Popular advice is occasionally wrong, but always simple. The claims may be exaggerated, misguided or plain wrong, any of which seem more acceptable than being complicated. Over the years, pretty much everything we eat or drink has been demonised. Blaming our woes on a single ingredient is often based on a cocktail of scaremongering, sensationalisation, half truths while ignoring contrary evidence. It never leads to the happy ending anticipated, so the bad guy is constantly recast, forgiven or even championed just after we were sure we’d got the right one this time.

While ‘bad food’ exists, it’s not the nutritional cyanide capsule some headlines would have you believe. Even water can be bad for you, but it is the dose that makes the poison. A healthy balanced diet consists of fat, carbs and protein. All have been on the naughty list, but it would be a mistake to eliminate any of them.

Fat

Fat has a pretty unfortunate name – it may as well have been called Darth Voldemort. Its name and high calories per gram suggest it will make you fat. High fat diets have been linked to various diseases, but a diet higher in fat is not inherently unhealthy. 

Fish oil has high levels of the essential fatty acid omega-3. Some believe that having a ratio of omega-3 and omega-6 as close to 1:1 is important for your health (rather than the typical Western diets ratio of 1:15). Taking supplements that contain both omega-3 and omega-6 would increase your intake, but not necessarily alter the ratio. Others think this is outdated and you just need to get enough omega-3 and forget the proportions (although not everyone will benefit from increasing their omega-3 consumption). 

The World Health Organization (WHO) recommends eating at least two portions of oily fish per week (140g). Not all fish are created equal – ‘large cod and chips twice’ isn’t going to cut it, nor would tinned tuna. Good sources include sardines, mackerel, herring, lake trout, salmon, anchovy, sablefish or bluefish. If everyone were to actually follow this advice then sustainability would be a serious problem, but for now that is just theoretical. Another downside is the accumulation of pollutants in fish, such as heavy metals and pharmaceuticals. The higher your fish consumption, the higher your exposure. However, in moderation, the potential benefits outweigh the possible risk.

Then we have trans fats. The most dangerous trans fats are fast disappearing from our shelves and the amount of fat we consume in general has decreased over the last thirty years. Despite this, our health worsens and our waist lines bulge. Clearly blaming fat for the obesity epidemic was misplaced and we learnt a valuable lesson about singling out a specific macronutrient and jumping to conclusions, sorry fat it won’t happen again…. It must have been the carbs this whole time! Quick, get my pitchfork and round up the other villagers!

Carbohydrates

There are longstanding recommendations to base meals on high fibre, starchy food such as rice, pasta, potatoes and bread. 200g of carbohydrates per day is said to maintain healthy brain metabolism and muscle function and the UK guidelines are set even higher than this. For dietary advice to be sustainable (for both individuals and the planet), such general advice must be familiar, environmentally sound, affordable, realistic and offer long term adherence. Basing meals around carbs ticks these boxes.

However, after fat was paroled, carbohydrates were next in the firing line. We were told you don’t need them – they turn to fat, get rid of them, simple. Going zero carb is an easy message to convey but really, there’s no reason to go lower than 30-50g daily. In reality this type of diet is rarely sustained and can be used as an excuse to avoid fruit and veg and eat whatever greasy crap you want. Hence you may look ripped but this is why this sort of diet is linked to a greater risk of all-cause mortality.

If you do decide to reduce carbs, you should still be trying to get in lots of fruit and veg. The five a day target is set deliberately low to make it achievable and there are lots of benefits with eating your greens (and purples, reds, oranges etc!). It can take a few weeks to get used to a lower carb intake, but it doesn’t prevent muscle and strength gains. However, it may make it harder, so if you struggle to put on muscle this may be counterproductive.

Low carb diets are not the only path to weight loss either. Given a calorie deficit and adequate protein is consumed, then a reduction in carbs, fat or protein would be equally effective at making you lose weight.

So maybe carbs aren’t all bad after all. Now carbohydrates are on appeal, sugar has been brought in for questioning. Sugar has been linked to obesity, cardiovascular disease, diabetes, liver disease and cancer. We all know that the world’s population eats far too much sugar. What may surprise is that recently, the average amount of sugar we eat has declined significantly, not just in the UK but also the USA, Canada and Australia. As sugar consumption has fallen, obesity levels have continued to climb. This has become known as ‘The Australian Paradox’. So, what about the golden child, protein?

