OK, so it’s not much of a looker.

Working from home brings many benefits. Apart from enjoying a flagrant disregard for sartorial etiquette in the workplace, I get to drink coffee from a proper coffee machine and real, loose-leaf herb tea. I also eat the most fantastic if not rather bizarre lunches.

My husband also works from home and between us we usually manage to concoct something from various oddities and leftovers in the fridge. Nothing is wasted in our house, and after the evening meal we scrape any leftovers off our plates and leave them in a bowl in the fridge. We usually deliberately cook too many vegetables so that we have plenty for lunch the next day. Yesterday was an exception – I opened the fridge and there was virtually nothing in it. I did however find a bowl containing the remnants of a three day-old ratatouille/pepperonata I had saved. So into the pan that went – a mixture of aubergine, red onion, yellow pepper, red pepper, tomato, garlic and herbs. There wasn’t much though, so I had to rummage through the cupboards. Consequently this lunch was a bit heavy on the tins, but that’s exactly what tins are for – stand-by. I opened a tin of sardines in spring water and in they went. Not enough for two I decided, so I added a tin of baby clams. Now you’re talking, I said to myself. It was still lacking a bit of bite, so I opened a tin of borlotti beans. It needed spicing up a bit so I added a few drops of hot red pepper sauce. Husband found a small bowl of something we were unable to give a positive I.D. to in the fridge. We guessed it might have been the juice from the chicken we had cooked a couple of days earlier, mixed in with some butter which had made it semi-solid. Whatever it was, in it went. Some rosemary and thyme which had survived the winter were picked from the garden and added the final touch. Voilà – a unique and, as it turned out, truly delicious lunch. I think you could call it a fish and bean stew.

You can keep looking.

Overall I would say it was the borlotti beans that were the stars of this particular show. Beans are the most overlooked, underrated and nutritious food and do not get the attention they deserve. When you think how heavily sugary cereals and other dietary tat of poor nutritional value are advertised you realise that it is only because there are no powerful commercial interests in beans that they barely get a look in. I’m not talking baked beans here – I’m referring to kidney beans, black-eye beans, haricot (the true identify behind baked beans) adzuki, butter and of course borlotti.

Rich in protein and fibre, beans contain both soluble and insoluble fibre. Insoluble fibre is the type that sweeps debris and waste out of the body and keeps you regular. Soluble fibre is partially digested and helps keep blood pressure down and regulates blood sugar levels. This fibre is also rich in compounds called oligosaccharides which provide food for the friendly bacteria in your gut, stimulating their growth. In addition to all this lovely protein and fibre, beans also contain very slow releasing carbohydrate (which stabilises appetite), plus good levels of iron, calcium and some B vitamins, especially folate.

What a shame I didn’t have any samphire to add to this fabulousy fishy creation. A bit of green and the taste of the sea would have been just the ticket, but the chances of my ever having any leftover samphire from a previous meal are none to zero.

Photo: Ambro/www.FreeDigitalPhotos.net

Kidney stones are made of calcium, but no one ever suggests that you should lower your calcium intake in order to avoid developing kidney stones. It is a pity that no such common sense applies to cholesterol intake.

Cholesterol is vilified as the enemy of heart health, and here’s the reasoning: plaques on artery walls contain mainly cholesterol. These arterial plaques can build up, causing narrowing of the arteries and a condition called atherosclerosis. Eventually a clot can break off, blocking flow to the heart and causing a heart attack.

It has always been difficult to grasp the concept of something seemingly dangerous yet known to be essential. Cholesterol is required to make vitamin D in the presence of sunlight. It forms part of virtually every cell membrane in the body and is needed to synthesise sex hormones – oestrogen, progesterone and testosterone are made from cholesterol. Your brain is full of cholesterol, because it is required to make the connections (or synapses) between nerve cells.

The cholesterol you eat has no impact on the cholesterol in your blood, in the same way that the saturated fat you eat has no impact on blood fat. Cholesterol is found in animal-derived foods – red meat and dairy – but most of your cholesterol doesn’t even come from diet – it is made by the liver. Furthermore, talk of “good” HDL cholesterol and “bad” LDL cholesterol” is inaccurate. All cholesterol is the same. HDL and LDL are just the proteins which transport cholesterol in the blood. High LDL is associated with heart disease and HDL is known to be protective of heart health, but low HDL is a greater risk factor for heart disease than high LDL.

