Bridging the nutritional divide

Imagine you’re an insurance company. You’re worried about covering the costs of people who get sick relatively young, then die slowly and expensively. You not only have to foot the bill for medical expenses, you have to pay out life insurance to the family once the client passes on.

Your scientific advisers are clear that nutrition is a big part of the complex ‘staying healthy’ equation, but you know this discipline is riddled with conflicting science and bias. It’s in your interest to cut through all of this debate and find out if it’s possible to get some consensus among leading experts.

What if you were to organize a closed event that pulled together leading researchers in the field from around the world? You then invite clinicians, researchers and other thought leaders to see which views survive their scrutiny. Since you’re aware that even the most eminent researchers can sometimes compromise their science to personal beliefs or biases and may have vested interests in Big Food or Pharma, you involve one of the world’s top peer-reviewed journals, which espouses transparency and openness.

Stop imagining – it really happened this summer, in a beautiful Swiss village near Lake Zí_rich, over two packed days. The 200 experts assembled – myself included – came from every inhabited continent on Earth. Nina Teischolz, the investigative journalist who was among the first to expose the lack of evidence behind low-fat policies and author of The Big Fat Surprise, was a panelist, as were Zoí‚ Harcombe, PhD, an internationally acclaimed commentator on nutrition science, and cardiologist Dr David Unwin, the ‘low-carb doctor.’

The intimately involved journal was none other than the British Medical Journal (BMJ), which devoted an entire supplement to papers by the lead speakers, and the insurance company was forward-thinking Swiss Re. The venue was its aptly named Centre for Global Dialogue. On the agenda were some of the major controversies in nutrition, including low-carb/high-fat diets, food quality, research methods and biases, personalized medicine, and public health policy and guidelines.

Fortunately, it wasn’t a waste of time. There appeared to be something approaching consensus on some very important points: food quality was more important than the amounts of individual macronutrients (carbs, proteins, fats) or micronutrients (vitamins, minerals, essential fatty acids, polyphenols, etc.); eating mainly plants was better than too much meat, especially processed meats, and starch; and eating more vegetables, fruit and fiber would be good for most, but watch out for too much sugar in juices and related products.

On the negative side, any amount of trans fats, too much sugar and ultra-processed foods are bad for everyone.

Perhaps more interestingly, some of those present who had advised governments to implement low-fat policies – which led to millions of premature deaths over three decades – admitted they were wrong.

While academia has never declared a mea culpa, it was good to hear a clear admittance of error from Professor Salim Yusuf of McMaster University in Canada, who explained, “We were simply all drawn into believing the findings from the Seven Countries study,” the infamous and deeply flawed study by Ancel Keys.

There was also ample evidence of frustration among some participants, especially clinicians and scientists, myself included. Epidemiologists like Darius Mozaffarian from Tufts and Walter Willett from Harvard were understandably cemented in their view that only large, epidemiological studies would do, preferably supported by evidence from randomized controlled trials. This is of course a classic ‘evidence-based medicine’ view that suits the likes of Big Food and Big Pharma.

But many of the assembled clinicians had witnessed stunning results reversing metabolic diseases like obesity and type 2 diabetes. On describing their incredible outcomes since encouraging low-carb or low-carb/high-fat approaches, they were told this was purely anecdotal and “the worst kind of evidence,” even if thousands of patients were involved.

This is perhaps the great divide in nutrition controversies. What methods should we rely on for future decision-making? Is an epidemiological study that might take 10 years or more to carry out still the best and only way forward? (Wasn’t it one of these that caused the misguided low-fat advice?) Should we discount hundreds or thousands of positive patient results just because we can’t fully explain exactly which factors contributed and by how much?

My own view is that a bottom-up, empowered approach to healthcare and self-care underpinned by individual choice is the way forward.

Real people in real-world environments are the true test that healthcare is working. And it’s better that we have healthcare that works than to wait until we know exactly how something works before it can be used by, or recommended to, the public.

Fortunately, the public isn’t waiting to be told what to do – we’re getting on with it. The only thing we’re waiting for is the scientific community to find a better way of explaining how more and more of us are getting ourselves healthier without medicine.

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