Whenever anything related to nutrition hits the media in the Netherlands, the first thing that tends to happen is that the Dutch media consults with the expert of the semi authority Voedingscentrum are consulted. This organisation that in the past has repeatedly been criticized for questionable ties with the food industry have acted as the conservative sentinels of both the food industry and of the low-fat school of nutrition for many years untill this very day. Fair to say that when the Voedingscentrum announced an update of their “schijf van vijf”, a Dutch variant of the Food Pyramid, expectations were not that high with those that viewed them with suspicion. And to be fair, as far as science based goes, the resulting guidelines are absolutely not without their faults. Yet given their reputation amongst critical thinking nutritionists and well informed consumers, they could have been much worse indeed. In this blog post I want to look closely at the Dutch guidelines. At how they both exceed expectations and fall short of delivering that what Voedingscentrum claims as its mission.
Lets start with the good part of the guidelines. And this is a big one that should silence many of the more paranoid critics of Voedingscentrum. The new guidelines take a firm stand against processed foods. At least most processed foods. We will look at the exceptions later, but its a clear sign that Voedingscentrum is not going out of it’s way to please the food industry parties that it has been linked too. A second really good one and a big step forward is their stand against fruit juice. Given that a glass of fruit juice has extreme levels of sugar that inarguably are very much unhealthy, a very good step forward indeed. The third and final truly good part is the addition of nuts and legumes. Both foods that have been shown to have amazing health benefits.
To summarize the good parts:
- Whole foods.
- A big NO for fruit juice
So much for the good parts. Now lets look at the stuff that Voedingscentrum got wrong. Or at least the part of the guidelines that are not directly supported by both epi data and controlled trails. And some of the parts that are simply and terribly wrong. Lets start of with the questionable stuff. The guidelines are pretty much dominated by starchy foods. Grains, and potatoes basically. Both epi data and controlled trails are known to show convincingly that there are strong links between grain consumption, specifically wheat consumption, and many serious modern illnesses including diabetes, heart disease, obesity and basically the whole package that comes with insulin resistance. Yet almost 30% of the food diagram is dominated by grains. Their defence: it’s all full grain exclusively, we ban things like white rice, white bread and anything not made from whole grains. Well, that is a nice theory and there are some signs that full grain, when not highly processed, may indeed be less harmful than highly processed white flour, but we are basing one third of the guideline on this nice theory that so far has very limited controlled trail evidence and basically non-existent epi data. Not something you should want to bet the health of a nation on. If we look at epi data from sizeable data sets for noticeable health effects, we see that starchy tubers have decremental effects on live expectancy and that people using unprocessed grains, especially rice, do much better than people consuming high amounts of processed wheat flour products. That is, there is compelling evidence suggesting switching wheat flour products and starchy tubers for rice is a good idea. There is a minimum amount of evidence showing that eating processed wheat at all is anything more than slightly less harmful when you choose the full grain variant.
Remember the good part of taking a stand against fruit juice? Well, they went one step further than that. They actually also discourage consumption of vegetable juice. To much sugar is the claim. A claim that might be true for beet juice or carrot juice, if however you make green juice using a slow juicer, the micro nutrient sugar ratio is absolutely off the scale. Yes they tell people to eat more vegetables, 250 grams a day to be precise, but they also advocate eating a whopping 200 grams of often sugary fruits like bananas, mango’s etc each and every day. Again both apparently based on very little actual science. If you replace the 200 grams of sugary fruit with 100 grams of lime and berries, you could easily juice a full litre of above ground, mostly green, vegetables and get the same amount of sugar at many times the vitamins and other important and beneficial micro nutrients. Note that I’m not suggesting that people need to drink a litre of veggie juice each day, just that veggie juice as a whole should not be on any black list, and there is no actual substantial body of evidence supporting any beneficial effect of choosing fruits over vegetables for more than a single serving a day.