Here’s what’s really interesting, and what also runs contrary to what I call ‘assumption’ thinking. When you eat a high fat, low carbohydrate diet, your HDL cholesterol actually goes up. Your blood fat – triglycerides – actually goes down. This is, indeed, exactly what you want. Do the opposite, however – eat a high carbohydrate, low fat diet and this will cause an increase in blood fat and reduces your HDL. That is the effect of insulin, which also increases LDL levels (actually it increases small particle LDLs which are the very worst kind).

This is all well established and not a contentious issue. Yet the official advice remains that we should eat a low saturated fat diet, a diet of assumptions and very little evidence.

References

Seshadri, P. et al (2004) A randomized study comparing the effects of a low carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity. American Journal of Medicine, 117(5):398-405. In: Kendrick, M. (2008) The Great Cholesterol Con. London: John Blake.

Volek et al (2009) Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids, 44:297-309.

Photo: Victor Habbick. http://www.freedigitalphotos.net

As sure as eggs is eggs, and with Easter approaching, a research report is released to the media, suggesting that chocolate can help keep us slim. Honestly, it was on the BBC today. Yesterday, I read that popcorn is the new superfood.

There appears to be some dissonance between the daily dross of pseudo science we are fed, the advice we are given, and the actual, genuine research which rarely makes the headlines.

In yesterdays’ blog I described how the hunter-gatherer, or Palaeolithic diet, is our best model of a healthy human diet. It is high in meat and contains no starchy carbohydrates such as potatoes, grains or cereals. It has plenty of plant foods though and is consequently much higher in nutrients than the modern diet. It is estimated that our Palaeolithic forebears ate a diet consisting of 35% fat, 30% protein and 35% carbohydrate, and that carbohydrate was in the form of fruit and vegetables. As you might expect, stone-age hunter-gatherers had a vitamin and mineral intake much higher than ours – typically 1.5 to eight times higher, the only exception, not surprisingly, being sodium. Vitamin C intake in the Palaeolithic diet has been estimated at 513mg daily. The current UK Government recommendation is 60mg daily.

Modern hunter gatherers have been found to be almost completely free of the diseases which plague us today, namely obesity, diabetes, heart disease and cancer. Anthropological research has consistently demonstrated relatively low cholesterol and blood fat levels among populations that derive most of their diet from animal foods. However, as they become Westernised, so too does their health. What changes? The introduction of carbohydrates from grains and sugars and refined vegetable oils represents the biggest shift in dietary patterns from traditional to modern. In a study of overweight, diabetic Australian Aborigines consuming a modern, processed diet who were temporarily placed on a traditional Aboriginal diet consisting mainly of animal foods for 7 weeks, remarkable changes were noted in health. They lost an average of 8kg, blood fat levels fell and they experienced either a great improvement or reversion of type 2 diabetes.

That was in the 1980s – similar such research has been overwhelming, but overlooked. The research consistently shows that carbohydrate-restricted diets lead to appetite reduction, weight loss and improved heart health. Even the much lauded Mediterranean diet has been shown to be less effective than the Palaeolithic diet when it comes to avoiding diabetes and heart disease.

The dietary advice given by the UK government is based on the Eatwell Plate, a policy tool which is designed to give a visual aid to people to encourage them to select the right foods. Have a look at this plate at www.food.gov.uk/multimedia/pdfs/publication/eatwellplate0907.pdf We are told ‘starchy foods such as potatoes, bread, cereals, rice, pasta should make up about a third of the food you eat.’ The British Dietetic Association advises that we should plan our meals/snacks around starchy foods such as bread, chapattis, breakfast cereals, potatoes, rice, noodles, oats and pasta.

Why is the official advice given today clearly diametrically opposed to what we know from the genuine scientific research? To answer this question, you have to ask another question: Who benefits? I’ll be attempting to answer that question very soon.

References

O’Dea, K. (1984) Marked improvement in carbohydrate and lipid metabolism in diabetic Australian Aborigines after temporary reversion to traditional lifestyle. Diabetes, 33:596-603

Eaton, S.B. (2006) The ancestral human diet: what was it and should it be a paradigm for contemporary nutrition? Proceedings of the Nutrition Society, 65:1-6.

