The Public Health Collaboration UK: Wrong about energy intake

Yesterday saw the launch of a funding campaign on indiegogo to establish a new charity called the Public Health Collaboration UK.

Without wishing to pre-judge, this group of doctors and low carbohydrate diet proponents who aspire to:

……collaborate our efforts into one singular organisation to inform the public and empower the medical community on the science and solutions of health. 1

……seems to look suspiciously like a thinly disguised lobby group who’s activities will produce opinion papers which will – inevitably – be sexed up to the level of fact on the BBC Breakfast sofa and in press releases, by the media savvy members to promote their diet de jour.

So what are they claiming?

…….in the UK 25% of adults are obese, the highest prevalence in Europe, and type 2 diabetes has risen by 65% in the past 10 years with no sign of slowing down. Together they cost the NHS £16 billion a year and the UK economy at large £47 billion a year. 1

Strong start.

These perilous percentages and shocking statistics have presented themselves despite the fact that as a population we are closely following the dietary advice that is being recommended to us. 1

Forgive me just one argument from incredulity, but really? We’ve followed the guidelines closely? 

I’m going to need some evidence for that.

Based on the latest National Diet and Nutrition Survey published in 2014 by Public Health England, our total food consumption is on average 383 calories below the recommended……1

Jesus. They appear to have taken the data literally.

A quick skim through the National Diet and Nutrition Survey report itself reveals the following:

Dietary surveys are reliant on self-reported measures of food intake. Misreporting of food consumption, generally underreporting, in self-reported dietary methods is a well-documented issue. The under-reporting of energy intake (EI) is known to be an issue in past and current NDNS, as for all dietary surveys and studies. This is an important consideration when interpreting the findings from this survey.2

The energy and nutrient intakes presented in this report have not been adjusted to take account of underreporting 3 

It is not possible to extrapolate this estimate of underreporting to individual foods and nutrients because they may be affected differentially. 3

The report also discusses how the doubly labelled water technique was used to validate the figures for a sub set of the surveys and it highlighted potentially large discrepancies between reported energy intake (EI) and total energy expenditure (TEE):

In the NDNS RP, estimates of EI from the four-day diary were compared with measurements of total energy expenditure (TEE) using the DLW technique in a sub-sample of survey participants. The results of this analysis indicated that reported EI in adults aged 16 to 64 years was on average 34% lower than TEE measured by the DLW technique, 12% lower in children aged four to ten years, 26% lower in children aged 11 to 15 years, and 29% lower in adults aged 65 years and over.  3

In short, these figures might show trends or where intakes of certains aspects of diet are below recommended levels but they are not robust enough to conclude that the UK is getting more obese and (T2) diabetic despite eating less. And if you must use the data state the level of uncertainty in the data. I raised the issue on twitter with the collaboration of experts but none were willing to acknowledge or correct the erroneous claim on energy intake which does not bode well for a wannabe charity.

It is also quite surprising to see the collaboration citing this as evidence when Exit Door favourite Aseem Malhotra has previously stated on national television that this type of survey is:

….heavily flawed because it relies on personal reporting which we know classically under reports calories consumed….

I’m not detecting much of a collaborative effort here – did Aseem even read this before release, and if so – did he recognise the mammoth level of hypocrisy involved in putting his name to this?

The call for funding goes on make further broad, unsubstantiated ideologically driven claims without even attempting to evidence them:

…..the Eatwell plate and simple calorie restriction, that have been used for the past 20 years with no improvements in public health 1

All of which is irrelevant conjecture until you have completed the monumental first step of demonstrating that the population have been following the guidelines throughout this period (good luck with that one).

I sense entertainment lies ahead – it will be interesting to see who of the experts are willing to be a trustee of a charity which is already playing fast and loose with the evidence, and more interestingly one whose begging bowl approach to funding seems to places their dubious claims within the remit of the Advertising Standards Authority.



National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009 – 2011/2012) p74 

National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009 – 2011/2012) p75 



Eat Like an Ancient Egyptian

Nina Teicholz  is again busy rewriting history to make it fit better with her hypothesis that a diet heavy in meat is the best for health:

Lets deal first with the premise that these two images are representations of how we used to eat. The models in question are funerary objects which were found in the tomb of an Egyptian noble called Meketre1, who was a chancellor and chief steward during the reign of Mentuhotepo II and III during the Middle Kingdom (between about 2000 BC and 1700 BC).

What is funny here is that Teicholz blatantly omits other parts of the find from the very same tomb, which are housed in the very same Museum, which run counter to her thesis. For example the tomb also contained a model of a bakery and brewery 3 :

DT208237There is also a model of a granary 4 which according to the Museum description includes an “…accounting area…[…]…Keeping track of grain supplies was crucial…”:

DT2518 (2)

This should come as no surprise, since the Egyptians were an agricultural society who pretty much invented , and their success was attributable to large scale agriculture and irrigation techniques which they used to exploit the nutrient rich flood areas surrounding the Nile to grow crops.

