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Let me be very clear. Anyone who tells you to eat your greens is all right by me. If that was the end of it, I'd be McKeith's biggest fan, because I'm all in favour of "evidence-based interventions to improve the nation's health", as they used to say to us in medical school.
But let's look at the evidence. Diet has been studied very extensively, and there are some things that we know with a fair degree of certainty: there is convincing evidence that diets rich in fresh fruit and vegetables, with natural sources of dietary fibre, avoiding obesity, moderate alcohol, and physical exercise, are protective against things such as cancer and heart disease.
But nutritionists don't stop there, because they can't: they have to manufacture complication, to justify the existence of their profession. And what an extraordinary new profession it is. They've appeared out of nowhere, with a strong new-age bent, but dressing themselves up in the cloak of scientific authority. Because there is, of course, a genuine body of research about nutrition and health, to which these new "nutritionists" are spectacularly unreliable witnesses. You don't get sober professors from the Medical Research Council's Human Nutrition Research Unit on telly talking about the evidence on food and health; you get the media nutritionists. It's like the difference between astrology and astronomy.
These new nutritionists have a major commercial problem with evidence. There's nothing very professional or proprietary about "eat your greens", so they have had to push things further: but unfortunately for the nutritionists, the technical, confusing, overcomplicated, tinkering interventions that they promote are very frequently not supported by convincing evidence.
And that's not for lack of looking. This is not about the medical hegemony neglecting to address the holistic needs of the people. In many cases, the research has been done, and we know that the more specific claims of nutritionists are actively wrong.
I've got too much sense to subject you to reams of scientific detail - I've learned from McKeith that you need theatrical abuse to hold the public's attention - but we can easily do one representative example. The antioxidant story is one of the most ubiquitous health claims of the nutritionists. Antioxidants mop up free radicals, so in theory, looking at metabolism flow charts in biochemistry textbooks, having more of them might be beneficial to health. High blood levels of antioxidants were associated, in the 1980s, with longer life. Fruit and vegetables have lots of antioxidants, and fruit and veg really are good for you. So it all made sense.
But when you do compare people taking antioxidant supplement tablets with people on placebo, there's no benefit; if anything, the antioxidant pills are harmful. Fruit and veg are still good for you, but as you can see, it looks as if it's complicated and it might not just be about the extra antioxidants. It's a surprising finding, but that's science all over: the results are often counterintuitive. And that's exactly why you do scientific research, to check your assumptions. Otherwise it wouldn't be called "science", it would be called "assuming", or "guessing", or "making it up as you go along".
But don't get distracted. Basic, sensible dietary advice, that we all know - be honest - still stands. It's the unjustified, self-serving and unnecessary overcomplication of this basic sensible dietary advice that is, to my mind, one of the greatest crimes of the nutritionist movement. I don't think it's excessive to talk about consumers paralysed with confusion in supermarkets.
Although it's just as likely that they will be paralysed with fear, because McKeith's stock in trade is abuse, on a scale that would have any doctor struck off: making people cry for the television cameras, I assume deliberately, and using fear and bullying to get them to change their lifestyles. As a posture it is seductive, it has a sense of generating movement, but if you drag yourself away from the theatricality of souped-up recipe and lifestyle shows on telly, the evidence shows that scare campaigns tend not to get people changing their behaviour in the long term.
So what can you do? There's the rub. In reality, again, away from the cameras, the most significant "lifestyle" cause of death and disease is social class. Here's a perfect example. I rent a flat in London's Kentish Town on my modest junior doctor's salary (don't believe what you read in the papers about doctors' wages, either). This is a very poor working-class area, and the male life expectancy is about 70 years. Two miles away in Hampstead, meanwhile, where the millionaire Dr Gillian McKeith PhD owns a very large property, surrounded by other wealthy middle-class people, male life expectancy is almost 80 years. I know this because I have the Annual Public Health Report for Camden open on the table right now.
This phenomenal disparity in life expectancy - the difference between a lengthy and rich retirement, and a very truncated one indeed - is not because the people in Hampstead are careful to eat a handful of Brazil nuts every day, to make sure they're not deficient in selenium, as per nutritionists' advice.
And that's the most sinister feature of the whole nutritionist project, graphically exemplified by McKeith: it's a manifesto of rightwing individualism - you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that's why you're healthy. You're going to see 78. You deserve it. Not like them.
How can I be sure that this phenomenal difference in life expectancy between rich and poor isn't due to the difference in diet? Because I've read the dietary intervention studies: when you intervene and make a huge effort to change people's diets, and get them eating more fruit and veg, you find the benefits, where they are positive at all, are actually very modest. Nothing like 10 years.
But genuine public health interventions to address the real social and lifestyle causes of disease are far less lucrative, and far less of a spectacle, than anything a food crank or a TV producer would ever dream of dipping into. What prime-time TV series looks at food deserts created by giant supermarket chains, the very companies with which stellar media nutritionists so often have lucrative commercial contracts? What show deals with social inequality driving health inequality? Where's the human interest in prohibiting the promotion of bad foods; facilitating access to nutrient-rich foods with taxation; or maintaining a clear labelling system? Where is the spectacle in "enabling environments" that naturally promote exercise, or urban planning that prioritises cyclists, pedestrians and public transport over the car? Or reducing the ever-increasing inequality between senior executive and shop-floor pay?
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full: http://www.guardian.co.uk/food/Story/0,,2011095,00.html
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Colin Brace
Amsterdam