable eaters so they have
everything stacked against them and they don’t even always adjust for all of
those things so that’s epidemiology so right the things that’s that’s what they
say we should be eating so I think we’re in agreement there there is just no
evidence for the fruit and veg and all the rest of it and then this is what
they say we shouldn’t be eaten if you remember it was sugar fat and salt now
when sugar we agree we agreed that sugar is is not great for people but what they
don’t seem to realize is that when they’re recommending carbohydrates
they’re recommending sugar because they don’t seem to know that they are single
sugars and double sugars and many sugars so that level of ignorance as well
astounds me salt we disagree why on earth do they demonize salt so they
demonize salt on the basis that there is a relationship between salt and blood
pressure which in the short-term there would be if you went out now and had a
salty bag of something you would find yourself getting thirsty because that’s
your body’s driver to take him potassium to balance out the sodium potassium and
to get you back to normal but if you having a salty die every day and and by
I think it’s an unnatural salty diet so I think anything that they see with salt
is actually more just a reflection of a process food diet because natural food
is naturally balanced in sodium and potassium but anyway even if you care
about the blood pressure angle this is something that came from the nineteen
ninety-four coma report that’s the Committee on medical aspects of
nutrition it was a British report and it was saying that the review group
recommendation was to reduce salt consumption by three grams a day that’s
practically having the average salt consumption and they said that that
might affect systolic blood pressure that’s the first number you get in the
blood pressure reading by three and a half million grams per liter
and the final quote comes from one of Gary’s books he might even recognize it
there because Gary said exactly the same in the diet delusion good calories bad
calories cutting our average intake of salt in half which is really difficult
to do in the real world might get something like four to five drops in
somebody with hypertension already and perhaps only a couple in the rest of us
it makes no difference whatsoever and they’re not setting targets that we have
in salt they’re trying to say oh if we just got rid of it by 0.2 of a gram or
something it would make a big difference Harvey it’s gonna make bugger all
difference so stop demonizing salt and if they had any evidence to link salt
directly with any chronic condition they would produce it and they have none the
fact that they cannot produce that tells us that they have not you will only ever
hear them say that salt raises blood pressure and blood pressure is
associated with heart disease and blood pressure is associated with heart
disease but is that because if you’ve got heart disease your blood pressure
goes up so is it a marker or a makeup I don’t think salt has got anything to do
that now fat we disagree and we disagree and this was the subject area of my PhD
so what I wanted to do for my PhD was to go back in time to say is this stuff
evidence-based was the evidence there at the time that we introduced those two
dietary fat guidelines to have no more than 30% of our diet in the form of
total fat no more than 10% of our diet in the form of saturated fat so I did
that evidence based pyramid thing I did the systematic reviews and the meta
analyses I did them first of all with RCTs then I did them with the
epidemiological studies and the unique thing about the PhD was that I went back
to the time when the Dietary Guidelines were introduced so the first two studies
were done on the data that were available at the time to those dietary
guideline committees and there were only six studies there are only six RCTs that
would have been available to that committee you’ll know them as things
like the Rose kornel trial the Oslo diet Heart Study the Sydney diet heart study
there were only six and none of them are concluded that we should intervene in
any way make any dietary interventions in fact a
couple of them warned about their interventions and so the rose corn oil
said that they were quite worried that it would didn’t appear to be beneficial
and could indeed be harmful and Woodhill warned about the toxicity the potential
toxicity of his intervention of a vegetable oil diet and the low fat diet
committee actually the final sentence of that paper from 1965 says a low-fat diet
has no place in the treatment of myocardial infarction heart attack and
yet the committee went ahead and introduced those guidelines so I’d also
looked at the epidemiological evidence the cohort evidence and that would
include things that you will have heard of like the Framingham study maybe the
London Bankim busman’s study and absolutely the seven countries study you
will all have heard of that only one of those six studies suggested that there
was even a relationship between saturated fat and heart disease not many
people know the seven countries study found nothing against total fat
whatsoever so there was absolutely no evidence underpinning the guidelines
when they were introduced so then you bring it forward and you say okay let’s
be generous there wasn’t evidence at the time is the evidence there now the RCT
evidence isn’t there now the epidemiological evidence isn’t there now
and if you want to read one paper from all of my PhD Thank You B GSM for
putting that on open view it just wraps up all of those four studies and says
where the evidence was if there was any and the overall evidence is resoundingly
we should not have introduced those dietary guidelines and those Dietary
Guidelines on fat should not be there today and I’m not alone in thinking this
