The big issue

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Praise the lard

For years we've been warned off red meat and animal fats. But we're no sooner out of the frying pan and into the fibre than scientists start extolling the virtues of bacon and eggs. Robin McKie gets to the heart of the matter

Sunday August 11, 2002
The Observer

It is a dietary mantra that has bordered on the fanatic: fat is a killer and a clogger and it furs your arteries, bursts your blood vessels, and sends your weight soaring through the stratosphere. Fry-up and die, runs the refrain. Or at least it did - for recently food scientists have had an unexpected change of heart. Suddenly, they don't seem so resolute in their rabid hatred of all things fatty. After 30 years of urging us to cut out chips, cheeseburgers, pizzas, deep-fried onion rings, suet puddings, and other food 'horrors' and to fill up instead on pasta, bread and cereal, they have begun to have doubts. Low-fat, carbohydrate-rich diets - far from being good for us - may be detrimental to our wellbeing.
So there you are. Just as you pour skimmed milk on your muesli, sip your black coffee and scrape some low-fat spread on your slice of toasted granary loaf, it now turns out that a plate of bacon and egg could actually have been just as good for you.

Only a few years ago such a suggestion would be have been medical heresy. But now the idea is being earnestly discussed by scientists and will form the core of a major lecture to be given by one of the country's top dietary experts next month. In a keynote address at the annual meeting of the British Association for the Advancement of Science in Leicester, Christine Williams, professor of human nutrition at Reading University, will reveal just how this sea change in nutritional thinking has taken hold. Fats - far from being tasty but evil - can be good for you, she will explain. Indeed, some are essential for our wellbeing.

'Opinion is now swinging back in favour of foods that are relatively rich in some fats, and I think that will be for the benefit of the general public,' she says. 'And yes, I agree that having steak and chips is OK - once or twice a week.' Hence, the title of Prof Williams's lecture on 9 September: Fats Can Be Friendly Too.

Nor is this revolution confined to our side of the Atlantic. In the United States, experts are also questioning the 'carbohydrates good, fats bad' shibboleth that has held sway for decades. Indeed, William Willett, chairman of the nutrition department at the Harvard School of Public Health, believes this ideology may actually be the cause of the epidemic of obesity that is not only sweeping his country, but also Britain where it is now estimated that more than half the population is either overweight or obese.

As he points out, all that pro-carbohydrate, anti-fat propaganda that has poured from a phalanx of medical missionaries - dietitians, health groups, consumer watchdogs, and cookery writers - over the past 20 years has coincided with one striking phenomenon: a 10 per cent rise in the average weight of Western man (and woman). Despite earnestly entreating us 'to eat sensibly', we have got fatter and fatter by the year. And Willett thinks he knows why. 'The exclusive focus on adverse effects of fat may have contributed to the obesity epidemic,' he states. Certainly, Willett has many supporters, such as his colleague Meir Stampfer, professor of epidemiology and nutrition at the Harvard School of Public Health. As he has said: 'People have got the wrong message that fat is bad. They have the mistaken assumption that if you eat fat, you get fat, but it is not the case that a low-fat diet will lead to a low-fat person. It all depends on what type of fat you eat.'

It is not hard to see why this grim state of affairs has arisen, of course. Gram for gram, carbohydrates contain only a half the number of calories as fat, so you should be able to shovel in great mounds of linguini carbonara or potato salad or mushroom-stuffed ravioli without putting on nearly so much round your girth. On top of that, you will be boosting your fibre count, another aid to a healthy life. At least, that's the theory.

The trouble, says Willett, is that in simply banning fat from our plates, and piling on the pasta instead, we are not being sufficiently discriminating. Carbohydrate-rich foods are often packed with sugar, and so our waistlines still swell. Then there is the simple matter of complacency. Convinced we are eating the right foods, we consume too much of them. In addition, scientists have uncovered a separate physiological problem associated with high carbohydrate diets. Such foods have a very different impact on the blood than do their fatty counterparts, particularly when it comes to insulin production. Insulin is the hormone, secreted in the pancreas, that carries energy-giving glucose to our muscles. It is the body's energy transport system and it also regulates fat metabolism inside our bodies.

The crucial point is that insulin secretion is regulated by carbohydrates. The more carbohydrates you eat, the more insulin enters your blood and the more fat is stored in your tissues. Normally that fat would be burned off once your insulin levels drop. But people stuffed on oatcakes and cereal bars and other carbohydrate-rich wonder foods keep their insulin levels constantly topped up, and so they never get a chance to use up their fat. The result has been a swelling wave of blubber bellies among the peoples of the West, says Willett. 'Carbohydrates can cause our metabolisms to hold on to fat,' he says. 'They also influence appetite and can cause us to overeat.' Hence Willett's heretical claim that there is virtually no health gain in giving up milk, butter, and cheese and eating crackers instead.

