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18th June 2018

I was supposed to write about Cancer this week – the third part in my series about Integrative Oncology. But there was another, more topical, nutrition debate that caught my eye – so I’ve decided to interrupt the schedule to bring you my thoughts on carbohydrates…

You may have caught the recent BBC News programme, “The Truth About Carbs”.

You may also have caught the online furore/backlash/debate and exchange of comments which either slammed or supported the programme. People were, to put it mildly, NOT happy that the BBC had chosen to put a programme on, in a primetime slot, that actually criticised the consumption of a specific variety of a macronutrient (in this case, refined carbohydrates).

To be honest, I didn’t watch the documentary initially. I perhaps ‘should’ have done, but these documentaries usually leave me either screaming at the screen objecting or feeling utterly bewildered at why they’re stating the obvious.

So my introduction to this whole argument was when I stumbled across an ANutr’s (this basically means Associate Nutritionist – and this suffix is a problem we’ll come back to later) “Open Letter” to the BBC and the makers of this documentary. She outlined and then vehemently criticised the points made about carbohydrates within the documentary.

From the reading of her letter I realised that the documentary itself must have come down pretty heavily AGAINST refined, processed carbohydrates and added sugars (i.e. refined carbohydrates) in the diet.

 

The general gist was a mainstream TV program was suggesting what those in nutritional science have known for a long time – that food is metabolised at different speeds and with different results within the human body. Basically, refined carbohydrates are metabolised far more quickly than vegetable-based carbohydrates or resistant starches. The documentary presented the argument that resistant starch (note: this is still carbohydrate, just a different cellular structure and therefore metabolised differently) is more beneficial to the metabolism than plain old sugar.

 

So far, fairly uncontroversial… so why the huge outcry?

 

SPITTING OUT YOUR DRINKS

 

Well, it seems that the nutritional community weren’t happy with the fact that the programme presented an argument that exercise performance was increased by swilling a carbohydrate drink in your mouth prior to exertion. This was swilling and spitting out the drink, rather than drinking the carbohydrate drink. The argument being made by the scientists was that the sugars we somehow feel are vital to performance and energy output are not actually essential. Mere exposure of the mouth to sugar gives the brain the expectation that fuel is on the way. It reacts “as if” carbohydrates have been consumed and even after spitting the whole thing out, this was enough to provide a boost in output. The basic challenge was to the importance of ingesting carbohydrates for energy.

Unfortunately, the ANutr who wrote the open letter misspelled Swilling – using the word “Swirling”. She then went on to make this process akin to disordered eating behaviour known as rumination. (She even referenced the DSM to do so). This is a behaviour in which people chew their food and then spit it out to avoid the calories it contains.

My sense is that this dangerously-close-to-disordered behaviour (plus a language issue which I’ll go into below) got people’s backs up.

So this ANutr decided to embark on a takedown of the data the programme’s scientist presented about exercise performance improvements post-swilling. Xand Van Tulleken (presenter) and the scientist in the exercise trial both jumped in to defend both the programme and their evidence. From a reading of the Twitter spat, I was falling on the side of the science – and then I watched the programme.

The deal with exercise performance is that output is measured in small increments… because it has to be. The performance benefits the science demonstrated were perhaps not sensational… but the point they were trying to make had little to do with the level of performance increase – and everything to do with the fact that it happened at all.

The level of change should have been immaterial, NO CARBOHYDRATES WERE CONSUMED, and the output increased, albeit incrementally. But they weren’t coming up with a strategy to boost athleticism. They were making the point that carbohydrates weren’t essential to sporting output…

And here is where these agenda-driven arguments on Twitter really, really aggravate me.

 

There is a deep caution, rightly so, in the modern media about not endorsing disordered eating behaviours and/or unrealistic body types. The pressure of the visual Instagram world is intense and I think that there do legitimately need to be voices who counter the societal body norms and present the balanced view that diets aren’t just about body shape or size.

But the issue is that at the moment these voices can become HYSTERICAL at the faintest suggestion of endorsing disordered eating behaviours… and then they make inaccurate and poorly reasoned arguments (about points that weren’t even being made) against those who they deem to be promoting the disorder message. This just isn’t the way to debate.

 

Instead of assessing what the programme was trying to say, this ANutr had a very analytical take on science figures. She may have made some valid points about the minutiae, but in doing so she completely missed the large-scale point.

 

WHAT AGGRAVATES THOSE WHO DISAGREED WITH THE CARB PROGRAMME

 

It is my belief that the documentary did use loaded language (for more, see below) which ‘judged’ food. In a world where disordered food behaviours are often entered into as a way to control body shape, acceptance, self-worth etc. – using value-based terminology to refer to any food, ingredient or macronutrient attracts intense backlash from a community of nutritionists who are hyper-alert to this conversation.