and the final chapter of the PhD you have to put your own research into
context of what everybody else is doing and many people have also been looking
at this area and you may well recognize some of these names skia familiar or one
of the first to kick it off back in 2009 you’ve got the very well-known Siri
Torino paper you’ve got the two Hooper papers which are the Cochran ones
Chowdhury 2014 string shacking and Hofmann and only put in two sorry four
of our papers not the eight findings that I could have put in
and that amounts to 40 separate findings and a finding might be looking at
saturated fat and heart disease or saturated fat and cardiovascular disease
or it might be total fat and all cause mortality there were 40 different
findings among those different teams of researchers and the most important thing
to notice on that combined slide and that is the totality of the evidence
where people also looked at mortality that’s really important because there’s
no point dying less of one thing to die more of something else so those that
people looked at mortality 37 out of 40 found nothing why is that not the
headline why is the newspaper headline not 37 independent findings from
different teams of researchers came to nothing whatsoever so what were those
three well one was from Chowdhury saying that trans fats seemed to be bad for
cardiovascular disease coronary heart disease whatever no disagreement I think
from anyone in the audience on that one and the other two then came from the
Hooper study and it should have been again important for Hooper to say we
found nothing if I bring up some of the things here because this is where the
Hooper study will come in nobody has found anything against total fat ever
not even the Hooper study and then Hooper will also report as do all the
others there’s nothing significant for all
cause mortality or coronary heart disease mortality or cardiovascular
disease mortality or fatal heart attacks a non-fatal heart attack stroke clarity
as coronary heart disease events nothing for all of those they found one thing
for cardiovascular disease events and swapping out saturated fat and swapping
in polyunsaturated fat so they said we recommend that you do that you eat less
saturated fat more polyunsaturated fat in the name of cardiovascular disease
events and they just repeated that finding four years later and those are
the only findings that we have against saturated fat now when you look at the
body of that massive paper and I always credit dr. Trudy Deacon for finding this
on about page 157 or something they did a sensitivity test and they said let’s
look at the studies not just where they set out to swap out saturated fat and
swap in polyunsaturated fat but where they actually achieved what they set out
to do and the finding falls away so in the
studies that actually did that swap there’s again nothing to report and that
is the totality of the evidence again it’s saturated fat so I’m sorry
dietitians Academy whatever you want to call yourself you can’t keep standing up
there and saying there’s a problem with fat or a problem with salt because the
only problem is with sugar so what do I think we should be eating well if again
we could get rid of the con fix could we perhaps agree that real food would be a
good idea some people say well what’s real food well oranges grow on trees
cartons of orange juice don’t fish swim in the sea breaded fish sticks don’t
it’s not tough you can teach a five-year-old its way to gets very
excited when you start talking about real food it’s like come on guys grow up
choose that food for the nutrients it provides remember why we need to eat
because we need those complete proteins essential fats vitamins and minerals eat
a maximum of three times a day another piece of their advice is that we should
eat little and often we should graze I have this little stain unless you are a
cow or want to be the size of one stop grazing because you will end up that way
now these are not the dietary related ones or just flash these up manage
alcohol intake to manage fat burning because alcohol the issue is not
calories you can’t process the calories from alcohol you cannot store them as
fat what’s going with alcohol is it inhibits the operation of glucagon so
you cannot burn body fat while you’re processing the alcohol it can be helpful
for diabetics not to be abused but it’s not great for trying to lose weight and
then this was the phrase that I used in my 2010 obesity book I hadn’t heard of
CrossFit then but it’s functional fitness do what we’re designed to do lug
things around walk clean garden if you’ve got a cleaner and a gardener and
then you’re going down a conventional gym they’re getting a better workout
than you are that’s crazy so we backed this what should we be
eating well point clearly that’s where we should be focused in terms of
macronutrients because we’re going to get the complete protein and the
essential fats in the form that we need them in those animal foods on the right
hand side and I probably should have declared an interest earlier I was a
vegetarian for 20 years I did not want to discover that when I discovered that
it was not a good day but you have to go with the evidence and the evidence says
you need to eat red meat and oily fish and so you need to eat red meat and oily
fish so then if you look at the micronutrients and what I’ve done on
this slide is put up one of their five a day that’s a laugh as well isn’t it an
Apple brown rice so you’ve got your healthy whole grain
so you’ve got lentils legumes you’ve got a green vegetable and then of course you
put them up against what I know to be the healthiest food on the planet which
is liver steak and sardines so you’ve got to read me and an oily fish and then
just put up some of the things that we need the protein quality is a slightly
subjective score it comes from the USDA database you’ve got along the left-hand