Westman, E.C. et al (2007) Low-carbohydrate nutrition and metabolism. American Journal of Clinical Nutrition, 86(2):276-284.

Lindeberg, S. et al (2007) A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia, 50(9):1795-1807.

Photo: Mrpuen www.freedigitalphotos.net/images/view

We’re all going to die, and the more red meat we eat along the way, the sooner we can expect to shuffle off. That was the finding of a recent paper which analysed data from two epidemiological studies and which was reported and contorted by the media into a damning indictment of red meat as the enemy of human health.

The full spectrum of the media, which has never understood, or wanted to understand, the nature of research, cheerfully ignored the fact that this report looked at associations only, not cause and effect. This is what the authors of the study actually said, and I quote:

“Men and women with higher intake of red meat were less likely to be physically active and were more likely to be current smokers, to drink alcohol, and to have a higher body mass index. In addition, a higher red meat intake was associated with a higher intake of total energy but lower intakes of whole grains, fruits, and vegetables.”

But let’s not let the truth – or the blindingly obvious – stand in the way of a good story. And if it’s truth you’re after, and you want to know what constitutes the best diet for the human animal, you need only study our hunter-gatherer ancestors who despite not studying the subject themselves, just got on with being human.

We have to do this because in this highly industrialised, commercialised and processed world we are so far removed from knowing our true nature that we struggle to answer basic questions relating to what is normal and appropriate for us to eat. Pre-agricultural humans – our hunter gatherer ancestors – give us the best indication of the diet to which we are most adapted. For 99.6% of human history we lived in the Palaeolithic era. Unfortunately our ancestors left no food diaries for nutritionists to analyse, but many modern-hunter gatherer societies whose lifestyles remained basically unchanged over the millennia did survive into the 20^th century. In 2000, researchers published the results of a study of 229 modern hunter-gatherer societies located all over the world. Their findings were a revelation.

Of these societies, most (73%) derived more than half of their energy – calorie intake – from meat and fish. Only 13.5% of worldwide hunter-gatherers obtained more than 50% of their subsistence from gathered plant foods. Not one of those societies consumed a vegetarian diet. These findings were consistent, despite the changes of latitude, although less plant food and more fatty food was consumed with increasing latitude.

The other interesting thing about all this meat devouring is the type of meat selected by hunters. It is well known that lean meat, high in protein and low in fat, has deleterious effects on human health if eaten to excess. A very high protein diet can eventually lead to death. It is fascinating that these hunters had a preference for larger and therefore fatter prey, tending to avoid smaller animals with a higher protein content. They also consumed all edible portions of the animal, including marrow, organs and of course fat. You’re not going to go to all the trouble of hunting and killing an animal just to let most of it go to waste. Meat eaters today know that fat is what makes meat tasty – personally I never select the leaner cuts of meat because without fat there is less juice, and flavour is compromised.

So surely these people must have had serious heart disease? Of course not. Heart disease (and other chronic disease) is virtually absent from these societies (which also tells you a lot about the genetic influence on chronic disease). On the whole, they were immune to what are frequently termed diseases of civilisation. More of this later – it’s too fascinating to ignore.

References

Pan, A. et al (2012) Red meat consumption and mortality. Archives of Internal Medicine, published online March 12.

Corain, L. et al (2000) Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. American Journal of Clinical Nutrition, 71:682-92

Photo by: Africa. www.freedigitalphotos.net/images/view

Why are so many poor people obese? This is a question that invites prejudice and scorn because it is all too facile to associate obesity with sloth and greed.

I am a regular visitor to Italy so am a keen observer of what Italians like to eat. I remember about a year ago having lunch in a country restaurant. By UK standards, it was the sort of place that would be considered upmarket – top quality, fresh regional food, crisp linen tablecloths and napkins. However in Italy that comes as standard – these restaurants serve everyone from local bigwigs to passing lorry drivers. Two workmen from a nearby quarry, still in their overalls, were having the lunch special. Each had a grilled pork chop and potatoes and were sharing a large green salad. They also had a small glass of red wine each. Shall I dress this? I overheard one say to his companion, pointing at the salad. This really tickled me.

