Zoë Harcombe on the obesity paradox: why fat people can’t lose weight

Zoë Harcombe is a Cambridge University graduate in maths and economics, and an  obesity researcher, author and speaker. She was a speaker at the world-first low-carb, high-fat summit in Cape Town from February 19 to 22. She is well-known for demolishing health myths, such as the 5-a-day fruit and veg recommendation. Here she tells me why it makes no sense to eat grains, even in their wholegrain form, and what made governments issue unscientific dietary guidelines that may have killed millions! – MS

With me today is Zoë Harcombe. She is an obesity researcher, author, and speaker and she started out studying mathematics and economics at Cambridge University.   Zoë thank you very much for speaking to me today.

Thank you very much for inviting me and thank you very much for supporting what we’re trying to do with this movement.

 Zoë, you’re a graduate of Cambridge University.  What made you go into maths and economics?

They were my passions at a child.  Some children are more mathematical and some are more language-orientated.  I confess to being appalling at learning languages.  I like to think my English is very good, but nothing else.  I just loved numbers as a child and I think maths and music go very well together, and I was very musical as a child as well.

Music is another language.

It’s a language, but it’s very mathematical to me.  It’s very numeric.  It’s very logical.  It flows.  It’s very consistent.  I like logic.  I like things that make sense and so, I don’t like things that don’t make sense.

We’ll get onto that.  Tell me, how did you move from mathematics and economics into nutrition?

That’s a great question and it took some time.  I graduated from Cambridge.  The Cambridge and Oxford graduates at the time were being attracted by the management consultants, so I did management consultancy.  I travelled the world.  I learned some great business skills and I then started out on a classic blue-chip career.  I worked for some of the organisations, which I now campaign against and should probably remain nameless.  I was in my twenties and was getting a great education, and thoroughly enjoying my career.  I ended up as an HR Director, which reaffirms my fascination with people, numbers, and logic and enabled me to travel greatly as well.  My first book was published in 2004.

During all of that time, I’d had this hobby/fascination/preoccupation with what I call the obesity paradox.  We want to be slim more than we want anything else in the world and yet, two thirds of us are not.  It doesn’t make sense and I have to tackle things that don’t make sense.

What’s the name of your first book?

It’s called Why do you overeat when all you want is to be slim – a million dollar question.

When was that published?

In 2004.

You are currently doing a Ph D.  Through which university?

The University of West of Scotland have been very kind in supporting me with my PhD and I’m examining the evidence base for dietary fat guidelines that were introduced in 1977 in the US and in 1983 in the UK.

Speaking of current dietary guidelines, you seem to be causing stirs very often.  Your latest stir comes after a study in BMJ.  Is that right?

Yes, BMJ Open Heart published a paper from our research team.  We also collaborated with a couple of colleagues from other universities in the US,  one in Wales and one in the US.  These days, it’s very common to collaborate with a number of people.  We can work remotely as a team together, but this is obviously the core of my PhD so yes, I did drive the research.

It’s not original research, but rather a meta-analysis.  Is that right?

Yes, the question is very original, which is why I think it piqued the media’s interest last week.  I’ve had a number of people contacting me, saying “I can’t think why we didn’t think to do this sooner”, because it asks very an obvious research question, but it hasn’t been done before.  If we had been around at the time, the guidelines were introduced and we had looked at the best available evidence, would we have come to the same conclusion as the dietary committees did?

What is your conclusion in that research?

The conclusion was that the dietary guidelines were introduced without even having been tested, let alone with evidence having been found to support them.

That was both in 1977 in the US and later, in the UK?

Yes, in 1983.  There were six randomised control trials available to the US.  In 1977, there was only one more available to the UK committee.  No one individually recommended dietary guideline changes.  One even cautioned that a low-fat diet has no place in the treatment of myocardial infarctions; in other words, heart attacks or heart disease.

How many people would have been affected over the years by introducing dietary guidelines with no scientific evidence whatsoever?

At the time, they were being introduced to two countries and the populations of those two countries, whether they were going to immediately, apply to them because they were adults or whether they were going to apply over time; you were looking at 276-million.  We must now, be at one-billion people in the world today, let alone those who’ve perhaps died over the last 30 years (who were affected by these guidelines).

That’s horrific.  What do you think possessed people to pass dietary guidelines that don’t have any scientific basis?  It doesn’t make any sense.

That’s the question I’ve been asked most often over the last week, when people have realised they weren’t evidence-based and so little people were studied.  Our other great finding was that just 2500 men were studied.  They were predominantly secondary studies, which meant the men were not healthy.  They’d already had a heart attack.  We didn’t study any women.  We didn’t have an exclusively healthy population study and yet, we introduce these for everyone.