Nor is he alone in expressing doubts. Prof Williams also warns about the danger of eating too much carbohydrate, thus provoking unwelcome insulin surges in the blood. 'There are other effects,' she adds. 'Beside increasing risk of diabetes and heart disease, excess insulin has been linked to cancers of the breast and colon, for example.'

Critical evidence for the fact that substituting carbohydrate for fat in your diet is no nutritional panacea was provided last year by scientists led by Dr Lee Hooper, at the University Dental Hospital in Manchester. In an analysis of 27 separate trials, carried out in different parts of the world and involving a total of more than 30,000 healthy adults, she and her colleagues concluded that although a low-fat diet could slightly reduce the risk of a fatal heart attack, its effect on overall mortality was 'essential zero'.

'Most of us who start on a low-fat diet will be doing it in our twenties, thirties, or middle age and might stick to it for 20 or 30 years, but we still don't know whether that might make a big difference to mortality,' Dr Hooper said at the time.

To most experts, such findings have been somewhat dismaying. However, to a few people - such as US dietician Robert Atkins - this apparent failure of low-fat diets has gone down like a cup of pure ambrosia. For the past 30 years, he has been promoting his own, controversial high-fat, low-carbohydrate New Diet Revolution and has been urging people to eat 'truly luxurious foods without limit' - steak with bearnaise sauce, bacon cheeseburgers, and lobster with butter sauce, while at the same time avoiding fruit juices, flour- or sugar-based foods - even vegetables. These low-carbohydrate, high-fat regimes have been enthusiastically taken up by celebrities such as Geri Halliwell, Courteney Cox , Calista Flockhart and Portia de Rossi from Ally McBeal, along with Christina Ricci and Sarah Jessica Parker. All claim that their recent, slimline physiques were acquired thanks to Atkins's diets. Catherine Zeta Jones is even said to have used the diet to shed almost 50 pounds, gained during her recent pregnancy.

This apparent acceptance of the importance of fat in our food by the medical establishment must seem a welcome vindication for Atkins. He has been vilified roundly throughout his career to the extent that he once had to defend his diet before the US Congress - because his regime includes high levels of saturated fats from meat and dairy products which have been linked with high cholesterol levels in the blood, which in turn are correlated with high risks of having heart attacks and strokes.

Nevertheless, we should take care. Fat has not been completely rehabilitated. Many nutrition experts remain cautious about its dietary benefits. 'Yes, it's no longer seen as the killer that it was once thought to be, but equally we should be careful about diets that promote fat at the expense of eating fruit and vegetables,' said Dr Margaret Thorogood, of the School of Hygiene and Tropical Medicine in London. 'Those would be very bad for you.' This point was backed by Professor Williams who is also concerned that extreme approaches to diet could have undesired side-effects. Fat should still be taken in moderation, and those that are taken should be made up of as many mono-unsaturates and balanced poly-unsaturates as possible, she says.

Dr Wendy Doyle, of the British Dietetic Association, also counselled caution about removing carbohydrates from the diet. 'They are a key source of fibre and a range of B vitamins, so you have to be very careful what you do. One should display a sense of moderation and balance with all the foods you eat.'

Yet it is clear that the way we think about food and fat has changed and that we no longer view the latter as irredeemably bad, added Dr Thorogood. 'In fact, some fats are good for you, and not just unsaturated fats such as those we get in sunflower and other oils. Mono-saturated fats like those found in olive oil are now known to have a beneficial effect as well. And I would agree that having steak and chips once or twice a week, despite the saturated animal fats, will not do you great harm.'

One intriguing study carried out by Dr Thorogood and her colleagues compared cholesterol levels in vegetarians with levels in their (carnivorous) friends and relations (people who were presumed to share otherwise identical lifestyles). Those of the former group were distinctly lower than those of the latter, yet there was no statistically significant difference in health between the two sets of individuals. Meat eaters were slightly more vulnerable to heart disease, while non-carnivores were slightly more prone to certain cancers. Once more that plate of steak and chips doesn't look so deadly, though again one should take care in over-interpreting results. 'In many Mediterranean countries, people have diets that are far more fatty than diets in this country, yet they tend to live longer,' said Dr Doyle. 'Of course, they get most of their fat from unsaturated sources like olive oil. Nevertheless, we can see some fats clearly have benefits for your general health. On the other hand, it is very definitely bad for your waistline.'