Try to imagine this scenario anywhere in Britain and you can’t. One of the things I admire most about Italy is the universal love of good food, which transcends class and even age. The idea of a separate children’s menu would be baffling to Italians. Poor people might choose cheaper cuts of meat and fish, but they still talk about food in the same way that rich people do – with passion and knowledge.

In her 2006 book Bad Food Britain, Joanna Blythman describes how politicians, keen to win the populist vote, like to demonstrate their fondness for junk food. You wouldn’t catch them dressing a green salad when there are cameras present. On the contrary: as Blythman recounts, politician make a point of being photographed eating fish and chips (Tony Blair and John Prescott in 2005) or a McDonald’s meal (Boris Johnson) because good food is too posh for ordinary people. Only this morning David Cameron was on the BBC news, attending a basketball game on an official visit to the U.S. and eating a hotdog, proving he is a man of the people.

It’s not just poverty, it’s culture. And when you combine the two, it’s obesity. It is patronising to say that low-income people cannot afford to eat good food. You only have to look at countries like Italy where the tradition of cooking (and appreciating) real food endures, despite financial hardship. They have just learned to be creative, and believe me they are really feeling the pinch over there. Here, we have a culture of aggressive, relentless advertising and marketing of junk food aimed at both adults and children which undermines any efforts to change poor eating habits. When successive generations are born into households which only know microwaves, ready-meals and snack foods, that becomes their food culture.

If you are prudent you can get an awful lot of calories for your junk food money, which is the bottom line when you have children to feed. But cheap refined carbohydrates are a passport to obesity, as well as diabetes and heart disease. If they are the mainstay of your diet they will constantly raise blood sugar and therefore insulin levels. Insulin is the hormone which makes you fat – it directs fat and carbohydrates into fat tissue and prevents stored fat from being released. You just keep piling on the weight. If this happens regularly the chances are you will develop insulin resistance which can lead to both heart disease and diabetes. The current rate of obesity in England is around 24% of the adult population. In Italy it is 10%.

Still, there are glimmers of hope. In my local pub, in a small Hertfordshire village, the men (trust me, not posh) stand around discussing football and food, in equal measure. They swap cooking tips, as well as recipes (seriously). I don’t know how common, or unusual, this is, but I find it inspirational in the face of the prevailing culture.

Photo: Stuart Miles. http://www.freedigitalphotos.net/images/view_photog.php?photogid=2664

Where there’s egg there’s crime. There really is no aspect of our lives, or our diets, that hasn’t been infiltrated by villains.

Because organic eggs are considerably more expensive than battery eggs, they are susceptible to fraud. After all, they all look pretty much the same. Don’t be fooled though: there is a world of difference in terms of nutritional value between a battery egg and an organic egg. Crack that egg and you can even see it – the truth lies in the yolk. That yellow pigment, so bright in organic eggs, so insipid in a battery egg, is evidence of the carotenoid content. Carotenoids, you may recall from an earlier blog (Life-long sunscreens: natural protection from carotenoid pigments in plants – 13 February) are those yellow pigments found in plants that act as antioxidants, protecting the skin (and eyes) from sun damage.

Some clever boffins, happy to embrace a good challenge and fight crime wherever they find it, have come up with an ingenious way of testing batches of eggs to determine their provenance, i.e. whether they were born in a barn, or into a privileged, free range or organic lifestyle. A method of selective fingerprinting (profiling) of eggs has been developed in the Netherlands, which can identify organic, free-range and barn eggs by examining the carotenoid content of the egg yolk. Organic eggs come from hens with the best diets, thanks to their organic natural feed and to the amount of freedom they have to forage for grubs, worms and seeds. This affects the carotenoid levels, and organic eggs have been found to have distinctively high levels of two particular carotenoids, namely lutein and zeaxanthin. These are the two carotenoids believed to decrease the risk of developing age-related macular degeneration, or failing eyesight as you get older.

The nutrient content of an egg is not genetically encoded – rather, it is a reflection of the hen’s diet. Eggs laid by free range hens have been found to have 38 per cent higher vitamin A and twice as much vitamin E as those laid by their caged sisters. Organic, free-range eggs also tend to have a higher omega-3 fatty acid content than battery eggs.

