Food and Nutrition Sciences, 2013, 4, 240-244
http://dx.doi.org/10.4236/fns.2013.43032 Published Online March 2013 (http://www.scirp.org/journal/fns)
Food for Thought: Have We Been Giving the Wrong
Dietary Advice?
Zoë Harcombe1, Julien S. Baker1, Bruce Davies2
1Institute of Clinical Exercise and Health Science, Faculty of Science and Technology, University of the West of Scotland, Hamilton,
UK; 2University of Glamorgan, Pontypridd, UK.
Received January 16th, 2013; revised February 18th, 2013; accepted February 25th, 2013
ABSTRACT
Background: Since 1984 UK citizens have been advised to reduce total dietary fat intake to 30% of total energy and
saturated fat intake to 10%. The Nationa l Institute of Clinical Excellence [NICE] suggests a further benefit for Coronary
Heart Disease [CHD] prevention by reducing saturated fat [SFA] intake to 6% - 7% of total energy and th at 30,000 lives
could be saved by replacing SFAs with Polyunsaturated fats [PUFAs]. Methods: 20 volumes of the Seven Countries
Study, the seminal work behind the 1984 nutritional guidelines, were assessed. The evidence upon which the NICE
guidance was based was reviewed. Nutritional facts about fat and the UK intake of fat are presen ted and the impact of
macronutrient confusion on public health dietary advice is discussed. Findings: The Seven Countries study classified
processed foods, primarily carbohydrates, as saturated fats. The UK government and NICE do the same, listing biscuits,
cakes, pastries and savoury snacks as saturated fats. Processed foods should b e the target of public h ealth advice but no t
natural fats, in which the UK diet is deficient. With reference to the macro and micro nutrient composition of meat, fish,
eggs, and dairy foods the ar ticle demon strates th at dietary trials cannot ch ang e one typ e of fat for another in a contro lled
study. Interpretation: The evidence suggests that processed food is strongly associated with the increase in obesity,
diabetes, CHD, and other modern illness in our society. The macro and micro nutrients found in meat, fish, eggs and
dairy products, are vital for human health and consumption of these nutritious foods should be encouraged.
Keywords: Cardiovascular Disease; Obesity; Fatty Acids; Saturated Fatty Acids; Monounsaturated Fatty Acids;
Polyunsaturated Fatty Acids; Dietary Fats; Dietary Carbohydrates; Epidemiology
1. Introduction
History has presented us with a very confused and some-
times misinformed message with reference to healthy
eating. Following the completion of the Seven Countries
Study in 1970, the seminal work of Ancel Keys [1] had a
profound influence on the diets of the USA [2] and the
UK [3]. K e ys’ conclusions were:
1) The incidence rate of CHD [Coronary Heart Dis-
ease] tends to be directly related to the distributions of
serum cholesterol values.
2) The average serum cholesterol values of the cohorts
tended to be directly related to the average proportion of
calories provided by saturated fats in the diet.
3) The CHD incidence rates of the cohorts are as
closely related to the dietary saturated fatty acids as to
the serum cholesterol level.
2. Dietary Advice
In 1983 these findings prompted the National Advisory
Committee on Nutrition Education [NACNE], to rec-
ommend a reduction in total dietary fat intake to 30%
with saturated fatty acids being no greater than 10%. In
1984 this was followed by the Committee on Medical
Aspects of Food Policy [COMA] policy paper “Diet and
Cardiovascular Disease [4].” This report endorsed the
findings of Keys stating that the dietary energy derived
from saturated fatty acids tends to be related to mortality
from CHD and that this relationship is consistent be-
tween countries.
The 2010 public guidance document from the National
Institute of Clinical Excellence [NICE] [5] entitled “Pre-
vention of Cardiovascular Disease at a Population Level”
also emphasised that the reduction of dietary saturated fat
is crucial to the prevention of CHD. They recommended
that a halving of the average intake (from 14% to 7%)
might prevent 30,000 deaths annually. Personal corre-
spondence with NICE with reference to these recom-
mendations confirms that they were very much influ-
enced by the work of Harris et al., 2009 [6 ]. In retro spect
it would seem that the work of two research groups i.e.
Keys et al., 1970 [1] and Harris et al., 2009 [6] have con-

Food for Thought: Have We Been Giving the Wrong Dietary Advice? 241
siderably influenced the conclusions and recommenda-
tions of two of the most important and influential health
reports that have been published in the last quarter of a
century.
When we examine the work of these two research
groups it is surprising how their results and conclusions
were accepted with such conviction and more impor-
tantly superimposed on society to such an extent that
they determine UK eating habits.
3. Classification Errors
Volume XVII of Keys’ study is called “The Diet” [7] and
yet there is very little mentioned about the diet of any of
the countries studied. Each country is discussed in a
separate volume and there is no scientific quantification
of the foods consumed by any of the countries involved
in the study. The dietary references that were mentioned
used unquantifiable descriptions such as “loaded with
saturated fatty acids” and “cholesterol from butter, cream,
meats and eggs”.