The only answer that we can propose to that question is that the anecdotal evidence at the time, very nicely portrayed in books like The Diet Delusion, Good Calories, Bad Calories by Gary Taubes.  Nina Teicholz’s Big Fat Surprise, and Denise Minger’s Death by Food Pyramid: all of them describe an anecdotal impetus coming from Senator George McGovern whom himself, was a low-fat practitioner.  He’d been on a low-fat boot camp and opened a low-fat Pritikin diet conference.  It’s not unreasonable to say that one failed presidential candidate has made a huge impact on the world as a legacy.  Probably an even greater legacy than whoever went on to beat him and become president.

Later on, there was Bush.

Yes.  Nobody has overturned these.  They were the guidelines of the time.  Successive governments could and should have relooked at these dietary guidelines.  One of the most interesting responses to last week was just the rapid closing down by the establishment.  There was no response, which said: “Wow, what an interesting paper.  Let’s look at dietary guidelines.”  The media reaction is defend, attack, dismiss.

Yes, the response has been rather negative.  What do you think is behind those attacks?

Defending one’s position.  Defending the status quo.  This is not a personal attack on any individual.  It’s just saying that the evidence was not there for the dietary guidelines.  Anyone working in public health today, assuming they weren’t part of those dietary guideline committees setting those proposals should not feel any guilt and should not feel any embarrassment.   They should feel nothing.

They should feel sufficiently distanced to be able to say: “Okay, I didn’t implement those.  Let me, in the modern day, look at what the evidence is saying and let me see if I need to rethink what I’m advising one-billion people to do.  What is in the best interest of their health?”  If someone says they’ve inherited the ownership of the introduction of those guidelines as well as having inherited delivering that advice today, they dig their heels in and close their minds even further.  There has simply been no openness to the idea that we could possibly have gotten things wrong.  It’s been incredible.

Very disturbing.  Do you think  the UK dietary guidelines will change much in the near future?

Sadly, I really don’t.  Many people who work in this field constantly talk about it being more likely to be a bottom-up revolution with conferences such as this, rather than a top-down change in dietary advice when you see how embedded the fake food companies are with governments, with universities, and with advisors.  Another brilliant study in the BMJ – just Google BMJ and the sugar web of influence – in the paper last week was phenomenal.  That’s what we’re up against.

 What are you focusing your work on next?

I need to finish my PhD and of course, the randomised control advice is only one part of it.  In addition, I’m looking at the epidemiological advice.  I’m looking at the retrospective justification.  We’ve looked up until the guidelines.  If we then look at our RCTs (randomised controlled trials) and epidemiological evidence since, have we just, by good fortune, retrospectively supported the guidelines that were introduced?

With the studies that I’ve done so far (unpublished), the evidence is no;  we still do not have evidence today for the introduction of those dietary guidelines.

We seriously need to look at what has happened since they’ve been introduced because of epidemics of obesity, Type 2 Diabetes, problems with cancer, heart disease, and the emergence of new conditions such as non-alcoholic fatty liver disease, depression, anxiety, dementia, and Alzheimer’s.  Dementia is being called Type 3 Diabetes.  Type 2 Diabetes is when the body can’t cope with the high level of insulin and glucose.  Type 3 Diabetes is when the mind can’t cope with glucose and insulin.  It’s just, so obvious to people here at this conference but unfortunately, it’s so far from obvious to the people dishing out public health advice.

That’s a great pity.  You have your own diet, but in one interview, you said you don’t actually call it low carb, high fat?

Every book I’ve written was written before I’d even heard of the term low carb, high fat.  The books that I’ve written were between 2004 and 2012.  I’ve been doing a PhD since then.  The term has come into my consciousness in the last two years.  My principle advice to anyone who wants to become healthy and reach their natural weight is simple.  Three words: eat real food.

What do you mean by “real food”?

Fish swim in the sea.  Fish fingers don’t.  Cows graze in the fields.  Salami sticks don’t.  You’ll see an orange on a tree.  You won’t see a carton of orange juice.  You can train it to a five-year old.  I tried it with my nieces.  They grasp it within seconds.  You play a little game in which, you’re walking around the kitchen and walking around the supermarket.  Would you see this in the natural environment?  Yes or no.If you would, it’s on list of considerations.  If you wouldn’t, it’s not.  That’s the first step and that will get most people most of the way there.

Simply ditching the junk will get most people most of the way there.  Then you start looking at good practices.  We have to stop grazing.  We have to eat no more than three meals per day.  I’m hearing a lot at this conference.  People are rarely happy if people skip a meal or two meals per day.  The general message is if you have weight to lose, eat when you’re hungry and not because the clock says: “Now you should be eating.”

Don’t graze unless you’re a cow?

