Diet Dilemmas.

CatsFive said:

It's easy to decry Eatwell, but there are huge numbers of people in the UK who don't even eat that well, for a variety of reasons including not being able to afford to do so. If the majority were eating Eatwell, there would be quite a bit less of obesity, T2 diabetes, heart disease, strokes, many cancers.

I wanted frozen okra. It wasn't in my local Asda, Sainsburys or Morrisons. I found it in Icelan where the frozen non-potato veggies were tucked away in a small corner.

Finding it was very depressing. I walked past row after row of UPF, mostly with far more carbs than Eatwell would have. But that's what has made food cheap compared to the 60s & 70s.

I grew up in a house with a decent size garden where we had plenty of room to play, and where my father grew a lot of our summer food. Then we got a chest freezer and were eating home-frozen runner beans all winter as well. Yuck - we had the last of the frozen one day and the first of the fresh the next, which was chalk & cheese. UPFs were a novelty back then.

Cooking is no longer taught. Quite a few people at the bottom end are living in properties where cooking would be very difficult. Quite a few people are working so many hours that cooking is a chore they don't want to do when they eventually get home. I see plenty of expensive kitchens on the media clearly designed by people who never cook. The worst I think was a hob in an old kitchen breast, with a wall each side so no room for handles, and you had to lift a pan around the wall to put it on a worktop. Also kitchens with almost no drawers, and/or drawers no-where near the 'working triangle'.

The rise of the huge American-style fridge is another indication of how much UPF we eat, and maybe of how people are storing food that should be in a larder in a fridge.

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Definitely some good insights here, and much closer to the actual truth than the narratives about 'eatwell' and 'the' guidelines being spread by many in the current nutrition space.

Paul_ said:

All perfectly valid points, I agree with many that you've outlined, particularly the home economics/cooking angle ("teach someone to fish" and all that). However:

1) Eatwell plate was devised in 2012. This was updated to the Eatwell Guide in 2016. In 11 years, obesity has continued to rise, as have all metabolic syndrome conditions. Maybe it's time to review and acknowledge it's not working?

2) The problem with saying that 50% of the plate needs to be carbs is that for many this will mean processed potato. This is due to many factors, including cost, poverty, not knowing better, or just not having the time.

3) As many of the "charities" and organisations involved in pushing healthy eating are funded by the food industry, many of whom have the sugar industry not far behind them, it's not difficult to see why these initiatives fail. A cynical person might think they're intentionally awful campaigns.

4) Maybe if the NHS didn't serve up such unhealthy slop in their hospitals, people might take them a little more seriously on nutritional guidance.

5) Recommending diabetics consume 150g or more of carbs per day, particularly at initial diagnosis when reducing blood sugars is critical, is so barking mad and negligent that it's inexcusable. There's no nuance to the advice, it's just pushed by the NHS with an attitude of "look up this picture of a plate on the internet and follow it, there's a good little stupid, fat peasant". I cannot adequately sum up my anger and rage in words when it comes to this advice, and I doubt it would be constructive for me to attempt to do so. It needs to change, it's doing more harm than good.

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Yes, obesity continues to rise, but are the people becoming obese eating as per Eatwell?

Eatwell says 1/3 of the plate, not 1/2.

And yes, there are a lot of vested interests who seem likely to have a malevolent influence.

Some of the worst food I've ever eaten is in hospitals. However patents need to be served what they will eat, and if that's 'unhealthy slop' it's better than them not eating.

Finally, I've not found 150g as a recommendation, and I suspect that for many people that would be quite a reduction in their carbohydrate intake, especially those drinking beer as well.

CatsFive said:

Yes, obesity continues to rise, but are the people becoming obese eating as per Eatwell?

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When trends such as obesity and metabolic syndrome are upward and to the extremes they are, does it matter?

If there's a sign next to a river saying "don't swim in the river", but hundreds of people drown in that river per year, the advice is irrelevant, regardless of how good that advice is. We can all look on saying "well, no one would drown if they read the sign", but maybe some better measures are needed because the current advice isn't working.

My issue isn't with Eat Well as such. My issue is that it's a waste of public money as only a minority follow it, it's poorly communicated by the NHS and public health campaigns are dreadful, and most important is the NHS recommends it to diabetics as though it's helpful. It's a waste of money and time, and harmful to diabetics.

