The Sinister 6

The Sinister 6

I was once asked by a patient recently…


“Everything in nutrition is so confusing! Surely in this day and age, with all the modern technology we have, we could figure out something as simple as what to eat!”


Frankly I have to agree with them.


I tend to find that even amongst the most esteemed nutrition experts from time to time they disagree as what is healthy and what is not.


The human body is very complex, it’s not black and white.


To put things in perspective, the biochemical processes that go on in one cell cannot be replicated by even the most sophisticated computers.


That’s just one cell. You have a few trillion more.


You are also an individual, we all have the same genetic blueprint but the way we live our lives dictates our nutrition needs.



Operation lied to us...the human body is way more complicated sadly...

Operation lied to us…the human body is way more complicated sadly…


‘One man’s meat, is another man’s poison’ as an unknown author once said.


So nutrition is and will continue to be an ever-evolving field of science and medicine, more of a spectrum of grey rather than black and white.


I quite like it that way. However, I do agree, things can be confusing at times.


Just recently there seems to have been an influx of nutrition-related stories hitting the media headlines…


…and it’s left my patients even more confused, bewildered and lost!


At the end of the day, who likes being confused?


So today I’m covering the ‘Sinister 6’, the top issues that are hitting the headlines and what you actually need to know to stay out of the fog of confusion.






What’s it all about? 


A medical pressure group called Consensus Action on Salt & Health (CASH) was set up by Professor Ian MacGregor in 1996 with 22 other expert scientific members as a rebuttal to the release of a department of health report in 1991 that, despite a body of evidence did not result in the a decrease of salt recommendations at the time to be less than 6g (that’s 2 level teaspoons) per day.


Salt intake is related to hypertension (high blood pressure) carrying with it the risk of stroke and ischaemic heart disease (that’s on top of everything else that increases blood pressure, such as stress, sleep patterns and your weight). Since the work of CASH, salt intake has fallen from the UK average of 9.5g per day to 8.6g/day (2008 NDNS) and now, 8.1g per day (2012 NDNS). The latest guidance is to aim for 3g per day by 2025 (eek!).


So what’s the message? 


Try to avoid adding additional salt to cooking wherever possible, use herbs, pepper or other spices to add flavour, try not to add salt to food.


Watch out for salt in packaged foods, salt is a preservative so it will always be in there in some shape of form (watch out for it listed as sodium, multiple by 2.5 to get the salt in grams)


Foods people tend to forget about are delicatessan and smoked meats, cheeses, gravies, tinned foods, stock cubes, soups and even sauces.





What’s it all about?


Sugar has taken the title as the new ‘whipping boy’ of the nutrition world, replacing where fat was approximately 30 years ago. Whilst I would never vilify any food as a rule, as a nation we do tend to eat too much added sugar in the diet and the World Health Organisation (WHO) is pushing for a reduction in dietary recommendations from 10% to 5% of our total intake. However, the Scientific Advisory Committee for Nutrition (SACN) who provide the majority of the recommendations the underpin the UK’s health guidance are most likely to keep guidance the same.


Why you may ask?


Well, it’s not a simple case of ‘cut it all out’. Intrinsic sugars found in fruits, starches (bread, pasta, potatoes, rice) and dairy products do not contribute to the health effects that some media headlines would have you believe and have other health benefits (such as fibre, vitamins and minerals or other nutrients)


However, extrinsic and free sugars (those found in juices, soft drinks, table sugar, honey, cakes biscuits, sweets…you get my drift) are the one’s to watch out for.


So what’s the message? 


Sugar intake can be related to obesity (if the sugar contributes to excess calorie intake) and dental caries but is not directly related to cancer, cardiovascular disease or diabetes as some would have you believe.


Sugar is not ‘addictive’ in the medical sense at all but is easily over consumed (in the same way as fat-laden foods), possibly due to the sensitivity of the sweet taste receptors of the tongue.


Watch your labels, if sugar ranks high on the list of ingredients then it may be one to watch your portion size of. Also look at front of label packing (Traffic Lights).


You don’t need to exclude every ounce of sugar from the diet, try to make low sugar swaps where possible (e.g. diet drinks versus full sugar) and watch the portion size (read the label) of those foods that are high in sugar. Foods that call for sugar in their processing (e.g. baking) can often be made with low sugar alternatives or less.


Oh and I’m not a dentist but please, floss and brush your teeth.


Saturated Fat



What’s it all about? 

A meta-analysis of all the scientific research to date by the University of Cambridge (funded by British Heart Foundation), showed that the relationship between saturated fats (those from predominantly animal products, e.g. meat, fish, eggs, dairy and hydrogenated vegetable oils, coconut oil) and risk of coronary events (e.g. angina, heart attacks) was weaker than previously thought.


The study showed a neutral effect for saturated fats and polyunsaturated fats, an increased risk for trans fatty acids, beneficial effects for dairy fats and possibly omega 3 fatty acids (but not conclusively for omega 3 supplementation).


So what’s the message? 


The current advice stands, it’s not a license to go crazy on the pork pies.