The BBC ran an item yesterday about the price of eggs being set to rise, since an EU ban on battery hen cages came into force on 1 January. British chicken farmers are a bit miffed because they’ve spent a lot of money converting their battery cages into ‘enriched’ cages, but it turns out that 13 EU countries have ignored the ban, so we can’t import their now illegal eggs. The result, we are warned, will be soaring egg prices. The BBC had a short film showing the new cages of laying hens which have been enriched with extra space to nest and roost.

I watched this video several times on-line and frankly couldn’t see any difference between the old battery cages and these new, enriched ones. Still, they must be better, so I’ll take their word for it. Much more visible is the quality of the organic, free-range egg – crack one and see.

Photo: jiggoja http://www.freedigitalphotos.net/images/view_photog.php?photogid=2525

References

Karsten, H.D., Patterson, P.H., Stout, R. & Crews, G. (2010) Vitamins A, E and fatty acid composition of the eggs of caged hens and pastured hens.Renewable Agriculture and Food Systems, 25:45-54.

Sparks, N.H.C. (2006) The hen’s egg – is its role in human nutrition changing? World’s Poultry Science Journal, 62:308-315.

Van Ruth, S., Alewijn, M., Rogers, K. et al (2011) Authentication of organic and conventional eggs by carotenoid profiling. Food Chemistry, 126:1299-1305.

If you want to know where the big money is, watch Coronation Street. This is prime time television so only companies with massive budgets can afford to advertise during this slot.

I’m a life-long fan which means I’ve been watching adverts for junk food for longer than I should admit to, though I do feel smug that I have always remained impervious to their charms. Even so, the dross on the screen before, during and after my beloved Corrie has always been a source of irritation. What sort of food philistines do these advertising executives think we CS fans are? Ready-meals feature strongly, as do breakfast cereals and snack foods. I don’t really mind the ads for junk food which are not pretending to be anything that they are not; sometimes they are quite entertaining. It’s the ones that present themselves as public health broadcasts, doing us all a favour, that are most vexing.

Especially galling is Flora Cuisine – “For the Hearts you Love”. It’s full of the usual flannel but with more lather than Corrie itself. Vernon Kay’s mother has been engaged, together with her son, to persuade us that this product is a healthy alternative to olive oil. She tells him/the UK that Flora Cuisine has 45% less saturated fat than olive oil, as if that were a good thing. She’s about to cook a stir fry for her strapping lad. If she really wanted to do him a favour, she’d cook that stir fry in extra virgin olive oil, or perhaps some butter, or even a combination of the two. These fats remain stable when heated. But no, what she’s using is a blend of mainly polyunsaturated oils: sunflower seed, rapeseed and linseed oils together with stabilisers, preservatives and emulsifiers. This is the last thing you should use for frying. That much has been known for a long time; in 2001 researchers looked at twenty years’ worth of studies and concluded that heating cooking oils, especially polyunsaturated oils, poses serious health hazards. These findings were published in a food industry journal, so not likely to have escaped the attention of Unilver, makers of Flora Cuisine, and their ilk.

Frying these oils generates large amounts of free radicals, the sort that are well known to be very, very bad for the heart. But very good for business.

Grootveld, M., Silwood, C.J.L., Addis, P. et al (2001) Health effects of oxidized heated oils. Foodservice Research International, 13(1):41-55.

In my previous post I discussed saturated fat and obesity, and how it is a travesty that sat fat has for so long been singled out as major cause of this disease. It is not; neither does it cause heart disease. It is unlikely that it is a cause of cancer, either.

There is so much conflicting evidence surrounding fat and heart disease that, in order to resolve the issue once and for all, the World Health Organization and the Food and Agricultural Organization held a joint, four-day expert consultation on the subject of dietary fat and health at the WHO headquarters in Geneva, in November 2008. The aim of this four-day consultation was to consider all the scientific evidence, taken from the most robust studies. The results were published in the Annals of Nutrition and Metabolism. The experts involved in the consultation concluded that “there is no probable or convincing evidence for significant effects of total dietary fats on coronary heart disease or cancers”. A year later, the British Nutrition Foundation reported that the amount of fat in our diet is not linked either to obesity, or heart disease, or cancer.