side here you’ve got the recommended daily amount I don’t know how accurate
they are but it’s a guide and then you’ve got the winner in each row that
I’ve put in red so brown rice wins on calories that’s probably not the one you
want to be winning on and then just look at live on I mean liver then just cleans
up on everything else she needs so this is per hundred grams for all of them you
need so little liver just slipped into your diet every now and again to just
get this fantastic nutrition sardines then of course start knocking it out of
the park on the bone nutrients vitamin D and they will on the minerals as well
come to see broccoli does very well on vitamin C but this is one of my other
favorite nutrition factoids did you know that liver has almost four times the
vitamin C of an apple so of course you’ve got to be able to get the
nutrients from animal foods because carbohydrates are not essential remember
back a few minutes ago so then we bring in the minerals and you keep the same
foods and because the plant foods come from the ground they should start to do
quite well for minerals and I did get a little bit irked when I saw things like
brown rice and lentils doing really well so I thought I’m just gonna slip in a
new food there because I’m a bit partial to very very dark chocolate so if you
put in cocoa powder which is of course the basis of 85% and above dark
chocolate then cocoa powder will be all of those healthy whole grains and
legumes and fruits and vegetables so jolly good for cocoa so in summary what
do I think we should be eating number one real food choose that food
the nutrients it provides I think Michael Pollan has famously said eat
food mostly plants not too much and I’ve come to the conclusion we need to eat
food mostly animals quite a lot because you do need something like a good 200
gram mistake sorry for you guys in ounces that’s like an at least an 8
ounce steak to be getting your zinc requirement for the day zinc doesn’t
just grow on trees as I’m also fond of saying so Michael
will think we should be having the whole grains and pulses and I think we should
be having ideally ideally I do understand not everyone can afford it or
access it but pasture fed meat eggs dairy fish and berries we agree on
vegetables and salads so we do have some agreement with the the healthy whole
food guys and then I slipped in one new chart for this presentation that might
be worth a little camera photo because I put up at the top what they want us to
eat which is the veg fruit grains dairy of course fat-free and then I’ve put it
against what we actually need as human beings so we need the essential fats we
need complete protein so the caveat is in the top left hand of the table in the
right form for the body so I’m not scoring plants for vitamin A because
they provide carotene they don’t provide retinol and the body needs retinol and
when you get to the fat soluble vitamins the body wants d3 which comes from
animals not d2 that comes from plants it wants k2 from animals not k1 from plants
it wants heme iron that’s the most absorbable form that also comes from
animals all the evidence points towards the fact I’m sorry but we need to be
eating this stuff down at the bottom of the eggs the dairy the meat and the fish
and of course even meats will provide some vitamin C so we have new areas of
conflict going on in the world we don’t just have the Academy for nutrition and
dietetics with their fabulous 100 billion worth of sponsorship behind them
you cannot have failed to spot the eat Lancet report earlier on this year and
those are the organizations behind the eat Lancet report I’ve just circled some
of them I think it actually would mean easier to circle the ones that either
aren’t I agree food biotech companies or just fake food companies I think there
might be I’m where there’s Google in this I think Google is probably being
about the only good company but if you like conspiracy theories and
gary says he doesn’t do conspiracy theories I love conspiracy theories the
best conspiracy theory and I don’t think it’s a conspiracy theory is when you’ve
got the agry tech companies wanting to control us our food supply the eat
lancet report is the way to do it because there is only one food on the
planet that gives back to soil and without soil we can’t grow our own food
and that is ruminants so there’s cows and sheep and goats and they chew the
land and they give back to the land and they host the microflora and then
regurgitate them and defecate and we and whatever it’s just this fantastic cycle
of life that maintains topsoil now go to a vegan world where you don’t have those
ruminants you don’t have the topsoil now these guys are already growing food
upside down in greenhouses no soil required if you really want it to
control the world’s food supply which is surely the Armageddon end game of any
fake food or agry food company we are going about it the right way damn red
meat promote the vegan agenda get this kind
of nonsense in The Lancet call it in the name of climate change when actually
you’re doing the exact opposite you’re destroying the planets ability to grow
food this is the final slide the mess which is where we started off if you
remember is the combination of runaway medical costs and disease which many
profit from and we’ve gone through a number of people who are profiting from
those at the moment from individual dieticians to huge agrochemical
companies but none are combating effectively the Academy the Dietary
Guidelines for Americans that credential an organization they are at the heart of
those who are profiting and yet are failing to combat and their advice is
not even evidence-informed let alone evidence-based so I think they need to
be countered with an equal and opposite force and I think these guys would
probably make a great start thank you very much for listening