We already talked about processed grain where the Voedingscentrum ignored their own core stand against processed foods, but it gets worse. In the previous guideline the dietary advise was to consume fish twice a week. The revised guidelines have reduced that to once a week. In an other part of the guideline, the use of vegetable oils is promoted. Next to these vegetable oils being classifiable as highly processed oils, and thus not in line with the base stand against processed foods, there is something that makes this a serious step back from a health point of view. In recent years, the role of inflammation as major health risk has come to light, and the ratio of omega 6 to omega 3 intake plays a major and unmistakable role in inflammation. Less fish means less omega 3. More vegetable oil means more omega 6. Combined result: the omega 6 omega 3 ratio shoots up. A healthy ratio should normally be somewhere between one and three. Raise it an order of magnitude and mortality rates shoot through the roof. These two guidelines combined thus are not just poor advise. They combine into potentially deadly advise working directly against the excellent advise to eat more whole foods, avoid fruit juice and eat more nuts and legumes.
To summarize the bad part:
- Massive amounts of (full grain) processed wheat products.
- A NO for vegetable juice
- Worse Omega 6 / Omega 3 ratio when compared to previous guidelines.
Much of the avoid this and limit that advise in the guidelines stem from the combination of two ideas:
- Saturated fats raise bad cholesterol (LDL).
- Bad cholesterol raises the risk of heart disease.
At fist glance a large body of research seems to agree with these two ideas and with the idea that as a result saturated fats raise the risk of heart disease. If however we look closely at most of the research one thing stands out, most of the research that supports this link can be linked in one way or the other to pharmaceutical companies and the promotion of statin drugs. Statins are a drug that reduce the bodies own cholesterol production and as a result lower the blood cholesterol levels, and in clinical trails a modest reduction of cardiovascular events has repeatedly been seen with the use of statins. In recent years however, it has been discovered that statins also have anti-inflammatory properties, and produce other effects that could reduce cardiovascular events. Taking that into account, proof that the LDL lowering property of statins is in any way related to the modest results of this drug has basically evaporated. In fact, statins can now be actually be considered the most convincing proof that just lowering LDL cholesterol, either by dietary or drug intervention has zero effect (at best) on heart disease mortality. Recent studies even suggest that LDL particle size may be an important factor, while other studies underline the role of inflammation. Both factors where saturated fat actually does better than both processed vegetable oils rich in omega 6 and full grain wheat flour that are so actively promoted as being heart healthy. Basically we should face up to the fact that statins are probably the biggest scam in the history of the pharmaceutical industry, and as a result we should just throw away a large body of tainted science and start over. Organizations like Voedingscentrum however stick to the tainted research and as such tainted science spreads from pharma to nutritional science leading to dietary advise that, in an attempt to reduce the cardiovascular epidemic actually may end up contributing to it. Let me sum up:
- LDL-c is an established risk MARKER for cardiovascular disease.
- Evidence showing intervention in LDL-c reduces cardiovascular events is all statin based evidence.
- Meta analysis of statin studies have shown the positive effects of statins to be minimal
- Non cholesterol related effects of statins have been found that could more than explain for statins positive effects without any effect from the cholesterol lowering properties of statins.
- Statins are most likely the biggest scam in the history of the pharmaceutical industry, yet much of nutritional science builds upon statin infomercials posing as real science.
- LDL size has been identified as a stronger risk marker than LDL-c. Large size being good, small size being bad.
- Inflammation has been identifies as a risk marker as well.
- Saturated fats improve LDL particle size profiles.
- Vegetable oils are significantly more pro-inflammatory than saturated fats, and so are processed grains.
Non of this is Voedingsentrum’s fault of cause, it’s a giant stain upon the field of nutritional science that may take many years to clean. By that time however, many people may have already died prematurely from a guideline that bans innocent saturated fats for its LDL link and promotes foods that through their inflamation link may be much more dangerous.
To summarise the ugly parts:
- A big NO for SFA
- A big yes to a multitude of inflammatory food choices.
The bad is pretty bad and the ugly is terribly ugly for sure. The focus on whole foods and the guidelines on fruit juice, nuts and legumes taken together however, I must admit I’m still rather positively surprised about the new guidelines. A critical note so to speak, not just for the Voedingscentrum, but to nutritional science as a whole that has been duped by statin infomercials into believing LDL-c to be a useful control. Inflammation and metabolic syndrome should absolutely be a bigger concern in future guidelines than saturated fats, and both full grain and fruit intake lack the scientific data to truly support having them in such large quantities. Having said this however, kudus for the good parts, especially the stand on whole foods. If whole foods would include grains and fats it would be that much better though.