Some of the worst food I've ever eaten is in hospitals. However patents need to be served what they will eat, and if that's 'unhealthy slop' it's better than them not eating.

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I can't agree with this point. Hospitals have had burger chains and fast food outlets in the same building. If patients want unhealthy options, there's an abundance of them in hospitals already. If hospitals offer actual healthy options, it provides choice, and anyone not wanting that can just leave the hospital food and do what many already do - get family/friends to bring them food in, or buy it from one of the fast food outlets in the hospital. By making the food awful, it railroads more people down the fast food routes.

Either the NHS believes in Eatwell, in which case every hospital meal option and eating establishment on NHS premises should conform to it, or they don't. They clearly don't, it's just a tick box exercise at best, which is why the majority don't care what it says and the initiative is a total failure.

Finally, I've not found 150g as a recommendation, and I suspect that for many people that would be quite a reduction in their carbohydrate intake, especially those drinking beer as well.

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Low carb is generally considered to be less than 150g of carbohydrate per day. The NHS doesn't recommend low carb to diabetics as standard practice, so the absolute raving lunatics are therefore recommending a diet, based on their Eatwell plate, with 150g or more of carbohydrates per day.

CatsFive said:

Yes, obesity continues to rise, but are the people becoming obese eating as per Eatwell?

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No

CatsFive said:

Finally, I've not found 150g as a recommendation, and I suspect that for many people that would be quite a reduction in their carbohydrate intake, especially those drinking beer as well.

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This is something I'm also curious about. Somewhere, around 8-9 years ago, I was messing around with low-carb. I spent much of my online time reading on Mark Sisson's forum, along with Richard Nikoley's 'Freetheanimal' and various other sites. Since being a member of this site, I've seent this figure of 150g carbs many times. But I've yet to find any solid scientific reference for there being a cut-off at 150grams. The only time I've ever seen reference to it was via excerpts from Sisson's 'Primal' book, all those years before. But from memory, this was just a number he threw out there as part of his 'Grok' fantasy i.e he claimed that 150g of carbs was the amount of carbs paleo/primal man would've been eating.

Even as someone who believes the compelling evidence of carb-eating during various moments and locations of 'our' evolution, it'd be hard to make such a definitive claim as far as quantity is concerned.

Of course, few diet books these days seems to be able to avoid making false claims about carbs. Here is Sisson's:




Anyway...I digress.

It seems somewhat specific for there to be a cutoff set for carb intake. Is the assumption that there is some kind of mechanism that switches at this specific amount? And does anyone have any information to support this cut-off?

Like you, I don't see 150g of carbs as either high or low. Is it high? Compared to what? Is it low? Compared to what? It just is.

If, as it seems, the generally-accepted narrative is that an individual's response to carbs is dictated by their own insulin-(in)sensitivity, then why is there the need for a distinction?

Edited for spelling mistakes, grammar and formatting. Perhaps I might one day learn to edit before posting ;_

Beating-My-Betes said:

It seems somewhat specific for there to be a cutoff set for carb intake. Is the assumption that there is some kind of mechanism that switches at this specific amount? And does anyone have any information to support this cut-off?

Like you, I don't see 150g of carbs as either high or low. Is it high? Compared to what? Is it low? Compared to what? It just is.

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I think much of the issue around carbohydrates is that the majority of people, because they have the luxury of not needing to know, don't realise that all carbs are not created equal. Therein lies the problem with most public health nutritional advice.

I work in a job that requires a lot of communication to customers and internal staff. One common theme is that people don't do detail. Public health nutritional advice can't win in its current form. Either you over-simplify and just say "carbohydrates" without explanation, or you explain the detail and people don't read it/care. Add in other factors, such as ultra-processed carbohydrates being so much cheaper than healthy carbohydrates, combined with work/life balance increasingly moving in favour of work, and before long people make bad nutritional decisions out of necessity, regardless of what the advice may or may not say. Most people consider cereal to be a healthy carbohydrate source, providing it's got some fibre in it, or the wholegrain symbol. Fact is though that most cereal isn't healthy, regardless of what it's got in it.