Protein

The average gym bro obsesses about protein because water, sunlight and wishful thinking don’t build muscle – protein does! While true, it is also an essential nutrient that helps build and repair tissue. Current government guidelines suggest 0.8g of protein per kg of bodyweight, so daily 45g for women and 55g for men daily for ‘the standard person’. 

Before you punch the screen for suggesting such a heretically low figure, remember that making the nation muscly is not high on agenda when setting the numbers. Secondly it is considered ‘adequate’ for 97% of the population and based on structural requirements (and so ignores the use of protein for energy).

When I first started training ‘normal folk’ would question protein supplements and call them ‘steroid shakes’. They were stodgy and tasted revolting, only the most serious gym goers would consider them (twice). Since then, protein has moved out of the dark corners of gyms and become mainstream. Some believe apart from a few at risk groups, you can’t get too much protein. It is now added into products as diverse as ice cream and chocolate bars to breakfast cereals and bread. It even tastes OK nowadays!

Most people reading this will not be the government’s ‘standard person’. So if you want to build muscle or strength, try 1-2g of protein per kg of lean body mass (LBM). Despite the difficulty in estimating LBM, I prefer this metric because consuming protein based on bodyweight alone would otherwise be wasteful, particularly if you are not a stage ready bodybuilder. 

If you are getting close to a physique competition, then likely your other macros are being heavily restricted. In this case, even 2.6g-3.1g per kg of bodyweight may be needed. Even at this level most health risks would be minimal but not for everyone so proceed at your own risk.

In any case, once adequate protein is consumed, more will not cause muscles to grow. 

A chink in the saintly seeming proteins armour and popularity has also recently appeared. It is now causing controversy because of its environmental impact. If protein is good for us, but bad for the planet, I’m not saying we should all become vegan but we need to keep an open mind on how much protein we eat and whether it all must come from animal products. 

The preceding discussion shows that finding the optimal macronutrient distribution for our bodies and our planet won’t be a welcome, easy or binary answer. 

Calories

Recent US guidelines have said that an overconsumption of calories represents the single greatest health threat to individuals. Calorie restriction not only causes weight loss but is associated with an improvement in a number of health markers, including lowered risk of cardiovascular disease, a reduction in inflammation, improved insulin resistance and may even help keep you young and improve longevity by decreasing (not reversing) the biological rate of ageing and increasing both the average and maximal lifespan. If you want to make the most of these sorts of effects, then start sooner rather than waiting until you’re 65 to do it.

As there are calories in fat, carbs and protein, a low-calorie diet will mean you won’t be able to overeat any of the aforementioned macros. Be warned, people are notorious for underestimating calorie intake and overestimating expenditure. Typically the more overweight someone is the greater the discrepancies tend to be.

Lucky for us we have labelling on food and calorie trackers on our phones. These give ballpark figures of the calories being consumed, but are by no means infallible. I’ve seen plenty of obvious errors where grams of protein exceed the weight of the product in question or dubious serving sizes that will almost certainly catch people out. Even if it were accurate calorie counting is far more complicated (find out why here).

Pestering whoever just cooked for you for the packets of all the ingredients they used will make you lose friends and invites quicker than weight and inches. It can be helpful to occasionally review your calorie intake, but the ball-ache of measuring and weighing everything gets old fast. Without long term adherence, nothing will be effective, whether a crash diet or slower more ‘sensible’ approach.

So what really is the problem?

Obsessing on one element of a diet in isolation guarantees disappointment. You cannot single out fat, cholesterol, carbs, sugar, protein, salt, alcohol or a particular food such as eggs as being the sole contributor. Any and all are mixed in with ‘other food’ and as preventative cardiologist Michael Blaha once wrote ‘It is impossible to disentangle the effect of one particular food or one macronutrient’. 

This is not to say there are no potentially harmful foods, nor that some individuals can’t be be outliers. Using an ancient relative who never exercised, smoked like a chimney, drank like a fish and lived off bacon sandwiches dipped in sugar does not give you license to emulate their behaviour (unless you fancy a quadruple heart bypass). Perversely, such exceptions proves the rule. They are notable exceptions due to their uniqueness. Some people survive plane crashes, but that doesn’t mean taking up skydiving without a parachute is a good idea. 

There is nothing unique in any aspect of your diet, in the sense that any excess or deficiency can cause problems. That is what ‘too much’ or ‘not enough’ means. The harsh truth is focusing solely on one element of your diet will have limited benefit – the whole diet matters. I’m not trying to sell you a diet pill, so I can tell you straight that the effect of too many little indulgences over too many areas of your diet and lifestyle will accumulate. Eventually the evidence will be hanging over your waistband.

