Dr Joe Kosterich must be thanked for his editorial last year pointing out some of the misguided food policies that have been at least partly responsible for the soaring rates of obesity we are seeing worldwide.
It is a case study in how the health profession was duped, largely thanks to secret lobbying by powerful players in the food industry, and which has only recently come to light.
I’d like to explore some of these issues a little more, showing how they affect the health of our patients, as well as our planet, and with some suggestions on a way forward for our profession.
YUDKIN VERSUS THE SUGAR INDUSTRY
In 1972, John Yudkin, a British professor of medicine and nutrition, published Pure White and Deadly.1 Aimed at the general public, it summarised work he started in the 1950s, suggesting sugar as the main reason behind the increase in obesity, heart disease and diabetes since the end of World War II.
Although Yudkin’s methodology was not perfect, the food industry saw the threat, and along with Harvard physiology professor Ancel Keys, was largely successful in discrediting Yudkin, via an industry-front organisation called the Sugar Research Fund. (SRF) The subterfuge was finally exposed in 2016, after years of misrepresenting the dietary facts.
An article the JAMA summarised: “The SRF sponsored its first Coronary Heart Disease research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD, and downplayed evidence that sucrose consumption was also a risk factor… The SRF’s funding and role was not disclosed. Policymaking committees should consider giving less weight to food industry-funded studies…”2
Time magazine3 was more direct: “The sugar industry has a long history of skewing nutrition science” and “the sugar industry sponsored research that turned attention away from (sugars) link to heart disease and towards fat and cholesterol as the biggest culprits.”
Researchers found that of the 26 nutritional studies showing no link between sugar and obesity, all were funded by the sugary drinks industry. Of the 34 studies which showed the opposite to be true, only one received industry funding.4
The sugar industry strategy was sophisticated, and very effective in protecting its interests right from the start.
The profound result of this behind-the-scenes battle? Sugar was largely exonerated as a natural energy source, and fats, such as eggs and butter, unnecessarily demonised. Exhorted to simply do more exercise and eat less fat, patients still struggle to lose weight on “low-fat” products. These are often highly processed and pumped up with added sugars to render them more palatable.
Little has changed since those earlier days. In the UK over the past decade, funding from companies, including Coca Cola, Pepsico and Nestle, has flowed into research bodies such as the UK’s Scientific Advisory Committee on Nutrition and the Medical Research Council, as these de-funded institutions desperately seek cash.
The office of the UK Advisor on Obesity received $2.36 million in funding from food giants such as Sainsburys, Unilever, Coca Cola and Nestle, between 2004-2015.5
No surprise that the average Briton consumes two to three times the WHO recommended daily sugar intake, and that one in three is overweight or obese.
It’s worth noting here that approximately 1.9 billion Coca Cola drinks are sold around the world every day.
In Australia, the Obesity Policy Coalition (OPC), a group of 34 health, academic and consumer bodies, recently urged the government to adopt a 20% tax on sugary drinks.6 Such a tax has reduced sugar intake, and raised money for health, in 26 other countries, and has been endorsed by the WHO and AMA.
However, the tax has been fiercely opposed by the powerful Australian Beverages Council (representing Coke, Pepsi and others), in alliance with the Canegrowers Association, and the Australian Food and Grocery Council.
The outcome? The soft-drink tax stands “zero chance” of being implemented by the Turnbull government, which recommends “personal responsibility” instead.
Ministers Greg Hunt, Fiona Nash and Barnaby Joyce are among the Coalition politicians who have lined up to condemn the idea of a sugar tax, echoing Convenience Stores CEO Jeff Rogut’s position: “Common sense seems to have prevailed against the powerful health lobby.”6
Nothing could be further from the truth. No wonder AMA President Michael Gannon concluded that tackling the impact of sugar on health is a struggle “comparable to taking on big tobacco”.7
The OPC is amazed at how openly the sugar industry speaks of its activities.
“They usually talk about how they are part of the solution, so to see them openly boasting about lobbying politicians against public-health measures is a big surprise. It’s normally behind closed doors,” WHO senior research fellow Dr Gary Sacks told Fairfax Media in October last year.8
This leaves Australia trailing the UK, which will finally introduce the soft drink tax this year.
Even with the cost of obesity now around $5 billion annually,16 our politicians show little inclination to heed the experts. So today we have a system that effectively subsidises unhealthy food and drink.
Sadly, in Australia there are many more examples of successful corporate lobbying to obstruct action against harmful products, including smoking, alcohol, gambling, asbestos, and some of the banking and pharmaceutical industries’ activities.
The fossil fuel industry’s campaign against climate science, renewables and a carbon tax, is another classic example. It would seem there is a revolving door between parliament house and those industries. Big corporate money buys big political influence.9-12
HEALTH AND ENVIRONMENT
So how do we, as health professionals, respond to this ongoing subversion of health research and policy? Who do we trust, and how do we fight the pervasive self-interest of corporate lobbying that so often undermines our own well-being?