29 thoughts on “Dr. Zoë Harcombe on the Mess: The Money vs. the Evidence

  1. Adds more noise to “The Mess” along with a bit of the CrossFit agenda and contributes very little in terms of understanding.

  2. This sort of talk would work well in podcast form. Please remember there is channel already there, with probably a lot of live subscriptions and you have the opportunity to drop info straight to them.

  3. Meh…a lot of people struggle with low carb dieting too. I don't think videos like these are helpful to getting at the truth. I don't need to lose weight and when crossfitters tell me to eat paleo or keto, I just laugh! I fuel my workouts with starchy carbs (at meals prior) and I feel great. If I have a rest day, sure, I'll eat less carbs and a little more fatty food. Zoe seems like a zealot.

  4. I fell for the food guidelines for 15 years. I dutifully boiled my real whole grains like wheat berries, oat groats etc, avoided processed sugars and processed grains, ate lots of vegetables, very little fat and meat only once or twice a month, fish 2 or 3 times a week etc. I was a poster boy for a healthy diet. Somehow, in spite of being pretty active I could not get my BMI below 25 (5'10" and 180-190) was hungry all the time in spite of eating 5-6 times a day. Arthritis set in a few years ago and got worse and worse in spite of my "healthy" diet.

    Desperation sent me looking for an anti-inflammatory diet and drew me into keto. I had mocked and ridiculed my keto friends for years but thought it was worth a shot. Damn if it didn't work. 9 months in and all my blood markers are normal to great, I lost 20 lbs and am now at 5'10 and 160 lbs, my high school weight. I feel great, tons of energy, arthritic pain subsided about 75% and back to doing stuff I couldn't do last year like walking 18 holes of golf, hiking etc.

    Best of all and you lifelong fatties (I was as much as 240 at one time!) will understand, is the appetite control. On a standard "healthy" diet I was hungry all the time. A high fat/protein diet like keto leaves you satiated after every meal. No more regular snacking, I only eat twice and sometimes once a day and intermittent or whole day fasting is very easy, something I could never have done before. My bloodwork confirms that nothing radical is occuring inside my body and I feel great!

  5. The funny thing is how they (plant based diet promoters) tells us how Hamburger Meals and Pizza are "loaded with saturated fats that clogs our arteries".
    So when I look up the nutrition of these things the saturated fats are the fat that's least represented in these meals. Both Poly and Monounsaturated fats are higher, in which they claim are the healthy types fats. When I look what's really prominent in fast food it's carbs. The majority of the calories in a hamburger meal or pizza comes from plant based sources. So every time they show these meat fear mongering images from burgers or pizza they are simply trying to trick you into associate those foods with meat. Those types of foods are not meat, they are carbs and vegetable oils.

