The Eatwell Guide has long been used by the government to define recommendations on what constitutes a healthy diet. Formerly known as the Eatwell Plate, it provides a visual guide of how to compose a balanced diet on your plate. But as more and more people achieve type 2 diabetes remission from eating healthy, real-food diets, criticism of the Eatwell Guide has escalated. Why does it continue to advocate starchy carbs when research is showing a high intake of starchy carbs – which turn into sugar in the body – increases the risk of obesity, type 2 diabetes and heart disease? Moreover, as science evidences that low carb is a sustainable dietary method capable of yielding incredible health benefits, why has the Eatwell Guide not caught up, or at least so far rejected the mounting evidence base?
On BBC Radio 4’s The Food Programme presenter Sheila Dillon (pictured) talked to healthcare professionals on both sides of the debate. Professor Louis Levy, Head of Nutrition Science at Public Health England, defended the Eatwell Guide. Dr Aseem Malhotra, an NHS cardiologist and author of The Pioppi Diet, and Dr David Unwin, 2016 NHS Innovator of the Year, whose Southport GP practice is now saving more than £38,000 a year on its diabetes drug budget alone, were among those calling for change.
“I tried to follow the Eatwell Plate,” begins Dr Unwin. “Much of the guide is good. I love the green veg focus. But what I found was over many years my patients just seemed to get fatter and I was adding medication. What I have found and what I’m trying to do is get people to give up sugar and starchy carbohydrates, because starchy carbs digest down into sugar. And that’s something that we don’t always realise. I didn’t use to tell them any of that. I’d actually forgotten it.”
When asked if starchy carbs breaking down into glucose was covered when he was at medical school, Dr Unwin answered: “Not really”.
Dr Malhotra expanded upon this nutritional knowledge gap. “Currently our healthcare system is failing and we have an epidemic of misinformed doctors and misinformed and harmed patients. We need to increase awareness if we’re going to improve and resolve the system.”
Is the Eatwell Guide fit for diabetes?
The Eatwell Guide, as explained by Prof Levy, is not compulsory advice to follow, rather a guide on what to eat. “What it won’t do is make you eat it,” he said.
However, Dr Unwin argues this is one of the guide’s major flaws. The Eatwell Guide doesn’t mention that if someone has type 2 diabetes then the high levels of starchy carbs and high-sugar fruits recommended will raise blood sugar levels and further worsen a person’s insulin resistance, which causes type 2 diabetes. This then reinforces the cycle of doctors prescribing additional medication to lower patients’ glucose levels.
“My concern is that if the Eatwell Plate is what we’re supposed to be advising the population to do, and I find a third of it is carbs. That’s a worry because somewhere between 10-15% of the UK population either have type 2 diabetes or prediabetes. Then you’ve also got bananas, raisins and grapes, which all digest into sugar. For someone with type 2 diabetes this is not necessary. And nowhere does it mention that if you have type 2 diabetes you may need to think about this.”
“Branding opportunity for junk food”
Dr Malhotra raises another pointed concern: the most recent revision of the Eatwell Guide in March 2016 included involvement from members who had financial ties to the food industry.
“I don’t think those people are deliberately trying to mislead people, but their conflicts of interest essentially mean that the plate is not based upon independent scientific research.”
Dr Malhotra was also asked about the Private Finance Initiative (PFI), where private firms are contracted to complete and manage public projects, which Sheila explains is “how most of our hospitals have been built”.
His response was alarming.
“There are contracts in hospitals that ensure bed-bound patients take sugary drinks, chocolate and crisps to their bedside. This was going on in a hospital I worked in. We have to make sure that when these contracts run out the chief executives of these hospitals in advance say ‘ok this is going to be removed’, because this is really not acceptable.
“These hospitals may be getting some short-term financial gain selling crisps and sweets on the premises, but it’s causing the system great cost. We had a supply of cheap, sugary foods everywhere including our hospitals, which had become a branding opportunity for junk food. If this carries on as it is then our NHS is going to collapse.”
For Dr Malhotra, the way to salvage the Eatwell Plate is simple: “We need to make sure that the guidance is based upon the totality of scientific evidence on what constitutes healthy eating.”
Prof Levy disagrees that change is needed. In fact, he argues calls for amendments stem from confusion over “fad” diets that are not properly backed up by medical science.
“The real thing about the Eatwell guide is that it’s there to understand what a healthy diet is,” he said. “The difficulty we have in the UK is that people aren’t eating a diet consistent with the Eatwell Plate and the continued commentary from people from a non-evidenced based view about different fad diets or approaches means that people are confused.”
“We need to make sure that the guidance is based upon the totality of scientific evidence on what constitutes healthy eating,” – Dr Aseem Malhotra
Diabetes.co.uk is among the staunch proponents of a low carb diet – full of healthy fats and low in sugar – and our award-winning Low Carb Program has helped more than 40% of people with type 2 diabetes who start the intervention on medication eliminate a diabetes drug at the one-year mark. We would argue that low carb is not a fad diet, as would Dr Unwin’s patients who are no longer taking over £38,000 of medication.
The importance of eliminating sugar from foods is evident. In BBC One’s recent programme The Truth About Carbs, Dr Xand van Tulleken stated how avoiding white and beige carbs helped a cohort of obese participants achieve better type 2 diabetes control. Meanwhile, a 2017 study revealed how bad sugar is for people with type 1 diabetes. This study showed how cancer cells are addicted to glucose. And significantly the government recently proposed several ways of reducing childhood obesity, of which tackling sugar was paramount.
Could the Eatwell Plate therefore benefit from advocating less high-sugar foods? Prof Levy says the Scientific Advisory Committee on Nutrition (SACN), which advises the government on health and Nutrition, “does not see studies which give the robust level of evidence [from low carb studies] that are used to make government’s advice”. And that is a shame. Because the evidence is there, and it lays bare the dire need for change.
During the program Sheila also talked to staff at Tameside Hospital in Greater Manchester which is overhauling its canteen food and vending machines to offer healthier low-sugar drinks and snacks. As of 4 July, the hospital is going totally sugar free.
Progress is being made on several fronts in tackling sugar. But the Eatwell Guide team is at best, slow on the uptake, or at worst, anachronistic and unwilling to adapt.
Surely it’s time for change.