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Fat Chance

Robert Lustig

Robert Lustig, a American academic who has spent 16 years treating obese children, believes Swinson is right: most diets, even combined with exercise, do not work. Almost any change of lifestyle works for the first three to six months, he says. But then the weight comes rolling back on — leaving the dieter, often at a loss to understand why the fat is returning, getting the blame.

In fact, says Lustig in his book, Fat Chance, which draws on more than 300 scientific papers, today’s children in the developed world are likely to be the first to die younger than their parents because they are being slowly poisoned by a colossal dietary error a generation ago.

It is a big claim, based on a simple premise: when the Americans were hunting for the cause of rising rates of heart disease in the 1960s and the 1970s, there were two candidates. One was sugar and the other was dietary fat such as cholesterol.

John Yudkin, a British researcher, warned that excessive sugar consumption could lead to diabetes and heart disease. But the Americans decided fat was the enemy and by the 1980s a low-fat diet was being recommended in a message that spread worldwide. As the $2 trillion food (£1.2 trillion) industry removed fat from processed products, it raised sugar levels to keep them palatable.

“The goal was to alter our diet for the better,” says Lustig. “Instead, we’ve laid waste to every nutritional hypothesis, lost the public’s trust and killed countless millions.”

The fundamental change in our diet that resulted helps to explain why nearly 4,000 American teenagers are now diagnosed annually with type-2 diabetes — once so rare in the young that it was known as “adult” diabetes — and why more than 40% of US death certificates list diabetes, up from 13% two decades ago. The UK, says Lustig, is “right behind”.

Even giving young children top-notch organic juice instead of the whole fruit can set them on a path of sugar addiction that leads to diabetes, heart disease, cancer and possibly dementia, he warns.

Food is processed differently when it arrives in a sugary surfeit. Fructose, a component of sugar, gets metabolised into fat, including a dangerous form of liver fat. It also activates a liver enzyme, setting off a chain reaction that makes the pancreas release more insulin — the hormone that tells the body to store energy as fat.

The majority of humans, regardless of weight, release twice as much insulin as they did 30 years ago. This extra insulin is believed to block a signal from another hormone, leptin, that tells the brain when you can stop eating. Without this signal, the brain boosts your appetite even if you are full and sends you to the sofa to conserve energy. Something similar happens in a diet of the kind that involves skipping meals. Your leptin concentrations drop faster than your fat stores. You have not lost any weight yet. But your fat cells tell your brain you are starving, your sympathetic nervous system goes into energy-conservation mode and the vagus nerve, which connects the brain with the abdomen, goes into overdrive, boosting your appetite and ordering the release of insulin to tell your body to store some fat. Oops.

The number of people who can stick to any diet is exceedingly small There is hope, however. Lustig’s book, the long version of a paper in Nature this year, challenges assumptions by dieticians and doctors: that to lose weight we must eat less or exercise more; that a calorie is a calorie, wherever it comes from; and that to shed the pounds we need fewer calories.

Not true, says Lustig. The type of food we eat matters very much to the result. Successful diets do exist and have two things in common: they are low in sugar and high in fibre.

Even some popular diets work, although they are flawed. The Atkins diet, a low-carbohydrate regime in which you keep the burger but ditch the bun, is effective for weight loss and improved metabolic health. But it can result in inadequate micronutrients and compromised bone health. The Ornish diet, a low-fat, no-fun diet popularised by Dean Ornish as long ago as 1993, has been proven not only to promote weight loss but to reverse heart disease.

The Mediterranean diet — olive oil, legumes (beans, lentils and peas), fruits, vegetables, unrefined grains, dairy products and eggs, fish and wine in moderation — is excellent, as is the South Beach diet, which keeps insulin low, has plenty of fibre, and avoids added sugar.

But the number of people who can stick to any diet is exceedingly small. So the key, says Lustig, is to follow some other simple principles, chief among them shopping on the periphery of the supermarket, where the “real food” is kept, not on the shelves. Real food does not have, or need, a label showing nutritional values. The more labels you read, the more rubbish is in your trolley.

Real food takes time to cook but eating it will raise your levels of micronutrients and reduce your fructose. “If you eat real food, your weight will take care of itself, just as it did for the 50,000 years since irrigation and the taming of fire,” says Lustig. “We have no choice but to try to recreate the kind of food supply our grandparents had, before the food processors tainted it.”

To make sure, take all your recipes and cut the amount of sugar by a third. And exercise.

Lustig sees a long battle ahead in the war on sugar. “First they ignore you”, he says, quoting Gandhi, “then they laugh at you. Then they fight you, then you win. We’ve just started the fight.”

Traffic light food guide

Robert Lustig uses traffic lights to divide food into three types: greens are “real” foods you can eat as often as you like; yellows are “minimally processed” and can be consumed three to five times a week; and highly processed reds are for special occasions. Green foods include high-fibre cereals such as porridge and shredded wheat. Eggs, milk, grass-fed beef, wild fish, lamb, turkey and free-range chicken can also be eaten without restraint, as can wild or brown rice, whole-grain bread, home-made salad dressing and even lard. Nuts and seeds, fruit and vegetables, plain yoghurt, beans, butter, cheddar cheese — you don’t have to think. Just put them in the trolley. Overall, the green foods are high in fibre and low in sugar and “bad” omega-6 and trans fats. They also include tea, coffee and red wine (stop before you feel drunk). Yellow foods include whole-grain pasta, pitta bread, baked beans, dried fruit and processed meats such as bacon, salami and hamburgers. The red list has the surprises. Some foods we think of as healthy — bagels, baked potatoes, basmati rice, couscous, fruit juice, rice cakes — are in the danger zone with white bread, pizza and doughnuts.

Advice to chew over

■ In 1829 the American Presbyterian minister Sylvester Graham invented a diet of fruits and vegetables, whole wheat, high-fibre foods and his own Graham crackers. He said it would prevent people having impure thoughts and self abuse.

■ William Banting, a British undertaker, published a booklet in 1863 setting out a low-carbohydrate diet he said helped him lose 50lb. It became so popular that “banting” became a synonym for dieting.

■ In 1903 Horace Fletcher, a self-taught American nutritionist, became known as the Great Masticator for his idea that food should be chewed 32 times: this would extract the maximum benefit and make people want to eat less.

■ In 1961 Herman Taller, a Romanian-born American doctor, published the bestseller Calories Don’t Count, where he claimed you could eat as much as you liked provided you avoided carbohydrates and chased your food with safflower oil capsules.

■ The Atkins diet, a modern-day Banting plan that eschews carbs in favour of protein-rich meals, was written in 1972 by Robert Atkins, an American cardiologist and has been adopted by millions.

■ The South Beach diet, which became popular in the early 2000s, replaces “bad” carbs and fats with “good” ones. Other recent favourites include the self-explanatory cabbage-soup diet and the lemonade diet, based on lemon juice, maple syrup, red pepper and hot water.

■ Created by Pierre Dukan, a Parisian doctor and first published in 2000, the Dukan diet is based on a list of more than 100 allowed foods and four phases: attack, cruise, consolidation and stabilisation. Released in Britain in 2010, it has sold more than 10m copies globally — but was named the No 1 diet to avoid for the past two years by the British Dietetic Association.

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