The reality is that your average person, who has worked a 12 hour day with a commute, gets home and needs to feed a family. Many in this situation open the freezer, or get some ready meals, and cook whatever. Maybe they get takeaway. It might be in proportion to the Eatwell plate, but it's not of the nutritional quality intended - and that's where the problems begin.

Eatwell, in itself, isn't a bad thing for non-diabetics. However, the reality is that any public nutrition advice isn't capable of improving public health on its own. With better campaigns, better communication, and other measures that make healthy foods cheaper than ultra-processed foods, maybe they can work. Until then though, they're screaming into the void, and it's not helping anyone.

Paul_ said:

I think much of the issue around carbohydrates is that the majority of people, because they have the luxury of not needing to know, don't realise that all carbs are not created equal. Therein lies the problem with most public health nutritional advice.

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Actually, I think the governments' messaging around carbs is pretty clear; at least it is when considered in tandem with their advice on fats. The issue(s), in my opinion, is that the guidelines aren't explicit enough when it comes to fat, and they do not offer easy/workable advice when it comes to getting an idea of total intake and output i.e tracking.

Of course, even with such information, the likelihood is that most people don't want to be told that ice-cream should be an occasional treat, or that cake is best left for birthdays and anniversaries. Most people won't care that replacing deep fried chips (Fries, perhaps) with boiled potatoes is a much healthier proposition. And what about the six-pints-of-ale-followed-by-a-kebab nights that'd have to become a thing of the past. Of course, with the appropriate understanding of energy-balance and tracking, along with an understanding similar to the concept of 'if-it-fits-your-macros (IIFYM)' nothing needs to be given up entirely.

Anyway, this isn't just a failing of the lower (not low)-fat, higher-carb paradigm that the governments have promoted for the last few decades. The issues of non-compliance would be just as pronounced (I'd argue much worse) if the government were to start recommending a low-carb approach.

Paul_ said:

I work in a job that requires a lot of communication to customers and internal staff. One common theme is that people don't do detail. Public health nutritional advice can't win in its current form. Either you over-simplify and just say "carbohydrates" without explanation, or you explain the detail and people don't read it/care.

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I think it's wrong to suggest that people "don't do detail". As I mentioned above, people generally just roll along (semi) unaware, or perhaps just without a care, until they are no longer happy with their results. Then they (we) seem to become rather adept at doing detail. Whether low-fat, or low-carb, people become extremely adept at measuring their chosen 'offending' macro, often to within an inch of its life, while at the same time becoming armchair scientists/nutritionists/toxicologists/psychologists etc. Of course, when speaking of others' diets all that detail, nuance and context flies right out the window

Paul_ said:

Add in other factors, such as ultra-processed carbohydrates being so much cheaper than healthy carbohydrates...

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Where I live, I can get a kilo of potatoes for less money than 150g of off-brand crisps (chips). Pitting those same whole potatoes against brands such as Doritos and Pringles and that divide becomes much higher. And while I've found a supermarket that sells wholemeal pasta cheaper than most other places sell white, it is generally the case that the whole-grain varieties add some measure of 'premium'. But this difference is mere pennies. This might be a distinction for those on the poverty line, but not an argument against those who for convenience will sink however many quid into one-meals-worth of McDonalds.

But I'd question what you mean by "ultra-processed". Are you suggesting white rice is an ultra-processed food? Are potato-chips fried in olive-oil ultra-processed? And why are you just referring to carbs, when it seems very clear that the foods that so many default to are mixes of both high-carb and high-fat (often with fat taking the lion's share of the amount of the caloric energy contained within).

Where do you draw the distinction between processed and ultra-processed?

Fat + sugar + salt is the key combination, often in highly-refined form, and in varying quantities so as to hit a particular 'Bliss-point' is the issue...not plain, steamed white rice. Or do you disagree?

Paul_ said:

...combined with work/life balance increasingly moving in favour of work, and before long people make bad nutritional decisions out of necessity, regardless of what the advice may or may not say.

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I've had my fair share of 7-day-a-week, 80+ hour jobs. I'm not without sympathy/empathy for people who have to work excessive hours. But I feel that priorities are the issue here. If someone has no time to watch Netflix, no time to surf online, no time to play video-games, no time to pursue hobbies, no time to socialise etc., then that's a different matter...and understandable. Just the same, I'm not talking about a single-parent, having to work three jobs.