I have a famous saying that I heard at a couple of conferences.  I think I said it on a radio show in the UK and it rather stuck.  Unless you are a cow or the size of a cow, stop grazing.  How we think we can be slim, following the Government advice to have a meal, snack, have a meal, snack, have a meal, and snack before you go to bed – you’re never going to burn fat if you’re constantly putting petrol in the body.  You have to stop it.

What about saturated fats?  How much saturated fat is there in your diet?

You cannot determine how much saturated fat is in anyone’s diet.  I just say “eat real food” and everything else will be what it will be but if you eat real food to get the nutrients that you need for optimal health, you will naturally choose animal-based products.  I have some blogs on my website.  If you go on zoeharcombe.com, just put in the words “healthy whole” and it will pick up a blog, called healthy whole grains.  There’s a table where it compares what we think of as healthy whole grains such as oats, brown rice, and whole-wheat flour with liver, sardines, and sunflower seeds, and it highlights the most nutritious product amongst those.

Healthy whole grains  may win on one nutrient, but not overall.  Then you look at minerals and the same happens.  They just cannot compete.  No whole grain can compete with sardines, liver, eggs, steak, or sunflower seeds.  They just can’t compete, so why are we telling people to have the less healthy foods (and in my ways, unhealthy food) when there are so much better, healthy foods?  When you choose the real foods for the nutrients, you would naturally eat meat, fish, eggs, and dairy.

One of the points that I’ll be making in my presentation tomorrow is “saturated fat is so misunderstood”.  The two things we need to know about fat are first that all foods that contain fat, contain all three fats: saturated, monounsaturated, and polyunsaturated.  There are no exceptions.  You cannot eat saturated fat without eating the other two fats.  You cannot eat monounsaturated fat without eating saturated and poly.   That is so misunderstood.

The second thing that people don’t generally know about saturated fat is that the only food group that has more saturated fat than unsaturated fat is dairy products.  Meat has more unsaturated fat.  Eggs have more unsaturated fat.  Lard has more unsaturated fat.  I’m not saying that unsaturated is better or worse than saturated.  Why is nature going to put one in a food to kill you and the other in a food to try to save your life?  It’s utterly nonsensical.  The only one that has more unsaturated than unsaturated (not that I care) is dairy products.

Unless you suffer from lactose intolerance, you give up dairy products at your peril because of the fat-soluble nutrients that they have such as vitamins A, B, E, and K and all the other vitamins and minerals that go alongside osteoporosis returning.  We have seen rickets re-emerge in the developed world, probably due to our dairy phobia.

Dairy phobia and fat phobia.  In effect, your diet works out to be low-carb, high-fat?

Yes.  If you choose the foods for the nutritional value, you will naturally gravitate towards meat, fish, eggs, and dairy products.  I caution against some nuts and seeds because they’re unusual foods in that they’re high in all three macronutrients and I discuss why in my books.  Vegetables are fantastic – completely separate to fruit.

Fruit is essentially sugar. Vegetables are little pocket nutrients.  You end up just having no room for the whole-grains because you’re filling up on the steak, sardines, and eggs etcetera that you desperately need.

In a post on Biznews that I ran on you, you said the dietary advice on 5-a-day is also without scientific foundation, but you aren’t saying don’t eat fruit and vegetables, are you?

We’re saying eat as many vegetables as is okay for you personally.  Some people’s obesity or Type 2 Diabetes is so carbohydrate resistant that they do actually, need to look at their daily grams of carbohydrate intake.  Thankfully, those people are rare in proportion to the population.  Anyone else can be eating vegetables and enjoying vegetables (and should be) freely, but I would really caution against eating fruit.

Gary Taubes has a great expression.  If you’re overweight, fruit is not your friend.  It’s just a packet of sugar and it really doesn’t come with the nutrients that you think it does.  Again, look on my website.  Look at the five per day.  I have a table somewhere that looks at five particular common fruits and vegetables, and compares them with five foods that regard as fantastic and where the evidence says it’s fantastic.  The fruit just cannot hold a candle to things such as liver, red meat, oily fish, eggs, sunflower seeds, and dairy products etcetera).

An ancestral diet?

It is an ancestral diet.  There are debates that Paleo people were less inclined towards dairy products, and it is a fact that dairy products are a more recent addition to our food chain.  Grains are too, which is the reason for opposition to grains.

I can see far more reason to avoid grains.  Dairy – I think your body tells you if you’re intolerant to it.  If you can tolerate dairy, I think it’s a fantastic part of the diet.  When you look at the nutrients in dairy products, I find it difficult to be convinced that we’re not supposed to consume them because of the nutrition that they give, that is so aligned to what humans need for optimal health.

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