It also seems that Teicholz fails to understand the purpose and context of these objects. These are not necessarily a record of what everyday people were eating at the time, they were specifically placed in the tombs of the elite – nobles and priests – along with actual food to sustain them in the afterlife, in the way in which they had become accustomed to during life.

Rather than showing how we used to eat, the “we” being the general population, these objects (including those awfully inconvenient depictions of grains) should more accurately be labelled: how the Ancient Egyptian elite ate.

Finally, lets looks consider the idea that when it comes to diet we forget history at our peril. While this appears to be a simple fallacious appeal to tradition (there is little reason to conclude this way of eating was the best for health back then, or that it is now) I’m going to agree with Teicholz on this one.

With this in mind, I look forward to hearing her thoughts on research 5 which shows that the mummified remains of Ancient Egyptian Priests (who ate the fairly well documented food offerings which were made to the gods – a meat heavy 50%+ fat diet high in saturated fat) showed the signs of what looks suspiciously like vascular calcification.







Action on Sugar’s Professor Graham MacGregor Misses the Point

Almost missed this letter to the editor of Food from Action On Sugar’s Chairman Professor Graham MacGregor, in which he makes a rather remarkable statement

We are not claiming that their is anything uniquely damaging about sugar, apart from the fact that added sugar is a completely unnecessary source of calories and a cause of dental caries.

I find this extraordinary for a number of reasons, firstly, you might argue that forming a single issue lobby group Action on Sugar

…a group of specialists concerned with sugar and its effects on health.

itself strongly implies that sugar has unique effects on health which need to be tackled.

Secondly you might point out that the idea that added sugar is uniquely dangerous beyond its effects on obesity has been the central theme in Action on Sugar’s 3 month long media campaign. At various times, Action on sugar have made the following claims about the dangers of sugar consumption:-

This is not singling out sugar as uniquely damaging? I’m sure Professor MacGregor would argue that these are clearly stated as ‘links’ and ‘associations’ rather than causative but when you continually bombard the public with claims about the harms from sugar – often whilst simultaneously espousing the virtues of once demonised fat – the cumulative effect is to establish that very premise.

I don’t know if Professor MacGregor cannot recognise this, or if he is profoundly ignorant of the activities of a campaign which he chairs. Certainly when Action on Sugar’s own launch day press release states the following

Common sense’ and the food industry say that all calories are the same. But the science says that sugar is different – that sugar is dangerous exclusive of its calories, just like alcohol.

it leaves him looking rather foolish.

The Dr Aseem Malhotra Missing Word Competition

I’m sure anyone interested in food and nutrition will have come across Dr Aseem Malhotra. In fact the way he springs up on the television, radio and newspapers like some demented anti-sugar, pro-fat jack in the box its pretty hard to ignore him.

Dr Malhotra occasionally asks some interesting questions about nutrition and diet. But he also propagates the views of fringe scientists and as others have previously documented (see here, here, here) recommends some questionable solutions based on weak arguments and rectally sourced statistics.

His recent appearance on Newsnight was supposedly to enable him to give Jeremy Paxman some ammunition to attack Coca Cola’s European President. So ignoring his claims that Coca-Cola

…markets these products as being full of energy….

(they don’t, but it is) and his hilarious just-say-no-tone when he says

…believe me, its energy your don’t want and energy you don’t need…

his main argument and evidence boils down to a summary he gives of this study.

The finding of the researchers at Imperial College are clear (well as clear as Epidemiological studies can ever be) and are broadly in agreement with other studies and meta analysis which show that regular consumption of sugar-sweetened drinks is associated with an increased risk of type 2 diabetes. In short this is an omelette which needs no more eggs, just good communication of the existing studies.

Here is a transcript of Dr Malhotra’s summary of the study (see video 1.26)

So we know that the consumption of just one sugary drink, typical of a can of Cola increases the risk of type 2 diabetes by 22% independent of body weight, and this was a study that was published from Imperial College researchers recently looking at about 16,000 people throughout Europe

So here is my challenge, a good old fashioned missing word competition*.

All you need to do is find the word that Dr Malhotra omitted in his summary of the study when he described it on Newsnight. Its rather an important word, particular if you are say a lay person who enjoys Coca-Cola in moderation. I’ll also give a bonus point for naming the actual % increased risk independent of body weight because Dr Malhotra doesn’t seem to know that either.

Now I’m sure this is just an oversight on his part rather than something deliberate but we often hear about how the publics understanding of science is damaged by confusing and poor quality reporting by the mainstream media.

When I see someone who is presented as an ‘expert’ making a sloppy error such as this (which co-incidentally massively enhances his arguments for taxing sugary drinks) as well as also making the same numerical error which the mainstream media appear to have copied from the press release I have to wonder whether we need an ‘expert’ to select the ‘experts’.

*the term ‘competition’ is used loosely. no prize. just for fun.

Update 07/03/2014

Dr Malhotra is still wrongly quoting the 22% figure in this article.