But if one is motivated towards making healthier choices, it's not that hard, expensive or time-consuming.

If you're someone who goes to McD's out of convenience, it's not too much more of a hit on convenience, time or finances to go to the supermarket next-doo and grab a tabouleh salad, a small bag of prepared greens/mixed-salad, a packet of pre-cooked-and-chopped chicken-breast, an apple and a small bottle of water. Right there is a healthy and eatwel-compliant meal.

Of course, that presumes that their workplace doesn't have a kitchen with a microwave (And I've not been in a work-place since I started working back in the 80's that doesn't). Access to a microwave opens up the the possibilities of meal-prep. This is where huge savings can be made in both time and money, as long as people are appropriately motivated to put the small amount anticipatory work in. For reference, I can meal-prep a vegan version of enough healthy and cheap, eatwell-compliant food to last a week, in less than an hour...on a Sunday.

Paul_ said:

Most people consider cereal to be a healthy carbohydrate source, providing it's got some fibre in it, or the wholegrain symbol. Fact is though that most cereal isn't healthy, regardless of what it's got in it.

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That would depend on what you consider healthy to mean, which specific cereals you are talking about and whether you have sufficient corroborating evidece to show negative health outcomes.

But I am curious to know how you would personally stratify cereals, if at all. Do you see oats as equivalent to Coco Pops? Is there room in a healthy diet for Weetabix?

Paul_ said:

The reality is that your average person, who has worked a 12 hour day with a commute, gets home and needs to feed a family. Many in this situation open the freezer, or get some ready meals, and cook whatever. Maybe they get takeaway. It might be in proportion to the Eatwell plate, but it's not of the nutritional quality intended - and that's where the problems begin.

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Well, it depends on the type of freezer food as to whether it is eatwell-compliant or not. But if finances are an issue, as I believe you mentioned in another post, then that rues out takeaways for the family.

Paul_ said:

Eatwell, in itself, isn't a bad thing for non-diabetics. However, the reality is that any public nutrition advice isn't capable of improving public health on its own.

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I hope my post doesn't come off as combative. I clearly take issue with much of the points you've raised, but it is somewhat refreshing to find someone here who understands why the eatwell plate (aka the guidelines) is not only not 'TeH eViLz!', but that it can be an effective blueprint for health (At least I think that's what you think).

The question as to whether these recommendations are suitable for diabetics is a conversation I've found to no longer be worth having here. Suffice to say, there're a growing number of people using a very similar diet to the betterment of all their health woes, including diabetes.

Paul_ said:

With better campaigns, better communication, and other measures that make healthy foods cheaper than ultra-processed foods, maybe they can work. Until then though, they're screaming into the void, and it's not helping anyone.

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As I've already agreed, better communication (especially regarding the implementation) would be great. And if much of the billions (trillions?) that the world's governments throw at the meat and dairy industry could be used to subsidise fresh-produce that'd also help. Add worldwide legislation to control how 'junky' junk-food can be and how, where, when and to whom it is advertised and sold, would also be of huge benefit.

Unfortunately this is at odds with both capitalism and personal sovereignty...which ultimately will win.

Anyway, this isn't just a failing of the lower (not low)-fat, higher-carb paradigm that the governments have promoted for the last few decades. The issues of non-compliance would be just as pronounced (I'd argue much worse) if the government were to start recommending a low-carb approach.

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I broadly agree, for the same reasons I've outlined where I feel current dietary advice has failed.

I think it's wrong to suggest that people "don't do detail". As I mentioned above, people generally just roll along (semi) unaware, or perhaps just without a care, until they are no longer happy with their results. Then they (we) seem to become rather adept at doing detail. Whether low-fat, or low-carb, people become extremely adept at measuring their chosen 'offending' macro, often to within an inch of its life, while at the same time becoming armchair scientists/nutritionists/toxicologists/psychologists etc. Of course, when speaking of others' diets all that detail, nuance and context flies right out the window

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I was possibly too sweeping in my statement of "people don't do detail".

Although I agree with some of what you say in reply, I would read your comments as "people do detail when they have to". Maybe I've misinterpreted.

