Stop counting calories and start promoting nutritional value, urge researchers
Writing in an editorial for Open Heart, researchers draw on published evidence to argue that there is too much focus on counting the calories in foods – without considering the nutritional value of what we eat.
They suggest that rather like stopping smoking, simple dietary changes can rapidly improve health outcomes at the population level – citing evidence that boosting omega 3 fatty acid (from fatty fish), olive oil, and nut intake have all been associated with reductions in deaths from all causes and from cardiovascular disease, within months.
"It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality. The evidence indeed supports the mantra that 'food can be the most powerful form of medicine or the slowest form of poison'," said the authors.
“Extensive empirical and trial evidence reveals that substantial reductions in mortality can occur within months of quitting smoking, or making healthy dietary changes,” they added. “These reductions apply to both individuals and to entire populations.”
Focus on nutritional value
The three researchers behind the editorial – Dr Aseem Malhotra, Dr James DiNicolantonio and Professor Simon Capewell – said strategies that prevent excessive weight gain in children and adults through curbing the consumption of the amounts of unhealthful foods should also be welcomed, but warned that simply focusing on weight loss in obese subjects misses a key finding from the PREDIMED trial; That a diet that increased nutritional quality achieved consistently large reductions in CVD risk irrespective of weight or the calories consumed.
Indeed, they noted that while daily consumption of a sugary drink (150 calories) is associated with a significantly increased risk of type 2 diabetes, daily consumption of a handful of nuts (30 g of walnuts, 15 g of almonds and 15 g hazelnuts) or four tablespoons of extra virgin olive oil (around 500 calories) is associated with a significantly reduced risk of heart attack and stroke.
"Shifting the focus away from calories and emphasising a dietary pattern that focuses on food quality rather than quantity will help to rapidly reduce obesity, related diseases, and cardiovascular risk," the trio of researchers wrote – warning that public health experts, and primary and secondary care clinicians have a duty to patients and the population.
"Our collective failure to act is an option we cannot afford," they said – adding that evidence shows that poor diet is consistently responsible for more disease and death than physical inactivity, smoking and alcohol put together.
Political solutions?
The authors also called for a series of political solutions that they argue could make an immediate positive change on population health. These solutions include: taxing sugary drinks; subsidies to make fruit, vegetables, and nuts more affordable; and tighter controls on the marketing of junk food.
"Applying these population wide policies might achieve rapid reductions in disease and hospital admissions visible even within the electoral terms of most politicians," they said.
They warned that simply focusing on total energy consumed, as opposed to nutritional value, has been exploited by the food industry, which has added sugar to over 80% of all processed foods.
“This global disease burden will clearly not be prevented by medications; it will require policy interventions that make healthier diet choices easier (the ‘default option’),” they said.
Source: Open Heart
Published online ahead of print, doi: 10.1136/openhrt-2015-000273
“It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality”
Authors: Aseem Malhotra, James J DiNicolantonio, Simon Capewell
