Could the unlikely pairing of a top medical journal and an international insurance company find out what so few can agree on: what we should all eat? Rob Verkerk PhD, executive and scientific director at Alliance for Natural Health International, joined a gathering of 200 leading thinkers on nutrition and health in Zürich last month to find out.
The food industry, governments and the public have struggled to find any kind of consensus on what represents the healthiest way to eat. The situation hasn’t been helped by exposés of research bias or widespread use of methodologies of questionable relevance to real world conditions. Then there’s the hidden, commercial interests among so-called independent experts advising governments; perhaps not so independent after all.
So what happens when a medical journal, with a long track record of promoting good, transparent science, gets together with a major re-insurance company, that has an interest in keeping people disease-free for as long as possible? Can they crack this particularly tricky nut?
The medical journal and re-insurance company in question are, respectively, the British Medical Journal (BMJ) and Swiss Re. To stimulate dialogue they pulled together an international bunch of the most influential experts on all sides of the thorny debate. The date of the unique gathering was 14th and 15th June and the venue was Swiss Re’s Centre for Global Dialogue on the shores of Lake Zürich in Rüschlikon. Around 200 people were invited to participate and ask questions from the floor. There was a note in the event programme requesting confidentiality of the list of participants. I was fortunate enough to be among them.
Gathered was a host of nutritional ‘rockstars’. Among them, epidemiologist Walter Willett from Harvard, cardiologist Dariush Mozaffarian and Spanish nutrition researcher José Ordovás, both from Tufts. Present too was prominent British geneticist, twins and microbiome researcher Tim Spector from King’s College London and glycaemic index and load originator Jennie Brand-Miller from Sydney University.
These and others laid out their cases – which often meant discussing their life’s work. After the first of day of lectures and questions from the floor a trend started to appear. The researchers who had spent most of their lives, like Willett or Mozaffarian, working as epidemiologists had something of a unified view. They all agreed that eating lots of plants, especially in formats that were akin to the Mediterranean diet was a good thing and that too much processing was bad. None of these scientists felt that government guidelines were seriously off-track. That’s to a large extent because it was their work that had some of the greatest influence on current versions of the guidelines.
But it soon became apparent that there was a large body of people present, particularly as panelists and members of the audience, who held a different view. I was among them. Many of these were clinicians who had witnessed remarkable outcomes with metabolic diseases like obesity and type 2 diabetes when people were encouraged to eat in ways that were not consistent with government guidelines. They included health journalist Gary Taubes, and Dr Sarah Hallberg, the low carb high fat (LCHF) doctor and scientist who’s had over 3.5 million views of her TEDx talk explaining how to reverse type 2 diabetes by avoiding government ‘healthy eating’ guidelines. Then there was Nina Teischolz, author of The Big Fat Surprise, the investigative journalist who was among the first to expose the lack of evidence behind low fat public health policies. And let’s not forget the two British ‘nutritional celebrities’, anti-sugar and processed food campaigner and consultant cardiologist Dr Aseem Malhotra and researcher, author, blogger and public speaker in the field of diet and health, Zoë Harcombe. Harcombe did her PhD on the subject and published a meta-analysis demonstrating lack of scientific evidence for 30-years of low fat government advice.
These opposing views were given more credence when another big name ‘rockstar’, Prof John Ioannidis from Stanford delivered his lecture. Being unable to make it in person, his lecture came via a high quality video link. Ioannidis rose to fame internationally after his 2005 paper in PLOS Medicine showed why “most published research findings are false.” Ioannidis laid waste to most of the epidemiology that underpinned nutritional recommendations. Referring to nutritional research, he cited factors such as poor randomisation, confounding, bias and incorrect interpretation of results by investigators as reasons for the worthlessness of the findings of many published studies. His views were bolstered by the retraction and republication from a New England Journal of Medicine analysis of the
PREDIMED study just two days earlier. PREDIMED has widely been viewed as one of the most comprehensive studies supporting the Mediterranean, plant based diet.
So – what did the BMJ and Swiss Re actually achieve? Top of the list has to be making the event happen in the first place. Fiona Godlee, editor-in-chief of the BMJ and master of ceremonies for the event, summed up the meeting. It was the closest thing to a consensus statement of the meeting but of course it didn’t properly represent consensus as there were no votes. But at least there were no clamours of disagreement, probably because some of the most thorny issues, such as how much saturated fat or high glycaemic carbs we should consume, were thoughtfully left off her plate.
Among Dr Godlee’s points was that food clearly matters when it comes to health, that evidence is key though some of it is problematic, and that a mix of methodologies is required. She urged that we must recognise the complexity of interactions, both between individuals and within, for example with the microbiome. She went on to propose the need for humility when it came to guidelines (i.e. don’t issue edicts when the evidence is uncertain), that there was no ‘one size fits all’ diet meaning that personalised approaches may often be necessary. She also made a call for the prioritisation of disease prevention and the urgent need for food system transformation – especially in ways that would address socio-economic disparities.
Dr Godlee’s final call was expected given her role as an editor of one of the most influential medical journals in the world. She addressed the issue of funding and research, having become something of a torch bearer for transparency and independence in science. If the food industry is to be viewed as ‘the bank’, she urged, it needs to be harnessed properly. We can only assume she means it shouldn’t use its influence to distort the science. Amen.
Photo: David Ausserhofer, for Swiss Re Institute.