What I would actually expand upon is that "people don't do detail", because we can't do detail anymore. People are bombarded with information in the age of technology we now live in. Hundreds of emails a day, Teams/Zoom/Slack messages, text messages, phone calls, meetings, endless adverts on TV, endless notifications from apps, the daily 24 hour news cycle.....it goes on and on and on. All of that, plus keeping up with running a household and family/friends' needs. It's no wonder people don't do detail, we can't, and study after study show that western world cultures are becoming more and more desensitised to the onslaught, only truly "doing detail" where it's a priority at that moment in time.

But I'd question what you mean by "ultra-processed". Are you suggesting white rice is an ultra-processed food? Are potato-chips fried in olive-oil ultra-processed? And why are you just referring to carbs, when it seems very clear that the foods that so many default to are mixes of both high-carb and high-fat (often with fat taking the lion's share of the amount of the caloric energy contained within).

Where do you draw the distinction between processed and ultra-processed?

Fat + sugar + salt is the key combination, often in highly-refined form, and in varying quantities so as to hit a particular 'Bliss-point' is the issue...not plain, steamed white rice. Or do you disagree?

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Firstly, it's my view at 43 years old, after 4 decades of ever-changing dietary advice from the "experts", that I'm not convinced by any particular approach in terms of this debate. Between general advice changing more times than I can count and media scare stories on food/ingredient X or Y, I think the public are bored by the advice - regardless of whether thats right or wrong. It comes down to that prioritisation of detail again and I feel that many have become disillusioned with nutrional advice. All I can say is that low carb/keto have resolved a number of issues for me already in 6 weeks, whereas following Eat Well made my blood glucose readings worse.

In short though, and probably lacking the nuance required for a complete answer, it's my view that there are "bad" carbs, fats and proteins.

The most obvious bad carb is added sugar. Then there's transfats for bad fats, and intensively processed or additive ridden bad proteins. More examples available for all these, but as a simple answer on a forum, that's where I stand. Anything containing one of these is probably "processed" in my mind, two or more are "ultra processed". Maybe that's too simplistic, but seems to sum up my personal past errors with food choices.

Of course, that presumes that their workplace doesn't have a kitchen with a microwave (And I've not been in a work-place since I started working back in the 80's that doesn't). Access to a microwave opens up the the possibilities of meal-prep. This is where huge savings can be made in both time and money, as long as people are appropriately motivated to put the small amount anticipatory work in. For reference, I can meal-prep a vegan version of enough healthy and cheap, eatwell-compliant food to last a week, in less than an hour...on a Sunday.

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For some, a microwave equals meal prep. Based on personal observation, I'd strongly suggest that a microwave equals ready meals.

Ready meals are nutrionally awful (as a general rule), but they're cheap, take no time to prep, no time to clear up, and they're very convenient for the people in your example in a workplace.

But I am curious to know how you would personally stratify cereals, if at all. Do you see oats as equivalent to Coco Pops? Is there room in a healthy diet for Weetabix?

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Again, at the risk of being too simplistic, added sugar cereals are unhealthy, regardless of what else they may promote for health credentials. The more added sugar, the more unhealthy.

All the mass market cereal industry has done is reduce salt after criticism in the 80s and 90s, and replaced it with another cheap flavour enhancer of sugar. Probably fair to say most cereals are unhealthy overall, with some exceptions.

I hope my post doesn't come off as combative. I clearly take issue with much of the points you've raised, but it is somewhat refreshing to find someone here who understands why the eatwell plate (aka the guidelines) is not only not 'TeH eViLz!', but that it can be an effective blueprint for health (At least I think that's what you think).

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I don't find you combative or offensive in the slightest. I have no issue with being challenged, plus forums are easy to make comment with brevity (which can be misinterpreted) rather than detail. Debate is a healthy thing in my opinion.

I don't think any public health advice is evil, I just don't think it's appropriate to recommend that same advice to everyone, regardless of condition. Nuance is important when it comes to health and medical professionals have become too comfortable in throwing tablets at people, rather than trying to address diet/lifestyle on an individual basis in my experience/opinion. Many reasons for this, most of which are outside of the control of medical professionals, but that doesn't make it ok in my book.

Unfortunately this is at odds with both capitalism and personal sovereignty...which ultimately will win.

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Agreed.


