My Nutritional New Year’s Wish List
On Dec. 22, the British Medical Journal (BMJ) published an online piece from its editor, Fiona Godlee, in which she urges us to “start the year as we mean to go on—by promoting rational health care decisions based on the best available evidence.”
In her piece, Dr. Godlee highlights a recent assertion by one of the BMJ’s columnists, general practitioner Dr. Des Spence, that many ENT operations performed on children— tonsil removal and insertion of tubes into the eardrum, for example—are quite useless and possibly hazardous.
Godlee also points to two BMJ articles that are particularly relevant to good clinical practice. One of these questions the use of aspirin as a preventive medicine for cancer and cardiovascular disease by highlighting the evidence that suggests this practice does not reduce the risk of death overall.
The other piece examines the issue of the widespread practice of prescribing newer, much more costly forms of insulin to diabetics, despite the fact that the evidence suggests they are simply not worth the additional expense.
I applaud the BMJ’s apparent desire for medical practice to be based on the best evidence. And this reminded me just how much of conventional nutritional practice lacks any substantial evidence base. So I thought I would write a New Year’s wish list of my own for humanity. In no particular order, here are some things I wish were more widely recognized.
For weight loss, neither eating less nor exercising more appears to work particularly well in the long term. While the calorie-principle has underpinned weight loss advice for decades, its application in the real world has been a crashing failure.
Low-fat diets are not effective for weight loss, despite what most doctors, dieticians, and health agencies would have us believe.
Low-carbohydrate diets generally outperform low-fat diets for weight loss and also lead to greater improvements in a number of disease markers, including triglyceride levels, blood sugar levels, blood pressure, and measures of inflammation.
Low-carb diets have the potential to improve blood sugar control in diabetics and often lead to much lower requirements for medication, and, quite-often, the ability to dispense with medication altogether.
Lower-carb diets tend to be more satisfying than higher-carb, low-fat ones, which means individuals quite naturally tend to eat less (sometimes a lot less) without hunger.
There is no good evidence that saturated fat (found, for example, in meat and dairy products) causes heart disease.
There is no good evidence that eating less saturated fat has benefits for health.
There is no good evidence that taking dietary steps to reduce cholesterol has broad benefits for health.
There is no good evidence that margarine is healthier than butter and at least some evidence exists that suggests the reverse.
There is no good evidence that artificial sweeteners such as aspartame promote weight loss, but considerable evidence exists that suggests they have the potential for adverse effects on health.
There is no good evidence that insoluble fiber has benefits for health.
Fructose is not a healthy sugar, and despite the fact that it does not raise blood sugar levels in the short term, it nonetheless has the capacity to damage health.
The consumption of dairy products is not required for good bone health.
Not all of the nutritional information we get is in our best interests, and it is often driven by a motivation for profit. That’s one of the reasons why there can be a yawning abyss between what we’ve been told repeatedly for decades and the truth of the matter as revealed by science.
I’d also like to take this opportunity to thank you, readers of this column, for your kind words of appreciation and support over the last year and to wish you Happy New Year!
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