March 1, 2013

We accept that it would be politically incorrect for the new 2013 Australian Dietary Guidelines to tag themselves with any descriptive names like: low fat, low GI, low carb, high protein etc.

Of course, the guidelines promote ‘energy balance’ and the simplistic message that weight control is all about kilojoules (calories) in versus kilojoules (calories) expended.

The first sentence of Guideline 1 (of 5)  reads: “To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious foods and drinks to meet your energy needs.”

I have some problems with this:

  1. If you are overweight (like the majority) and if the guidelines are correct (that it’s all and only about energy balance) then “meeting your energy needs” would keep you at the same weight.
  2. When the Guidelines Committee requested submission from the public I simply wrote “It would be helpful if the new guidelines clearly explained exactly what each overweight person should eat to lose weight.” I now don’t think they are capable or willing to do that, as it would mean limiting the number of serves that they believe are required to meet micronutrient and fibre needs. This is odd, as I read more and more about our obesity (diabesity) epidemic and the thousands of lives claimed or ruined each year, and don’t recall reading about any hint of nutrient deficiency. Heard about anyone with scurvy lately?
  3. Basically the guidelines say “If you’re overweight, figure it out yourself!”

Some of us believe that the ‘energy balance’ hypothesis is overly simplistic. It ignores the biochemical and hormonal forces that drive fat storage, hunger and cravings. These forces are different for each individual and are primarily influenced by foods and drinks that elevate blood sugar – those that contain carbohydrates.

There are some people who are trying to manage their weight and their health, who have learnt that they have to limit their daily carb intake to stay under their body’s individual daily carb tolerance.

Foods containing carbohydrates are not ‘bad’, especially those that have a low energy density and high nutrient density. But exceeding your body’s individual carbohydrate tolerance might be ‘bad’ for you, have negative health implications (think inflammation) and make weight loss very difficult.

So what is the carb count from the recommended servings for a woman 51-70 in the new guidelines?

We never expected the guideline authors to provide a carb count and so we did some sums. We only did these for the people who are most interested in weight control – women 51-70. There are more overweight men, but it seems that they are simply less interested.

The guidelines do provide online sample meal plans for men and women aged 19 to 50, but not if you’re over 51! (Don’t we matter?)

Here’s the food groups containing carbohydrates and I have varied the choices to provide a clearer picture.

5 daily serves of Vegetables and legume/beans

1 small potato,  ½ cup carrots, ½ cup broccoli, ½ cup squash, 1 small tomato = totals approx. 16.8 g carb

2 daily serves of fruit

1 medium apple, 1 medium banana = totals approx. 59.2 g carb

4 daily serves of Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties

1 slice bread, ½ cup cooked pasta, 2/3 cup wheat cereal flakes, 3 crispbreads = totals approx. 70.3 g carb

4 daily serves of Milk, yoghurt, cheese and/or alternatives (mostly reduced fat)

2 cups milk, 40g cheddar, 200g yoghurt, 100 ml soy drink = totals approx. 39.8 g carb

Total carb per day for 51+ woman = totals approx. 186.1 g carb!

Now if you were to add a “no-added-sugar” glass of juice in the morning, some spreads, sauces or dressings, any nuts, or an unmeasured glass of wine at night, you could easily go over 200 g carbohydrate per day!

We looked for any evidence or mention within the guidelines that an overweight 51+ women could eat over 180 g of carbs a day and be able to lose weight, regardless of her willpower or its sustainability. No mention.

What your waist might tell you about your own carbohydrate tolerance?

If you are reading this and you’re a female, get out a tape measure and measure your waist. If it’s 80 cm or more you have ‘a health risk’. If it’s 88 cm or more you have an ‘increased health risk’, particularly for diabetes. Extra weight around the waist is associated with extra diabetes risk and insulin resistance, which some call “reduced carbohydrate tolerance”.  If a woman has a waist over 88 cm and consumes 186 g of carb per day, she may be literally throwing “fuel on the fire”.

Although all the foods in the examples above provide nutrients, the Guidelines do not specify any  minimum carbohydrate requirements (or maximum), for any age, sex, size or activity level.

When it comes to weight control, the Guidelines take the myopic view that weight control is only about energy balance. “A kilojoule is a kilojoule is a kilojoule.” This means that they pay no regard to the hormonal impact of eating 400 kj of fat, versus 400 kj of protein versus 400 kj of carbohydrate.

Stepping away from our weight control lens, you can also question the health impact of different foods and drinks, especially those contain sugar (of any kind). Read this.

Of course,when it comes to weight control, the most important hormone (and there are others) is insulin, which is involved in fat storage (amongst other things). Insulin responds to carbohydrate (from any source), and to a lesser extent – protein. Each one of us has a slightly different insulin response to foods and drinks containing carbohydrate. A simple ‘low fat’ breakfast of fruit and muesli may have vastly different effects on different people’s weight control efforts. Energy balance still matters, but our body’s individual hormonal responses to different foods heavily influences how that energy gets stored or used.

How big is Australia’s weight problem?

On Page 12 of the Guidelines it reads:

“There is widespread recognition that overweight and obesity constitute a global problem requiring urgent attention. Overweight and obesity contributed 7.5% of the burden of premature death and disability in Australia in 2003. More recent data from Western Australia and Queensland indicate that overweight and obesity have now overtaken cigarette smoking as the single greatest contributing risk factor, being responsible for 8.3–8.6% of the total burden of disease and injury.

As is the case internationally, overweight, obesity and associated health problems place a significant economic burden on the Australian health care system. The total direct, indirect and social cost has been estimated at $37.7–$56.6 billion with direct costs estimated at $8–$21 billion. It is predicted that by 2023, the projected health expenditure for type 2 diabetes will have risen $1.4 billion to $7 billion per year, due mostly to increasing weight gain.”

I believe that these Guidelines are simply not good enough and lack any clarity in what people, who are overweight, and want to reduce their weight, should eat to lose weight.

I welcome your comments.

Jamie Hayes