Malta public health 9th January 2024 - Presentation.

  Francesco Branca, WHO director Nutrition and Food Security. 

Dietary Guidelines. "They have been designed to look at prevention of weight gain - the treatment of obesity is a different issue".

Dietary Guidelines were first introduced in 1976 with America leading the way.

By 2014 30% of Americans were obese. 

By 2023 it is more than 42% including 20% of adolescents and children.

92% of Americans no longer meet the definition of healthy.

  "And of course we also acknowledge that diets very high in carbohydrate could be very poor in diversity with very low nutritional value and with little macronutrients"

  "It is true that when we do our systematic reviews it has to be based on individuals that are healthy" 

(F. Branca)

"Of which there are fewer and fewer" (J. Schoonbee)

"Obesity is a disease per se"

  “We look at studies that only look at healthy people by design “

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“Services for obesity and diabetes are not sufficient and also there is no demand for those services”

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“Health systems do not consider obesity as a priority, most health systems don’t have that, they think 

it is a personal choice, so primary healthcare physicians are left on their own“

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“We need to do more about helping primary physicians to be 

very practical about their recommendations to patients 

in the context of obesity 

and type 2 diabetes, this is work which is going on”. 

  “I do think in populations in low-income countries, where you see the high proportion of fat, the quality of fat is extremely poor – we are talking about, for example poor neighbourhoods in Pakistan where they have a large consumption of industrial trans fats “

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(Amanda – in discussion with Branca directly) - THIS is what drives the WHO stance on fats, not the consumption of real food.

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“We are accepting that, there could be a flexibility up to say 40% “

  “We need to be looking a food-based guidelines” (Amanda -an egg is 62% fat).

“The next step has to be about food groups… The issue of highly processed food is the kind of element we need to consider”

“Animal sourced foods are definitely an important component. Our new guidelines on complementary foods are basically stating that there should be a daily portion for children below the age of two years’ “

"Definitely eggs, fish, dairy products, for example insects in other countries, not in the western culture" (Amanda -reflecting the global security issue in developing nations where lack of animal-based proteins is known to cause stunting in infants).

“I acknowledge the fact that we actually haven’t recognised mental health as an outcome.“ 

  "I have become convinced very strongly that the most powerful way to change brain health is through food because that is where brain chemicals come from in the first place".

  "The more refined carbohydrate you eat, the higher your blood sugar levels will be. But the higher your insulin levels will be. So, high blood sugar, high brain insulin. Overtime paradoxically the higher the blood insulin, the lower brain insulin".

 A ketogenic diet is a godsend for 

the insulin resistant energy deficient brain.

  What does a brain healthy diet achieve? 

-This element omitted from the presentation due to time constraints.

  Can they use the Freshwell app as a sample diet of what is being suggested?

Yes, it is free to download.

Dr David Oliver will be like exhibiting the Freshwell Low Carb app at our conference this year, having conceived of it after coming to a previous PHC conference.

  What about fibre and gut biome, lentils etc, provide fibre which is important for the gut biome?

A well formulated low carb diet has sufficient fibre because of the green vegs and nuts, please read this paper from the British Medical Journal:

‘a well-planned LCHF meal plan can be considered micronutrient replete. This is an important finding for health professionals, consumers and critics of LCHF nutrition, as it dispels the myth that these diets are suboptimal in their micronutrient supply. 

As with any diet, for optimal nutrient achievement, meals need to be well formulated.’

  What about diabetics with renal failure? There are a number of relevant papers on this.

 Diabetes Care Abstract:

‘In patients with T2D, unrestricted dietary protein intake was not associated with an increased hazard of renal function deterioration. Therefore, substituting carbohydrates with dietary protein is not contraindicated as a part of T2D management, although it may have a positive effect on body weight while minimizing loss of muscle mass.’