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J Cachexia Sarcopenia Muscle. 2017 Jun;8(3):345-348. doi: 10.1002/jcsm.12176. Epub 2017 Apr 25.

 

Protein requirements and muscle mass/strength changes during intensive training in novice bodybuilders.

Lemon PW, Tarnopolsky MA, MacDougall JD, Atkinson SA.

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Evaluation of protein requirements for trained strength athletes.

Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP.

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Dietary protein for athletes: from requirements to optimum adaptation.

Phillips SM, Van Loon LJ.

J Sports Sci. 2011;29 Suppl 1:S29-38. doi: 10.1080/02640414.2011.619204. Review.

Considerations for protein intake in managing weight loss in athletes.

Murphy CH, Hector AJ, Phillips SM.

Eur J Sport Sci. 2015;15(1):21-8. doi: 10.1080/17461391.2014.936325. Epub 2014 Jul 11. Review.

Protein, weight management, and satiety.

Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M.

Am J Clin Nutr. 2008 May;87(5):1558S-1561S. Review.

A systematic review of dietary protein during caloric restriction in resistance trained lean athletes: a case for higher intakes.

Helms ER, Zinn C, Rowlands DS, Brown SR.

Int J Sport Nutr Exerc Metab. 2014 Apr;24(2):127-38. doi: 10.1123/ijsnem.2013-0054. Epub 2013 Oct 2. Review.

International Society of Sports Nutrition position stand: protein and exercise.

Campbell B, Kreider RB, Ziegenfuss T, La Bounty P, Roberts M, Burke D, Landis J, Lopez H, Antonio J.

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Effect of Protein Intake on Lean Body Mass in Functionally Limited Older Men: A Randomized Clinical Trial.

Bhasin S, Apovian CM, Travison TG, Pencina K, Moore LL, Huang G, Campbell WW, Li Z, Howland AS, Chen R, Knapp PE, Singer MR, Shah M, Secinaro K, Eder RV, Hally K, Schram H, Bearup R, Beleva YM, McCarthy AC, Woodbury E, McKinnon J, Fleck G, Storer TW, Basaria S.

JAMA Intern Med. 2018 Apr 1;178(4):530-541. doi: 10.1001/jamainternmed.2018.0008.

Controversies about sugars: results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes.

Khan TA, Sievenpiper JL.

Eur J Nutr. 2016 Nov;55(Suppl 2):25-43. doi: 10.1007/s00394-016-1345-3. Epub 2016 Nov 30. Review.

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Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding.

Rippe JM, Angelopoulos TJ.

Nutrients. 2016 Nov 4;8(11). pii: E697. Review.

Current levels of salt knowledge: a review of the literature.

Sarmugam R, Worsley A.

Nutrients. 2014 Dec 1;6(12):5534-59. doi: 10.3390/nu6125534. Review.

The Sodium Debate: More or Less About More or Less.

Katz DL.

Integr Med (Encinitas). 2014 Oct;13(5):29-31. No abstract available.

Salt and hypertension: why is there still a debate?

Batuman V.

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Egg consumption, serum cholesterol, and cause-specific and all-cause mortality: the National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged, 1980 (NIPPON DATA80).

Nakamura Y, Okamura T, Tamaki S, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H; NIPPON DATA80 Research Group.

Am J Clin Nutr. 2004 Jul;80(1):58-63.

Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease.

Soliman GA.

Nutrients. 2018 Jun 16;10(6). pii: E780. doi: 10.3390/nu10060780. Review.

Eggs: good or bad?

Griffin BA.

Proc Nutr Soc. 2016 Aug;75(3):259-64. doi: 10.1017/S0029665116000215. Epub 2016 Apr 29.

Dietary cholesterol and egg yolks: not for patients at risk of vascular disease.

Spence JD, Jenkins DJ, Davignon J.

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The health benefits of moderate alcohol consumption: a review of the literature.

Baum-Baicker C.

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Key Findings on Alcohol Consumption and a Variety of Health Outcomes From the Nurses’ Health Study.

Mostofsky E, Mukamal KJ, Giovannucci EL, Stampfer MJ, Rimm EB.

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 Effects of caloric restriction on cardiovascular aging in non-human primates and humans.

Cruzen C, Colman RJ.

