Sunday 23 September 2018

The martyrdom of Aseem Malhotra

Aseem Malhotra's bid to become famous and sell his diet book protect the health of the nation has provided this blog with some hilarious content over the years, but he hits new heights of comedic gold in the Sunday Times today.

The low carb/LCHF movement to which Malhotra belongs is ultra-conspiratorial. Being essentially a cult based on magical thinking, it blames other people's failure to share their beliefs on a vast and growing network of corrupt scientists and government agencies. You might wonder what motivates so many scientists, dietitians and bureaucrats to hide the truth about killer carbs, thereby condemning millions of people to 'diabesity', but the answer is obvious: they're all in the pay of Big Food/Big Soda/Big Grain/Big Ag! Wake up sheeple.

Malhotra denounced the British Dietetic Association as Big Food puppets after they dissed his diet book. He has since added the British Heart Foundation and the American Heart Association to his list.

Now it's Public Health England's turn. In a barking mad op-ed for the Sunday Times, he claims that the quango is trying to silence him. 

For decades, powerful food companies have profited from promoting misleading health information and aggressively marketing junk food to children and the most vulnerable members of society. Public Health England is charged with help to protect and improve the nation’s health. My experience is that its officials undermine public debate and behave more like a front group for the processed food industry rather than an independent and trustworthy body that welcomes public debate.

Really?! To put it mildly, that is not my experience.

In an effort to combat the epidemic of health misinformation I co-wrote a book, The Pioppi Diet, which brings together the evidence on what individuals and policy-makers can do to rapidly improve health and reverse the twin epidemics of obesity and type 2 diabetes. I was pleasantly surprised when the deputy leader of the Labour Party, Tom Watson, contacted me a few months ago to let me know he had “relatively easily” lost 94lb and improved his health by specifically following the diet.

Good for him. By his own account, Watson 'basically stopped taking sugar, refined sugar, and then I started walking 10,000 steps a day and walking up staircases and when a bit more weight came off I started to jog and cycle.' You don't need to spend £8.99 on Malhotra's ludicrous book to know that a regime like that is going to lead to weight loss.

The most important message in the book — which recommends a Mediterranean-style diet low in refined carbohydrate — is how lifestyle changes are more powerful than any drug in preventing and treating heart disease; these also come without side effects.

A diet low in refined carbohydrate is not a Mediterranean diet and Malhotra's 'Pioppi diet' is not the diet of people who live in Pioppi. Malhotra's diet takes bits of the Mediterranean diet, removes the bread and pasta and adds in lashings of saturated fat and an assortment of his own bizarre LCHF recipes, such as boiled and eggs and soldiers with the soldiers replaced with bits of asparagus wrapped in bacon.

For inexplicable reasons, according to one prominent healthcare leader (who has asked not to be identified), Public Health England tried to “sabotage” the launch and press coverage of the book last year. I was told by one eminent doctor that he had been contacted by a senior official from the body and warned from attending the launch in London, to be held at the headquarters of Penguin Random House. To his credit, he did attend.

Another health leader, who heads a national charity, did not attend, and said he had been “poisoned” against the book. Andy Burnham, the mayor of Manchester and a former health secretary, endorsed the book and attended a launch in Manchester. His office also received a call from Public Health England, warning him against showing public support of the diet.

Assuming Malhotra isn't making this up to get attention (who knows?), it wouldn't be wholly surprising if one of PHE's many employees suggested to 'health leaders' that it might not be in their interests to be associated with a man whom even Action on Sugar regards as being 'completely mad' and who has a track record of embarrassing journals with his error-strewn articles. Public Health England has criticised Malhotra's version of the Atkins Diet in public. It stands to reason that they would also criticise it in private.

I was shocked by these attempts to try and undermine a healthy eating plan, to stifle debate and to damage my credibility.



Public Health England’s own recommendations for healthy eating — which are promoted by the Eatwell Plate, a diet guide backed by the Department of Health, which includes chocolate, crisps and cakes to eat “less often” — was drawn up in consultation with the food industry.