It is my belief that when people are highly sensitised to this one facet of the nutritional debate, if they hear pejorative language being used they then seek to diminish the entire argument of that person.

But it is not just these disorder-sensitive nutritionists who can be petty and reactive. Some numpties on Twitter did EXACTLY the same as the ANutr and completely missed the point when they responded to her.

Because they disagreed with her points, instead of debating on the science they chose to pull her up on a minor detail: the fact that she is an ANutr not an RNutr (therefore she’s actually not yet a fully qualified “Registered Nutritionist”).

As far as I could tell, this woman is approximately a month away from her full qualifications – and this qualification one-upmanship is utterly and totally irrelevant to whether her arguments had merit or not.

This is what makes me angry about Twitter Nutrition debates… nobody argues the message, they argue the irrelevancies. In the nutritional world this means that people often start hurling criticisms at one another before asking themselves two things about the points that that person is trying to make:

  1. Who is the audience?
  2. What is the question they are actually discussing?

Nutrition is a vast topic – and it is very individual. It would make a GREAT deal of difference if people with a little bit of knowledge bore in mind that this topic has to be segmented and delivered in an appropriate style to the appropriate population. We have to tackle single populations at once. Anyone who does this – through blogs, documentaries or another medium – doesn’t deserve to be intensely criticised for providing a message that doesn’t speak to everyone, or isn’t caveated enough to be safe for the vulnerable.

 

Instead, anyone attempting to promote nutritional medicine as a front-line, preventive solution to the nation’s chronic disease epidemic deserves a medal. We need to stop pulling everyone apart for trying to help and recognise that every nutritional paradigm can be true for certain people – and that those who are doing their bit to get the message out there require support and praise, not hauling over hot coals.

 

 

THE NITTY GRITTY OF THE LANGUAGE OF CARBS

 

And here we come to the crux of the issue when it comes to modern, young nutritionists and other health professionals, and the dietary advice recommended in The Truth About Carbs documentary.

This documentary was for the Type 2 Diabetes Mellitus population. It was for people who were struggling with obesity and/or blood sugar regulation issues. It was a layperson’s documentary to help them understand the food landscape as far as metabolism is concerned.

And yet, the ANutr and those who supported her points seem to completely gloss over the fact that some really valid, potentially life-altering, points were made in this documentary about the way the body metabolises certain carbohydrates more slowly than others – and that these may therefore be wiser choices for those with blood sugar control issues.

But people skipped all of that value because of one thing: an objection with some of the LANGUAGE used.

 

Basically, a TV presenter, in a PrimeTime television slot, went and used the pejorative term ‘bad’ in front of a macronutrient, in this case – carbohydrates. In doing so, he engaged in demonisation of a food group. And this, in a world of diet fads and disordered eating, is red rag to the bull that is the hyper-alert, disorder-preventative nutritionist.

 

I cannot BEGIN to explain how utterly incensed this whole argument actually makes me.

Quite frankly, and I don’t think it’s that difficult, I see both sides of this story. I completely understand the health message that is being promoted and why it is essential that that message is there, given the health of our nation. Obesity and diabetes cost our NHS billions of bounds – and the numbers are, in no way, slowing down. Documentaries like this stand a chance of changing that reality – and there should be more of them.

But as someone who deals with disordered eating in my clients on a daily basis – often instigated through mixed messages about the role of certain nutrients – I also see how utterly dangerous it can be to use loaded terminology when it comes to discussing foods or nutrition.

The thing is that Xand Van Tulleken did not, once, say that all carbs were bad. He made a very strong point that white and beige carbs could be replaced by green carbs (i.e. vegetables) and resistant starch and that the results would be better health outcomes – lowered blood sugars, more stable insulin levels and possibly weight loss in the obese. And in fact, this point was excellently proved by their experiments conducted as part of the programme itself.

As far as I could tell, he did not invoke the insulin-hypothesis when it comes to weight gain and obesity (which would have garnered a raised eyebrow from me because it isn’t that simple). Nor was he advocating for ketogenic (i.e. almost-no-carb) diets, and he ate a sandwich in one part – so far from suggested that carbs were the devil incarnate.

 

Instead, he was trying to push into mainstream consciousness an idea which, in health circles, is almost a given: fibrous carbs that are vegetables and bulkier/more cellulose-rich starches (rather than processed air) are, on the whole and in general, healthier for you. Whilst no-one is saying never eat a biscuit, we are saying eat your vegetables. He even, in the closing titles, recommended wholemeal breads and said, “It’s all about making carbs work for you”.

