Food for Thought (part 1 of 2)

I recently had the utter privilege of attending the Swiss Re/BMJ Food for Thought conference held in Zürich in June 2018.

It was great to catch up with friends who I feel I hardly see in person, like Jeff Gerber, Richard Morris, Georgia Ede (although I saw them all only in March at Low Carb Breckenridge).    And even better to meet new people, who I may have only spoken with over Skype, or simply read their work, like David Unwin, Sean McKelvey and Campbell Murdoch.

Full credit to John Schoonbee/Fiona Godlee of Swiss Re and BMJ for organising a conference that deliberately provoked difficult conversations and controversial topics.   They organised for a series of articles to be written (all found here) for a BMJ supplement that forced collaborations between people with opposing views on many topics – such as Gary Taubes and Walter Willet.  (I believe it was Gary who suggested their colleague should be nominated for the Nobel Peace Prize…..)

The amount that could be seen between everyone was incredible and I wonder if even more could have been achieved if the similarities were further discussed than some of the arguments over the differences.

Fiona Godlee summarised the key learnings of the event in the following way:

• We have a global crisis with nutrition. Poor nutrition is fueling non-communicable diseases, such as type 2 diabetes.  Poorer countries struggle with the double burden of malnutrition caused by a lack of calories and lack of quality nutrients, but richer countries struggle with an excess of calories, but still a lack of quality nutrients.

 

• We need action, but it is hard to know what research to trust we agreed that we do not really have any high quality studies with excellent evidence. With randomized controlled trials, it is actually very hard to only change one factor, but epidemiological studies are generally not strong enough on the Bradford hill criteria for strength of association to say what factor has really made a difference.

1. We also have no way of knowing what studies were never published…..people are often not interested in (and sometimes not allowed to) write up and publish the manuscripts of negative or antagonistic results
2. We don’t spend enough time investigating anomalies; sometime the best results don’t come from “Good – our results showed what we expected”, but instead from people looking at their results and saying  “that’s odd….”

 

• We need more transparency and independence for research. Everyone is biased and that can influence research and research write-ups.   Being able to have different groups independently analyse and write up the same data can lead to two very different conclusions.

 

• Diet recommendations should be personalized – to me, this was a big concession. Looking at the diversity of the world’s diets, why should one macro-nutrient profile based around foods that many of the world’s populations do not eat, be the only way to go?

 

• We need increased awareness of the gut microbiota. A lot of this information was new to me.  There was a push to eat an increased diversity of plant materials, including nuts and seeds, but it wasn’t believed necessary to eat a great quantity of plant material.  Some red wine and dark chocolate was also on the good to eat list.  Tim Spector’s presentation was very good and gives a great overview of the gut microbiota.  (Only 20 minutes long and well worth the watch).

 

• We need to reverse our thinking about current dietary guidelines, and this will take humility.
  1. Walter Willet freely admitted that there was no evidence that preceded and supported the development of the 1977 USDA dietary guidelines.
  2. There is no evidence that really supports a low-fat diet
  3. Fat, especially saturated fat should not be “demonized”, although there is still considerable debate as to which fats are “healthy” (NB: no one is arguing against monounsaturated fats, such as olive and avocado, but as pointed out to me the other day, there is little to no evidence proving them to be “healthy”)

 

• We should remain silent rather than making misguided claims. If no claims are made, it may be argued that science may not progress, but we should not let unproven claims go into national guidelines, and it also goes back to point (4) – different people will respond differently – there is no “one size fits all” when it comes to diet.

 

• Type 2 Diabetes is REVERSIBLE. Okay, there were disputes as to whether we should be saying “reversed”, “remission”, or “cured”, but there was absolute consensus that type 2 diabetes is not a relentlessly progressive disease.  Glycaemic control by lifestyle management should be the optimal and attainable goal for all – and not just for the newly diagnosed.

 

• We need to decrease dietary sugar and starch intake. If we are to focus on nutrient density and to ensure we get all our nutritional needs without overloading on calories, then we do need to limit our intake of foods that contain sugar and starches – e.g. potatoes, bread, rice, and pasta.

 

• Need more funding from food companies – but independent and agnostic. Food companies make billions of dollars each year.  Being able to access some of that for good quality nutritional research makes sense, but being able to remain agnostic and independent from the funders would be very difficult.

 

Finally, one key point that was driven home during some of the “robust academic debate” was that we are all biased and have conflicts of interest around food.   For example, can someone who advocates for a vegan diet and lifestyle remain impartial during a discussion on the health benefits (or lack thereof) of red meat?  Even detesting a food such as brussels sprouts because you had a bad experience with them as a child* can set up a bias against a food.  This is a part of human nature, but being self-aware can help to modulate these thoughts, while declaring these personal conflicts of interests can help others interpret the information you provide.

End of Part 1……

*My grandmother used to boil brussels sprouts until they were just short of “mush”.  Being served this eight times in a week when I was staying with them as a youth does not set one up for a liking for these in future.    However, I’m told that this was an improvement on her mother’s cooking; apparently my great-grandmother used to put the cabbage on to boil before the roast when in the oven for Sunday lunch.   These days, I prefer my brussels sprouts lightly sauteed with bacon and walnuts.