Health is our specialty, and we need to be a credible source of information. In my opinion as a GP, this is crucial; I don’t want to peddle tainted and possibly harmful diet and lifestyle advice to my patients.
One tactic is to educate ourselves. Look for sources less likely to represent vested interests, those with a track record in promoting the public good, using peer reviewed science, and without major religious or political affiliations.
And then to educate our patients. For example, what follows is a suggestion for a “sustainable” diet from the Food Climate Research Network13, following the Rome Declaration on Nutrition 2014, hosted by the WHO and the FAO, which concluded that current food systems are under threat from overgrazing, soil loss and the increasing encroachment of monoculture industrial farming.
- Eat a wide variety of foods
- Balance energy intake with energy needs
- Base your diet on plant fibre, preferably locally grown
- If you eat meat, eat it in moderation, and use all parts of the animal
- Moderate intake of dairy products or alternatives (e.g. fortified milk substitutes and other foods rich in calcium and micronutrients)
- Include unsalted seeds and nuts
- Sea food; small quantities of fish and aquatic products sourced from certified fisheries
- Greatly reduce your consumption of highly processed foods and beverages
- Preference oils and fats with a beneficial omega 3:6 ratio, such as olive oil
- Drink tap water in preference to other beverages, particularly soft drinks
This list correlates well with diets found in the “Blue Zones” of the world’s longest-lived peoples,14 and by recent Australian research confirming the vital role of diet in reducing cancer risks.15
It is unlikely to have been significantly influenced by the meat and livestock, sugar, alcohol, retail, processed- or fast-food industries. No fads, no liver cleansing, activated water, paleo or expensive supplements. And there are no hidden agendas. It is a diet appropriate for the 21st century and well beyond.
It is reassuring that some basic food numbers keep cropping up, and seem to be confirmed in the recent Prospective Rural Urban Epidemiological (PURE) study quoted by Dr Kosterich.
“Higher fruit, vegetable and legume consumption was associated with a lower risk of non-cardiovascular and total mortality,” with benefits appearing to plateau at three to four servings (375-500gm) per day.16
Raw vegetables seem to have a slight health edge over cooked ones. The authors also endorsed the Mediterranean-style diet, high in olive oil and nuts. The PURE study does not recommend increasing red meat consumption across the board.
The best diets will include a balance of approximately 40-50% carbohydrates, and around 35% total fat, including saturated and non-saturated fat. While very high fat intake (more than 40%) may be bad, the average intake is around 30%, and that is OK.17
Remember that the PURE study involved more than 135,000 individuals, many in poor households, where carbohydrate intake was very high, and regular meat and vegetables may have been difficult to obtain. In this setting, the replacement of CHO with protein, fat and vegetables will have significant benefits.
Although there is still debate around the details, it appears that we are finally reaching consensus around healthy diets.
LIMITS TO FOOD PRODUCTION
Ironically, while there is now genuine scientific consensus evolving around diet, we are fast approaching the ecological limits of our planet to provide that food for us. Food production, especially cattle grazing, is responsible for the vast majority of land clearing and species extinction; a third of the Earth’s surface is degraded, and soil loss is accelerating.18
More herbicides, pesticides and synthetic fertilisers are needed just to maintain current production levels, as soils turn to dirt, and resistant weeds proliferate. Money flows from farmers to large agrochemical multinationals, but the chemicals end up in our food and in our waterways.
In Australia, we have lost around half our native forests and grasslands since white settlement, and clearing is accelerating, even in the Great Barrier Reef catchment.
Queensland alone clears an incredible 300,000 hectares land annually,19 almost as much as Brazil. Most is destined to produce cattle, including for live export. The effect on ecosystems is catastrophic. Half Australia’s land surface is now dominated by cattle, yet this is by far the least efficient and most destructive way to produce protein and fat.
Beef cattle contribute to over 11% of total greenhouse gas emissions, and take up 25% of all useable land on the planet. Yet averaged worldwide, cattle provides a mere single gram of protein per person per day out of a total 30 grams per person per day of all meats – mainly poultry and fish – and 50 grams per person per day from plants, such as legumes, soy, nuts and wholegrains.
This is less than 2% of world protein. Yet it consumes 28 times more land than the equivalent in pork or poultry,13 and releases up to 25kg of CO2 for each kilogram of beef eaten; equal to burning 12 litres of petrol.
The impact of livestock grazing, combined with increasing demand, has led Brazil, Qatar, Germany and Sweden to start factoring sustainability into their diet guidelines.
A “meat tax” is now being discussed in Europe, and would be an important first step in recognising how toxic this industry is becoming. The average Australian consumes around 90kg of meat each year.20 Most health guidelines recommend less than a third of that, which even the meat industry appears to support.21
Even lower levels are still totally consistent with good health.
It is widely accepted that excess dietary red meat, particularly when processed, is associated with poor health outcomes, including antibiotic resistance, shorter lifespans, and GIT cancers. The negative effects on our planet are also dramatic.