Absolutely try to avoid trans-fatty acids (those labelled as hydrogenated vegetable oil) and until there is more evidence regarding certain saturated fats such as coconut oil, a mediterranean style diet high in monounsaturated fats (such as olive oil) is most likely to be the best for the heart.


Eat oily fish (salmon, sardines, mackerel, pilchards) or enriching your diet with plant oils that convert to the omega 3 fatty acids (e.g. hemp seed oil, chia seeds or walnuts).


Supplementation may or may not be beneficial but if you do not eat any sources of omega 3 then it might be a good option.


Carbohydrates (Carbs)



What’s it all about? 


Carbohydrates are simply more complex forms of sugar (lots of sugar molecules packed together). In our diet they can come from a number of foods but the predominant sources tend to be starches (potatoes, rice, pasta, breads, other baked goods and cereal grains), followed by fruits and fruit juices, vegetables, milk and added sugars (e.g. sweets, table sugar, sugar sweetened beverages).


Like sugar, carbohydrates have suffered a lot of bad press, mainly due to low carb advocates. Low carbohydrate diets (anywhere between 0-20% carbohydrate content of the diet) are popular due to the rapid nature of weight loss from glycogen stores being depleted (stored sugar in your muscles). By taking out the carbs you also remove a large chunk of calories from your diet, so losing further fat weight tends to follow (if you can keep it up).


Side effects include lethargy, dizziness, poor concentration, possibly increased risk factors for cardiovascular disease (depending on what you eat). Recently Sweden changed its government policy to reflect changing evidence (20-40% total energy from carbs) average in the UK is around 45% to help tackle obesity.


So what’s the message?


Different dietary approaches work for different people, that also includes altering carbohydrate intake. I laugh to myself every time a self-proposed ‘nutrition guru’ brandishes the EatWell Plate and despises at how Dietitians are somehow killing us slowly with all our carbs!


The truth is the EatWell Plate is just a guide (and a pretty simple one), nutrition advice needs to be tailored after that point depending on your personal needs.


Consuming less calories than you expend is the key to weight loss, some of that may come from carbohydrates. The overall message should be a balance of the food groups that you eat. It is the only proven method to lose weight and follows basic science. Every weight loss diet is simply a variation of that formula. End of story.


Some conditions may benefit from a change in total carbohydrate intake (e.g. Type II Diabetes) but very low carbohydrate diets should only be conducted under the guidance of a dietitian and your doctor.




What’s it all about?


A recent study on ‘high protein being as deadly as smoking’ hit the headlines recently based on the findings of a long terms study was part epidemiological (6,000 adults over the age of 50, and part-rodent study). After following the participants for 18 years and dividing them into high, medium and low protein groups. A positive correlation was found between high protein intake and diabetes related death versus low-protein.


Sounds bad doesn’t it?


But looking more closely, no relationship was found between all-cause mortality, cancer-related mortality or cardiovascular mortality. The risk was also reversed for people over the age of 65.


In terms of ‘how big’ this risk in mortality was, the authors noted 2-4 fold increase but in comparison to smoking (20 fold increase) this is nothing.


It should be noted that epidemiological studies cannot prove cause and effect. There were lots of unanswered questions…(e.g. no exercise levels were measured, the participants were asked to recall their food intake for just 24 hours and no indication of analysing fast food versus home cooked meat was noted).


So what’s the message?


Choose high quality sources of protein where possible (e.g. not heavily processed meats) cook it yourself and don’t burn to a cinder (this also cuts salt and sugar!)


No need to go crazy on protein intake (especially very high protein diets), but a serving of protein at each main meal (meat, dairy produce, eggs, fish, legumes or nuts) can help spare lean tissue mass, help to build strong bones and reduce appetite over time, helping to shed extra pounds.


Vary your protein sources, choosing plant based sources to cut salt/sugar and adds extra fibre to meals. Ever seen how cheap a bag of lentils is? You may also save money!


Gluten Free


What’s it all about?


Everyone and their friend seems to be going gluten free at the moment. Made popular by celebs (e.g. Gwyneth Paltrow) and followers of the Paleo diet. Gluten has been blamed for everything form weight gain, to nutrient deficiencies, food intolerances, skin issues etc. Gluten is a protein found in certain grains (rye, sorghum, wheat, barley, rye and oats) that causes an immune system response in certain individuals, at it’s most serious the condition is known as Coeliac Disease. For those that are true suffers, it can be a serious condition.


For others, it may be little more than a fashionable fad.


So what’s the message? 


90% of the UK population eats bread, if the damaging effects of gluten were so widespread we’d all be dropping down dead from malnourishment, funnily enough we’re not. The prevalence of coeliac disease is hugely inflated by anti-gluten protagonists (recent estimates suggest 1-2% of the population may suffer).


Most people can tolerate gluten just fine and issues such as bloating, skin conditions etc. can be multi-factorial, contributed to by other foods or lifestyle factors and not necessarily related to gluten. If you have gastric problems seeking professional dietetic advice rather than self-diagnosing or using a food intolerance test (which have been proven by Allergy UK to be inaccurate) are your best bet.



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