Tackling obesity (also in childhood) on a national scale, with legislation, is very much easier said than done. For a start, as Monday’s leader on Times of Malta pointed out, the definition of ‘junk’ or ‘fast’ foods is the subject of much scientific controversy which is the tip of an iceberg of 60 years of professional jealousies and commercial vested interests.
For decades, American health authorities convinced themselves (and others around the world, including myself) that saturated fats in animal meats, milk, cream, butter, lard and cheese and the cholesterol in egg yolks were directly linked to blood cholesterol levels and led to risks for heart attacks and stroke.
A British professor of physiology claimed early on that sugar was the culprit, not fat, but he was totally ignored.
Together with a Greek and an Italian doctor, the Americans invented the ‘healthy Mediterranean diet’ and recommended low-fat, high-carbohydrate intake.
The French were known to have a high fat diet (from cheese) but registered roughly half the heart attack rate of Scotland or the US. However, no contact with French health authorities was made.
Several decades later, this huge nutritional human experiment has resulted in an explosion of obesity and diabetes rates in America and in many other countries. At the same time, in spite of less smoking in the US, heart attack incidence did not decline and survival from heart disease has improved only because of the huge expense of interventional cardiology and open heart surgery.
Recent research showing that saturated fats are the only foods that actually increase the good blood HDL-cholesterol and that they do not significantly affect total and LDL-cholesterol blood levels has been ignored and its proponents sidelined by the American health authorities.
Besides increasing realisations that total and LDL-cholesterol measures are not good indicators of heart attack risk, the old British claim that sugar (not fat) is the culprit is now being proved right.
Sugar raises blood insulin levels and insulin is a powerful hormone that encourages weight gain and high blood pressure.
If sustained for long enough, high blood insulin eventually leads to a worn-out pancreas, diabetes and heart disease.
Fats do not increase blood insulin
Unfortunately, sugar is not only found in sweets, sugary drinks and fruit juices. All foods made from flour, rice and potatoes are converted by our body to blood sugar. Refined white flour and rice, compared to wholemeal flour and brown and red rice, produce even more blood sugar faster. This is really bad news for the Maltese version of the Mediterranean diet, full of bread, pasta, pizza, rice, pastries and biscuits.
More bad news is that margarine, a totally artificial food made by chemical transformation of a liquid vegetable oil into a paste, is unhealthy because it lowers the good blood HDL-cholesterol.
Recent research shows that the supposedly bad LDL-cholesterol is in fact of at least two types, one good and one bad. Routine laboratories do not measure the two types, so the total LDL-cholesterol measurement gives no indication whether this is made up predominantly by the good or the bad LDL.
It is not clear what highly advertised margarines with plant sterols, claiming they reduce blood LDL-cholesterol, actually reduce – whether the bad or the good LDL-cholesterol. There is no good evidence these margarines reduce heart attack incidence.
Even more bad news is serious suspicion (being hidden away) that heating vegetable oils (except, possibly, pure olive oil) produces toxic chemicals. Margarine and vegetable oils are the basis of most commercially produced foods.
Butter is not altered chemically by heating and is again being considered safest (and tastiest) for cooking.
Weight-loss calorie booklets are fundamentally wrong. The notion that fats have twice the calories of carbohydrates and are, therefore, more fattening, was based on an incorrect interpretation of human physiology: the body metabolises carbohydrates and fats differently. Carbohydrates (not fats) are way out the most fattening. This has been proven in clinical trials.
Fats are far healthier than carbohydrates. High carbohydrate diets mean high blood sugar and insulin, with their consequences: obesity, arthritis, diabetes and heart disease.
Fats do not increase blood insulin. If this ‘new’ finding is not kept in mind, any national strategy for tackling obesity, in any age-group, will be barking up the wrong tree, with eventual, disappointingly unhealthy results – as has already happened.
Albert Cilia-Vincenti is a scientific delegate to the European Medicines Agency.