 

This wasn’t some anti-carb, anti-gluten, sugar-is-evil propaganda. It made no prescription that processed carbohydrates should be eliminated all of the time. It advocated lifestyle change, no calorie counting and generally being ‘healthy’ by consuming more vegetables.

But, damn you Xand Van Tulleken – you had to say that phrase ‘bad carbs’ (though admittedly the phrase ‘beige carbs’ was the preferred terminology throughout the programme).

Perhaps the BBC should have insisted in the edit that words ‘good’ and ‘bad’ were not used – but the problem with limiting a nutritional debate to avoid all inflammatory statements is that if you do this properly you will lose the ability to ACTUALLY FLIPPING TALK ABOUT ANYTHING.

You can’t describe anything, particularly when trying to guide individuals’ choices, without using comparative and meritocratic terms. As human beings our brains are calculation machines BUILT to compare. Literally the ONLY way we can understand and assess the nutritional landscape is by having a comparative values system. And, to be quite frank, “good” and “bad” work really well as descriptors. As do ‘better’ and ‘worse’. See also: ‘preferred’.

 

You can play word semantics all day and insist that no food is innately ‘good’ or ‘bad’ – but all this does is water down any argument that someone is trying to make. It gets you lost in debating words rather than the issue at hand: is there a case to make for a certain sector of the population to take more care over their choice of carbohydrates?

 

And I’m sorry, but no matter how vanilla and benign you want to make your nutritional suggestions – at some point you have to conclude that even if no food is innately ‘good’ or ‘bad’, certain foods just are better for you than others.

 

WHO ARE THEY TRYING TO PROTECT?

 

For those trying to unhealthily control or regulate their body weight by manipulating their dietary intake, words such as ‘good’ and ‘bad’ can be inflammatory and triggering. These words endorse the sense of foods as ‘enemies’ and things that will make you fat, unhealthy or – at the extreme that I see daily in practice – sick.

And yet, it is not the language of ‘good’ or ‘bad’ that pushes people towards disordered eating. The groundwork for food manipulation must already be in existence. Documentaries such as this one can be used by those who are already suffering from a bad relationship to food as justification for their disordered behaviours, and possibly even force further restrictiveness. But the problem is not with the message of the documentary.

If a table full of people is served alcoholic drinks, this does not trigger them to all become alcoholics. And yet, if someone on that table has a predisposition to the chemistry of addiction and the circumstances are just so, that alcoholic drink may well trigger addictive behaviours in that individual.

In this situation we wouldn’t criticise either alcohol or the person who served the alcohol. We also wouldn’t criticise and say that by serving drinks, alcoholism was being endorsed.

For the same reason, we cannot criticise a programme for tackling one area of public health and suggest that it stimulates disorder in another.

In the case of this documentary, the science was relevant and critical to the public health crisis that is obesity and diabetes. And I feel that to protect certain individuals we cannot censor or prevent the publication of the information that could help others.

 

WHO WAS THE INTENDED AUDIENCE?

 

“The Truth About Carbs” programme (which I have now watched fully) was an effort to present, in an easy to digest (pun intended) way, how metabolic diseases such as type 2 diabetes and obesity can be benefitted by changing the macronutrient and sugar balance of an individual’s diet.

This is not revelatory to many working in the nutritional world – but from the other comments on Twitter it really was a relevant conversation to start because it got people to realise that our body processes foods differently. It started a thought process, a contemplation – and who knows, may just have stimulated some people to engage in behaviour change.

This programme wasn’t FOR the disordered or the undereating. There should be whole documentaries for those populations, perhaps – documentaries which add real balance to the nutrition debate, which demonstrate how there is a different set of criteria involved for your choices if you are underweight, malnourished or metabolically damaged in a different way.

But just because this documentary didn’t tell the WHOLE story (and let’s face it, how could it) does not, in any way, mean it should be criticised for promoting a really valid part of the nutritional story for ever-growing swathes of our population.

It is true that guilt around food consumption is a tricky area. As public nutrition figures we do have to be careful that we are not unnecessarily attributing danger to foods that, realistically, are just ‘less good’ for you. In that vein, perhaps there was one flaw in the BBC programme: the title.

There really isn’t a “Truth” about carbs (though it’s very appealing and undoubtedly secured viewers). Instead, “A View On…”, “One Side of…” or even, “How Different Carbs Do Different Things” would probably have been a healthier, less contentious title. And yet, censoring creative license is not something we want to get into. We ultimately should all want our nation to be healthier – and I for one think that this documentary was a good piece of media which helped us towards this aim.


Victoria Fenton Healthcare Ltd.

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