The Convention to Combat Desertification launched its Global Land Outlook22 in September last year. Unchecked, with populations growing and viable land shrinking, the outlook is bleak; some estimates see a mere 60 years remaining before agriculture as we know it, collapses due to soil loss, water scarcity and climate disruption.18
The oceans, too, are affected, with huge dead zones from contaminated farm water run-off. There will be no winners on a hungry, degraded planet.
This piece started with a specific case study on the damage to human health resulting from tainted research and dietary policy, now becoming apparent in the epidemic of obesity and overweight.
It pointed out that corruption is endemic in many other areas of government decision making.
In terms of health, we are now seeing the effects of distorted agricultural and nutritional policies, combined with rapid population growth, spreading on a global scale, and devastating ecosystems. Can we allow this to continue?
In the absence of effective political leadership, it is clear that health workers, along with innovative farmers, independent scientists and other informed and motivated citizens, have key roles in averting this scenario; change usually happens from the ground up. This is a diet and health crisis as much as an environmental crisis.
What we eat profoundly impacts the planet. Hippocrates said, “Let food be your medicine”.
Today he could add “Change your diet and save the planet!”
With appropriate policies and incentives, and using existing technology, land clearing could be halted, even reversed, and farmers assisted in converting to more efficient, sustainable systems. The benefits are overwhelming, and include regenerating degraded soils, landscapes and communities, increasing water retention and soil carbon capture and storage.
In other words, averting the collapse of a system which underpins our civilisation. No pressure!
In Australia, most people see one of our 30,000 GPs at least once a year. It would be a small but significant step for GPs to now strongly recommend low-impact diets that are much more plant-based, lower in carbs and red meat, and healthier for us as well as the planet. That is, real food, with minimal additives or processing.
Imagine the cumulative effect across a population, of individuals “voting” for such a diet at the supermarket checkout, let alone the next election. We are science-based, and can measure, monitor and reassess our interventions. Many doctors have already stepped up to the plate to be active in their communities, colleges and the media.
Until we achieve, or enforce, more enlightened political administrations, let’s begin by factoring in the health of our planet when it comes to improving the health of our patients. In reality, they are one and the same.
Dr Michael Schien is a general practitioner in Newcastle, a member of Doctors for the Environment Australia, and a (very) small-time farmer, transitioning from grazing to fruit, legumes, poultry and forestry
- Pure White and Deadly; Prof John Yudken 1972
- Journal of the American Medical Association Nov. 2016 quoting UCSF research
- Time Magazine “How the Sugar Lobby Skewed Health Research”12/9/16; from UCSF
- Research from University of California San Francisco reported in New York Times 9/8/15; ABC online news 24/1/18
- British Medical Journal 11/2/15 “Sugar; spinning the web of influence”
- http;// ABC online news 24/1/18, the Sydney Morning Herald 23/10/17, with quotes from the Obesity Policy Coalition; www.opc.org.au
- http;//www.guardian.com.au;article by Melissa Davey 8/1/18
- Sydney Morning Herald; quoting Dr. Gary Sacks ; 23/10/17
- http;//www.guardian.org.au; “ICAC forced to lay off investigators as budget slashed by $800,000” 2/11/17
- www.tai.org.au; The Australia Institute; Rod Campbell media release 10/1/18
- http;//guardian.com.au; Gareth Hutchens article 29/1/18
- www.abc.net.au;news; Emma Alberici “Sugar Tax and the power of big business; how influence trumps evidence in politics” 24/1/18
- Food Climate Research Network; http;//www.fcrn.org.uk “Plates Pyramids and Planet” 2016 (with Oxford University and the FAO of the UN). “What is a sustainable healthy diet?” and “The Future of Food”; (Oxford Martin program) www.futureoffood.ox.ac.uk “Appetite for Destruction”; WWF October 2017
- Rosemary Stanton “Good Gut” in the Australian Doctor Weekly 1/12/17
- Prof. David Whiteman “Nearly 40% of cancer deaths are potentially preventable” Queensland Institute of Medical Research www.qimrberghofer.edu.au; 12/12/17
- The Lancet; PURE study; 4/11/17
- The Atlantic; www.theatlantic.com; interview with PURE co–authors; Dr. Mashid Dehghan and Dr. Salim Yusuf.
- International Panel of Experts on Sustainable Food Systems; www.ipes.food.org; “From Uniformity to Diversity”; June 2016; WWF & UN cited The Guardian online; 14/10/17
- https;//soe.environment.gov.au; Australia; the State of the Environment; 2016.
- For the love of meat; a three part SBS documentary with Matthew Evans; 2016
- www.mlahealthymeals.com.au; Meat and Livestock Australia
- United Nations Convention to Combat Desertification www2.unccd.int; Sept.2017
- General background includes; Al Gore “An Inconvenient Sequel” 2017, “Food Inc.”; classic documentary on the industrialization of food systems 2008; “Call of the Reed Warbler” Charles Massy; UQP 2017; discusses regenerative agriculture in Australia; “Rotten”; 2018 six- part series on the crisis evolving right now, in our food systems; available on Netflix.