Firstly, the Eatwell Plate was replaced by the Eatwell Guide in 2016. You'd think a self-proclaimed expert would know that.

Secondly, I know of no evidence that the Eatwell Guide was drawn up 'in consultation with the food industry'. This claim seems to be based on a wafer-thin article by Malhotra's friend and fellow low carb zealot Zoe Harcombe. Harcombe claims that the Eatwell Guide 'was formulated by a group appointed by Public Health England, consisting primarily of members of the food and drink industry rather than independent experts.' She provides no evidence for this assertion. Public Health England says it commissioned experts from Oxford University to develop the Eatwell Guide. Indeed it did. Their work can be seen here. None of them report any relevant conflicts of interest.

Thirdly, you'd have to be on drugs to think that Public Health England encourages people to eat chocolate, crisps and cakes. Indeed, one of main differences between the old Eatwell Plate and the new Eatwell Guide is these foods were taken off the plate altogether because, as the British Nutrition Foundation explains...

Foods high in fat, salt and/or sugars, which previously featured in the purple section of the Eatwell plate, have been moved outside the main image.

This has been done to clarify consumer understanding of the role of these foods and drinks in the diet. They are not a necessary part of a healthy diet but such products can be included, although they should only be consumed infrequently and in small amounts.

Their inclusion in the guide may help consumers feel that moving towards such healthy guidelines is an achievable and realistic target.

The Eatwell Guide therefore recommends food that is entirely healthy, unless you are a low carb nutter who thinks that bread and rice cause diabetes. It doesn't say that sweet treats should never be consumed because that would be extreme and unrealistic, but it clearly doesn't endorse them.

Malhotra continues...

I have not seen any statements from the organisation’s health officials saying we should be eating less of the sort of ultra-processed food that now makes up half of the British diet. 

Has he been living in a cave for the last few years or does a high fat diet cause amnesia? How did he miss this, this and this, for example? Public Health England never stops haranguing people about sugar, snacks and processed food. 

Public Health England makes different dietary recommendations to the Pioppi diet. It recommends placing starchy carbohydrates, such as bread, pasta, rice and potatoes, at the base of the diet, and to reduce consumption of saturated fats.

Now we're getting down to brass tacks. Malhotra's problem with the Eatwell Guide isn't that it encourages people to eat 'ultra-processed food' (it doesn't) but that it encourages people to eat starchy carbohydrates, presumably because of the nefarious influence of Big Bread, Big Pasta, Big Rice and Big Potatoes.

The reason Public Health England - and every other health agency in the world - makes different dietary recommendations to the 'Pioppi diet' because the 'Pioppi Diet' is a load of unscientific, low carb toot created by an attention-seeking cardiologist whose slogan is 'fat is your friend'.

I have published evidence reviews showing no association between consumption of saturated fat and a heightened risk of cardiovascular disease, diabetes and death, but Public Health England doesn’t want to debate the issues.

Malhotra has never published anything resembling an evidence review. He writes comment pieces in which he references a few cherry-picked studies, such as this and this. That is not the same thing at all.

We want to trust government dietary guidelines, but Public Health England must give a clear commitment to systematic reviews of the evidence. It must stop engaging in dirty tricks to try and censor and silence those who want to engage in legitimate debate.

Far be it from me to defend Public Health England, but they have no more reason to engage in debate with a diet book salesman on the make than with any other random conspiracy theorist. They have already responded to his rubbish once, saying in 2016: 'In the face of all the evidence, calling for people to eat more fat, cut out carbs and ignore calories is irresponsible.'

What more is there to say? Scientific issues are not resolved by Public Health England debating with people. They are resolved through the accumulation of evidence in peer-reviewed journals. Malhotra has never conducted any primary research and has never published anything but op-eds in journals (usually the Z-list British Journal of Sports Medicine). It is quite possible to accept - as I do - that fears about saturated fat have been over-hyped without relying on a patently unreliable narrator like Malhotra to design a healthy diet.

Inevitably, Malhotra's response to PHE's criticism of his dietary theories was to accuse them of incompetence and corruption (see tweets below). It's his response to everything. Why would anyone want to engage in debate with such a person?

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