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Can we live longer by eating less? A review of caloric restriction and longevity.

Roth LW, Polotsky AJ.

Maturitas. 2012 Apr;71(4):315-9. doi: 10.1016/j.maturitas.2011.12.017. Epub 2012 Jan 26. Review.

Fasting or caloric restriction for healthy aging.

Anton S, Leeuwenburgh C.

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McCay CM, Crowell MF, Maynard LA.

Nutrition. 1989 May-Jun;5(3):155-71; discussion 172. No abstract available.

Dietary restriction with and without caloric restriction for healthy aging.

Lee C, Longo V.

F1000Res. 2016 Jan 29;5. pii: F1000 Faculty Rev-117. doi: 10.12688/f1000research.7136.1. eCollection 2016. Review.

The scientific basis of caloric restriction leading to longer life.

Fontana L.

Curr Opin Gastroenterol. 2009 Mar;25(2):144-50. doi: 10.1097/MOG.0b013e32831ef1ba. Review.

Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans.

Fontana L, Meyer TE, Klein S, Holloszy JO.

Proc Natl Acad Sci U S A. 2004 Apr 27;101(17):6659-63. Epub 2004 Apr 19.

U.S. Department of Agriculture. U.S. Department of Health and Human Services . Report of the Advisory Committee on the Dietary Guidelines for Americans 2010. 7th ed. U.S. Government Printing Office; Washington, DC, USA: 2010.

Validity of the assessment of dietary intake: problems of misreporting.

Westerterp KR, Goris AH.

Curr Opin Clin Nutr Metab Care. 2002 Sep;5(5):489-93. Review.

Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake.

Black AE, Prentice AM, Goldberg GR, Jebb SA, Bingham SA, Livingstone MB, Coward WA.

J Am Diet Assoc. 1993 May;93(5):572-9.

Limitations in the assessment of dietary energy intake by self-report.

Schoeller DA.

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Differences between estimated caloric requirements and self-reported caloric intake in the women’s health initiative.

Hebert JR, Patterson RE, Gorfine M, Ebbeling CB, St Jeor ST, Chlebowski RT.

Ann Epidemiol. 2003 Oct;13(9):629-37.

Calorie Estimation in Adults Differing in Body Weight Class and Weight Loss Status.

Brown RE, Canning KL, Fung M, Jiandani D, Riddell MC, Macpherson AK, Kuk JL.

Med Sci Sports Exerc. 2016 Mar;48(3):521-6. doi: 10.1249/MSS.0000000000000796.

Discrepancy between self-reported and actual caloric intake and exercise in obese subjects.

Lichtman SW, Pisarska K, Berman ER, Pestone M, Dowling H, Offenbacher E, Weisel H, Heshka S, Matthews DE, Heymsfield SB.

N Engl J Med. 1992 Dec 31;327(27):1893-8.

Accuracy of stated energy contents of restaurant foods.

Urban LE, McCrory MA, Dallal GE, Das SK, Saltzman E, Weber JL, Roberts SB.

JAMA. 2011 Jul 20;306(3):287-93. doi: 10.1001/jama.2011.993. Erratum in: JAMA. 2011 Sep 7;306(9):933.

The accuracy of stated energy contents of reduced-energy, commercially prepared foods.

Urban LE, Dallal GE, Robinson LM, Ausman LM, Saltzman E, Roberts SB.

J Am Diet Assoc. 2010 Jan;110(1):116-23. doi: 10.1016/j.jada.2009.10.003.

Food label accuracy of common snack foods.

Jumpertz R, Venti CA, Le DS, Michaels J, Parrington S, Krakoff J, Votruba S.

Obesity (Silver Spring). 2013 Jan;21(1):164-9. doi: 10.1002/oby.20185.

Effects of a caloric restriction weight loss diet and exercise on inflammatory biomarkers in overweight/obese postmenopausal women: a randomized controlled trial.

Imayama I, Ulrich CM, Alfano CM, Wang C, Xiao L, Wener MH, Campbell KL, Duggan C, Foster-Schubert KE, Kong A, Mason CE, Wang CY, Blackburn GL, Bain CE, Thompson HJ, McTiernan A.

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Calorie restriction is more effective for obesity treatment than dietary fat restriction.

Harvey-Berino J.

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Weight loss: slow and steady does not win the race.

Martin CK, Gadde KM.

Lancet Diabetes Endocrinol. 2014 Dec;2(12):927-8. No abstract available.