And this is a key point. Consider a tablespoon of oil - olive or sunflower or whatever - which you might typically use to stir-fry your mange tout or baby sweetcorn. That spoonful packs a single dose of 145 calories, a fair aid to a swelling waistline. 'It has nine calories a gram while carbohydrates and proteins only have four per gram, so it is sensible to think just how much fat you want to have in the foods that you eat every day, especially if you are trying to lose weight.' added Dr Doyle.

And while it is astonishing that our declining intake of fatty foods over the past two decades has been matched by a rise in our average weight, girth and obesity, there are other factors involved in the creation of a generation of big-bellied Britons. 'We live in an era where manual labour is in continual decline and where fewer and fewer people take exercise,' said Dr Doyle. You cannot rule out our increasingly sedentary existence from this equation.'

In short, if you eat too many calories you will get fat. Nothing has changed there. The real question is: how should we obtain those calories?

At present, government dietary guidelines recommend that we get 50 per cent of our calories from carbohydrates; about 15 to 25 per cent from protein (in the form of poultry, fish and eggs); and the remainder from fats. But what fats and what carbohydrates? Distinctions between the various forms are not provided by health guidelines, yet they go to the very heart of science's New Food Synthesis.

Take the example of fats, as we have seen, these are no longer viewed as a dietary anathema, particularly if they come in the form of mono-unsaturated and poly-unsaturated fats from nuts, fish, seeds and vegetable oils.

And so it goes for carbohydrates, for scientists now differentiate between two basic types. There are those made from refined sugar and white flour and which make your blood sugar rise quickly, giving you a rapid blast of insulin. These are high-glycemic index carbohydrates - or wet carbohydrates - and they are found in vast quantities in the syrups that go into the soft drinks, juices and sports drinks that now supply a stunning 10 per cent of our calories.

By contrast, those carbohydrates with a low glycemic index take much longer to affect your blood sugar levels, and have much lower impact on insulin fluctuations. Typically, green vegetables, beans and whole grains are good sources of low-index carbohydrates because they contain fibres that slow down their digestion. You should try to get most of your carbohydrates from these foods, which should stop those insulin surges.

'We now understand much more about diet,' added Dr Doyle. 'So the old "cut the fat" message is out of date. You still don't want to go stuffing yourself with lardy deep-fried food all the time, you will use up all your calory needs - but it is clear there is room for more give and take than was perhaps realised in the past.

'And food shouldn't be boring. A diet that is dominated exclusively with protein and fat consisting of nothing but slabs of meat or cheese is not much more fun than one that is made up of pastas and cereals. Both approaches are a bit tedious and hard to stick to. So yes, I think it is good to have a little of what you fancy: even an occasional plate of steak and chips.'

Dr Atkins: back in fashion
Thirty years ago the New York champion of complementary medicine, Dr. Robert Atkins, caused a stir by publishing the bestseller Dr Atkins' Diet Revolution which made the case for a high-fat diet. Its contentious message doomed it to medical-outsider status with health warnings from the American Heart Association.

Perhaps the time is now right again for Atkins, 71, and his counter-culture food message. His book was updated this year (worldwide sales exceed 10 million copies), he has established a foundation for nutritional research and his company, Atkins Nutritionals, is a successful provider of supplements and nutritional information to followers the world over. After decades in exile, he is now, it seems, living happily off the fat of the land. Carl Wilkinson

The OFM fat is good (to a degree) diet

· Monday
Steak and chips - a 5oz grilled fillet steak served with a large portion of oven chips, wholegrain mustard and a green salad.

· Tuesday
Smoked salmon and cream cheese bagels - bagel with smoked salmon and cream cheese, lemon juice and black pepper served with a mixed leaf salad. Plus pudding treat...
Raspberry meringues - meringue with raspberries, low fat creme fraîche garnished with hazelnuts.

· Wednesday
Felafel kebab - felafels served in pitta bread with salad and homemade hummus.

· Thursday
Chicken with peanut sauce and stir-fried vegetables - grilled skinless chicken breast with peanut sauce made from peanut butter, soya sauce, lemon juice and chilli/garlic to taste, thinned with water and served with a large portion of boiled white rice and stir-fried vegetables.

· Friday
Grilled trout - grilled trout served with a large baked potato and a Greek salad of feta cheese, olives, cucumber and tomatoes.

· Saturday
Kippers with savoury rice - grilled kippers with savoury rice, onions, tinned tomatoes and peas.

· Sunday brunch
Full English breakfast - cooked breakfast with baked beans, two fried eggs, mushrooms and toast.

· Prepared with the help of Nutrition scientist, Brigid McKevith of the British Nutrition Foundation. For further nutritional advice and information from the British Nutrition Foundation visit www.nutrition.org.uk. The diet has been prepared for somebody of good health.

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