The WHO et al must wonder why they bother. I too wonder why they bother (but I’m grateful they do). Despite the evidence, The British Heart Foundation currently advise on its website that we should “avoid saturated fats wherever possible”. The NHS website also currently recommends a low-fat diet, on the groundless premise that saturated fat increases cholesterol levels. The National Institute for Health and Clinical Excellence (NICE) has produced a booklet for the NHS which advises that, in order to avoid obesity, our diets should be based on starchy foods such as potatoes, bread, rice and pasta. We should choose low fat foods. Of course, a diet based on these starchy foods is notoriously linked to type 2 diabetes, which in turn is linked to .. obesity and heart disease.

FAO/WHO (2008). Joint FAO/WHO Expert Consultation on Fats and Fatty Acids in Human Nutrition (10 – 14 November 2008, WHO, Geneva). Interim Summary of Conclusions and Dietary Recommendations on Total Fat & Fatty Acids.

Skeaff, C.M. & Miller, J. (2009) Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials. Annals of Nutrition and Metabolism, 55:173-201.

Sanders, T.A.B. (2010) The role of fat in the diet – quantity, quality and sustainability. Nutrition Bulletin 35(2):138-146.

When Denmark banned Marmite from their hallowed turf, in May 2011, I was in awe of their nutrition acumen. (This is the country which also gave us the TV series The Killing, for which I shall be eternally grateful.) But I now withdraw all esteem and high regard for their dietary judgement for introducing a fat tax later that same year.

Denmark has one of the lowest levels of obesity in the developed world, yet has slapped a tax on all foods containing more than 2.3% saturated fat, because of concern over obesity levels. The UK government is so impressed with this that it is considering doing the same thing. Confused? That’s irrelevant. There’s an economic crisis on our hands.

Well, David Cameron wanted a Big Society and he’s certainly got one. Roughly 24.5% of the UK adult population are obese. Ireland can boast similar statistics. The US stands proud at just over 34%. With just over 11% adult obesity, Denmark has, cannily, decided to target the foods that the Danes famously love most, especially butter and cheese. There’s gold in that thar fat.

Over here in the UK, we have our own very curious paradox. The last National Diet and Nutrition Survey revealed that our total fat consumption, across all age groups, does not exceed government recommendations. Fat makes up 34-36% of our energy intake; the government recommendation is for no more than 35%. We are now consuming less saturated fat, as a percentage of food energy, than in any previous survey, for all age groups. This is partly because we have been persuaded to eat foul dross such as low-fat spreads, instead of butter.

On to our next paradox. What this survey also reveals, and nobody seems too bothered about, is that we are now eating vast quantities of bread and cereals – in fact cereals and cereal products are now, according to the findings of this same survey, the main source of energy for all age groups, from children to adults. That’s right – we eat less fat and more carbohydrates than ever, and are getting fatter than ever. So let’s tax fat.

Is anyone, anywhere, thinking that perhaps it’s time to start rethinking outdated thinking? Of course not. To do so would be unthinkable. I’ve always said that nutrition is the most unscientific of the sciences. Public health nutrition advice is rarely based on up-to-date knowledge. It’s not even the result of muddled thinking – people would rather cling on to long-held beliefs and cemented paradigms than admit that perhaps they were wrong all along.

To add irony to illogic, the fact is that there is no evidence whatsoever that saturated fat causes obesity, but plenty of evidence to show how cereals and other carbohydrates play a major role in weight gain. This is a well researched area, but here’s just one example. When researchers (writing in the New England Journal of Medicine) compared the effectiveness of a low-carbohydrate, Mediterranean or low-fat diet on 322 moderately obese people, those eating the most amount of fat, i.e. those following the low-carbohydrate diet, lost the most amount of weight over a two-year period.

It’s not just obesity – saturated fat is always implicated in heart disease and other chronic disease. Again, the evidence points overwhelmingly to carbohydrates and sugars, not fat, as the main dietary culprit. But that’s another blog, and the mood I’m in, it’s one coming soon.

Brown, M., Byatt, T., Marsh, T. & McPherson, K. (2010) Obesity trends for adults. Analysis from the Health Survey for England 1993-2007. Report by the National Heart Forum.

NHS/National Obesity Observatory. International comparisons of obesity prevalence. June 2009.

Bates, B., Lennox, A. Swan, G. (eds) 2010 National diet and nutrition survey: headline results for year 1 of the rolling programme (2008/2009). Food Standards Agency.

Shai, I., Schwarzfuchs, D., & Henkin, Y. et al (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. New England Journal of Medicine. 359(3):229-41.