(Edit: Apologies, it wouldn't let me reply in one post, had to split over 3)

Thanks for the thorough reply. But ultimately I think we disagree on far too much about certain fundamental points, to make it worth continuing further. I hope you understand this is no slight on you. I've just been here too many times before, and don't really have the energy or time for the back-and-forth of it all.

I have started one last try today at my intended, eatwell-influenced plan. We'll see how it goes. Health has taken a worse turn of late, so I need to do something.

Who knows...Maybe i'll do a cereal-run in honour of you

All the best!

p.s I'd still be very interested if someone could chime in with information about the 150g carb cut-off divide for low and high carb.

Cheers!

Beating-My-Betes said:

Thanks for the thorough reply. But ultimately I think we disagree on far too much about certain fundamental points, to make it worth continuing further. I hope you understand this is no slight on you. I've just been here too many times before, and don't really have the energy or time for the back-and-forth of it all.

I have started one last try today at my intended, eatwell-influenced plan. We'll see how it goes. Health has taken a worse turn of late, so I need to do something.

Who knows...Maybe i'll do a cereal-run in honour of you

All the best!

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No problem at all. Good luck with whichever route you pick.

Fascinating discussion.

What I'd like to see to balance research on whatever diet and its causing ill health is extensive study on people who are a "healthy" shape and size despite eating whichever foods are being pushed by nutrition sources as being healthy (anyone noticed how this changes year by year?) plus any amount of highly-processed food plus whatever junk they enjoy in whatever quantities they want. They don't have spots, they don't lack energy, they don't have digestive problems, they don't have BG, BP or cholesterol problems, they aren't over or underweight etc. ad. inf. I'm married to one and have studied these amazing abilities over 29 years. I think we need to know more.

lovinglife said:

it’s pretty much common knowledge on lots of diabetes forums and websites that anything below 130g is classed as a low carb diet.

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My apologies to all for saying sub-150g was low carb, my mistake. Am I still new enough around here to blame it on whatever the forum equivalent of "it's my first day" is?

Outlier said:

Fascinating discussion.

What I'd like to see to balance research on whatever diet and its causing ill health is extensive study on people who are a "healthy" shape and size despite eating whichever foods are being pushed by nutrition sources as being healthy (anyone noticed how this changes year by year?) plus any amount of highly-processed food plus whatever junk they enjoy in whatever quantities they want. They don't have spots, they don't lack energy, they don't have digestive problems, they don't have BG, BP or cholesterol problems, they aren't over or underweight etc. ad. inf. I'm married to one and have studied these amazing abilities over 29 years. I think we need to know more.

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Would be very interesting. The role exercise and general activity levels play as part of it would also be very useful to see for both sides of the diet equation too. Also how this all changes by age bracket.

My life, health-wise at least, is basically summed up by a line from Rimmer, in the TV show Red Dwarf:

When you're younger you can eat what you like, drink what you like, and still climb into your 26" waist trousers and zip them closed. Then you reach that age, 24-25, your muscles give up, they wave a little white flag, and without any warning at all you're suddenly a fat b**tard!

Paul_ said:

No problem at all. Good luck with whichever route you pick.

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Thanks

Outlier said:

Fascinating discussion.

[...]whichever foods are being pushed by nutrition sources as being healthy (anyone noticed how this changes year by year?)

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Not sure which nutrition sources you're referring to, but from my understanding the government guidelines have remained pretty similar.

lovinglife said:

I haven’t read through the whole thread as it’s pretty long, but it’s pretty much common knowledge on lots of diabetes forums and websites that anything below 130g is classed as a low carb diet

Here’s a link to our forums website here at DCUK explaining the classifications

Low Carb Diet - Beginner's Guide and Meal Plans

Many people follow a low carb diet due to its benefits in terms of improving diabetes control, weight loss and being a satisfying way of eating.

www.diabetes.co.uk

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Thanks for the link.

The expected issues aside, that article doesn't seem to provide a source for the cut-off bracket. And the video only serves to further muddy the waters (as well as adding some more suspect info ).

The cut-off points seem somewhat arbitrary, which I believe is problematic for various reasons. But that might not be the case. Perhaps it is informed by certain data.

This is not a dig at you. Like I said, I'm grateful for the link. But unless I'm missing something righ in front of me, it doesn't really answer my question.