  6. The most comprehensive, well explained, hard hitting and entertaining talk on nutrition I have ever heard. Well done Zoe – you’re a treasure

  7. While you have numerous individuals in the health space who are now debunking the many decades of food industry's and medical industry's false standards of dietary health (i.e. advice to eat low fat, high grain and high sugar foods) to where it has become a cliche, it was pioneers like Dr. Zoe Harcombe and Gary Taubes who were doing this over a decade ago, before it was popular. People like Dr. Harcombe and Mr. Taubes must be credited with being intrepid enough to refute the standard American dietary guidelines, and the erroneous assumptions that it was predicated on, well before it became common place. Being lone voices in the wilderness, both Dr. Harcombe and Mr. Taubes faced enormous opposition, ridicule, ad hominem attacks, and spurious accusations about how their skepticism and advice were literally threatening people's lives. Yet, despite the acrimony that was foisted at them from the medical establishment and agribusiness, they pressed on, illustrating to the public who was failed by the conventional advice, why they should do the exact opposite of what the dietary guidelines stated. More and more people no longer look at fat as this dietary archvillian precisely because Dr. Harcombe and Taubes had the temerity to actually do the hard work of looking at the evidence so as to exonerate dietary fat. They should get a large degree of the credit behind the massive popularity of low carb diets and the health benefits that millions of people are reaping from that dietary protocol. Both of them are, to the dietary world, what Copernicus and Galileo were to cosmology – speaking truth to deeply entrenched baseless dogma.

  8. Don't take this in a sexual way, but you look great. Keep wearing short sleeves and well tailored business outfits. They reveal you are thin and show off your muscular, well noursihed arms.

  9. Some would argue that eating only animal products eliminates vitamin C, but that appears to only be a concern if you are eating foods that cause inflammation. People speak of scurvy when fruits are eliminated, but my research on scurvy lead me to a ship's manifest documenting what the sailor's that experienced scurvy actually ate. A daily ration of food consisted of a couple ounces of meat, likely dried, a large amount of bread, and copious amounts of beer. So they were consuming a very high carb diet, but no food containing vitamin C. If they had eaten only meat they wouldn't have had an issue. The Inuit have eaten only fat and protein for many many generations and would have died off if vitamin C was necessary, but the fat and protein they ate didn't cause inflammation, so no vitamin C was needed, however, they likely ate the liver of the animals they ate, so they likely were getting much more vitamin C than they needed. The Masi only eat meat, and they also would have died off if we needed to eat fruit or veggies. It's interesting that nature put vitamin C in the foods that cause inflammation, and not in the foods that don't cause inflammation, something to think about…

  10. For non-significant results, you must give a Confidence Interval. A study may have merely been under-powered (very common!), and failed to rule out an effect size that would be of interest.

    The number of non-significant results does highlight that there is a multiple testing issue in some of these cited studies, which calls into doubt even their "significant" results. FDR and FCR adjustment should be performed.

    Use of Absolute Risk as an effect size was excellent, much less confusing than Relative Risk. A CI on the AR would be perfection!

  11. When I ask him if he plans to fund studies that would prove the efficacy of CrossFit or its nutrition plan, he tells me: “I don’t need a study. It’s my freak show.” -Greg Glassman. 🤷🏿‍♂️

  12. it seems like they're just trying to overcomplicate diet… i mean, why are humans (and their house pets) the only ones that get sick, fat and so on?
    coz we eat shitty foods
    stick to natural foods. like meat.
    it's simple. it's easy, it's full of nutrition. and it's making me feel MUCH better. both in body and mind.

  13. Everyone should share this and

    http://youtu.be/WbNDrcoRi8g as widely as possible. Soon teens like vegan denier will be bandied around as they are trying to shit the debate down

  14. Everyone should share this and

    http://youtu.be/WbNDrcoRi8g as widely as possible. Soon terms like vegan denier will be bandied around as they are trying to shit the debate down

  15. Everyone should share this and

    http://youtu.be/WbNDrcoRi8g as widely as possible. Soon terms like vegan denier will be bandied around as they are trying to shit the debate down

  16. Everyone should share this and

    http://youtu.be/WbNDrcoRi8g as widely as possible. Soon terms like vegan denier will be bandied around as they are trying to shit the debate down

  17. Everyone should share this and

    http://youtu.be/WbNDrcoRi8g as widely as possible. Soon terms like vegan denier will be bandied around as they are trying to shit the debate down

  18. Everyone should share this and

    http://youtu.be/WbNDrcoRi8g as widely as possible. Soon terms like vegan denier will be bandied around as they are trying to shit the debate down

  19. Everyone should share this and

    http://youtu.be/WbNDrcoRi8g as widely as possible. Soon terms like vegan denier will be bandied around as they are trying to shit the debate down

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