More importantly the study classified cake and ice
cream as saturated fats, as opposed to refined carbohy-
drates, an error which is repeated by contemporary food
scientists. Meat and eggs are described as saturated fat
when their fat content is primarily unsaturated. Butter
and cream are one third unsaturated fat, which was not
noted in their analysis. So here we have a profoundly
influential research project introducing imprecise evalua-
tions of macronutrients which have continued to the pre-
sent day.
The Seven Countries Study was not a scientifically
robust study. The dietary references are vague, sporadic
or absent. There were no comments on causation and no
attempt was made to consider association until 25 years
post study completio n [8] and 10 - 15 years after UK and
USA dietary advice had already been changed based on
the recommendations of Keys’ work. The study clearly
demonstrated that the science surrounding macronutri-
ents and nutrition was not as accurate as it is today. Yet
contemporary knowledge is not being applied when con-
sidering nutritional adv ice for the population.
4. Saturated Fats and Polyunsaturated Fats
Harris and his colleagues [6], using a meta analysis re-
view, were of the opinion that consumption of at least
5% to 10% energy from omega-6 polyunsaturated fats
[PUFAs] reduces the risk of CHD relative to lower in-
takes. They were confident about the safety of higher
intakes of these fats. The conclusion s to date are equivo-
cal with reports from robust research concluding that
diets high in PUFAs can increase the susceptibility to
LDL [low density lipoprotein] oxidation and vascular
inflammation [9].
In addition, Mozaffarian et al. [10], u sing angiography,
reported a direct association between PUFA intakes and
luminal narrowing in wo men with CHD. To date there is
no population study that has consumed large quantities of
polyunsaturated fatty acids for extended periods of time.
Therefore the benefits from the consumption of high in-
takes of PUFAs have not been proven to be safe [11].
Because of the important impact that PUFAs are claimed
to have on cardiov ascular h ealth it is critica l that research
disclosures are appraised with care to identify any con-
flict of interest with the sponsors of such projects.
Harris et al. excluded two studies, Rose [12] and
Frantz [13], which were unfavourable claiming no sig-
nificant effect was seen. Selecting six studies [14-19] for
their analysis as opposed to eight studies does present a
confounding variabl e when considering thei r conclusions.
5. Nutrient Classification
It would seem that two influential nutritional recom-
mendations written during the period from 1980-2010
were the COMA [3] and NICE [5] reports and that the
writing of these reports was in turn considerably influ-
enced by the research of Keys [1] and Harris [6]. To da te
we have been guilty of imprecision in the identification
and classification of foods. This leads to dietary recom-
mendations, based on incorrect information and in many
instances poor science.
There is a need to accurately define the macro and mi-
cronutrient conten t of food. Biscuits, savoury snacks and
processed food should not be defined as saturated fats
because they are substantially carbohydrates. Red meat is
not a saturated fat but a combination of various fatty ac-
ids. Sirloin steak for example is approxima tely 71% wat e r,
21% protein, 3% unsaturated fat and 2% saturated fat
[20,21]. Natural food such as meat, fish, eggs and nuts
contain saturated, monounsaturated and polyunsaturated
fats, only the proportions vary. Few people appreciate
that it is impossible to eat saturated or polyunsaturated
fat alone. Dairy products are the only food group with
more saturated than unsaturated fat. Many of the foods
demonised by past research groups, even lard, contain
more unsaturated than saturated fat. Dietary fat consump-
tion is a key provider of essential fats and fat soluble vi-
tamins.
The only foods that contain no carbohydrate or protein
are oils [22,23]. Sucrose contains only carbohydrate, no
fat or protein. Every other food contains protein with fat,
carbohydrate or both. The only food th at can be modified
to assess the dietary implications of fat consumption
without changing the macronutrient composition is oil.
This explains why the COMA [3] report stated “There
has been no controlled clinical trial of the effect of de-
creasing dietary intake of saturated fatty acids on the

Food for Thought: Have We Been Giving the Wrong Dietary Advice? 242
incidence of coronary heart disease nor is it likely that
such a trial will be undertaken”.
6. Dietary Fat and Coronary Heart Disease
The Heart of Mersey Paper [THoMP] [24], which con-
sidered dietary fats and the prevention of coronary heart
disease, concluded that saturated fats are a clear agonist
for the development of CHD with the unsaturated fats
assuming an antagonist and beneficial influence. Using a
100 g steak, as an example, with 5.4 g of fat, it is difficult
to accept that the 39% of the fat which is saturated is
damaging to the cardiovascular system while the 61% of
the fat which is unsaturated is protective. Keeping in
mind that the to tal fat conten t o f the steak will prov ide all
but 3 of the 13 vitamins and 16 minerals that are a pre-
requisite for the maintenance of good health.
The verification for the saturated versus unsaturated
fat theory is equivocal. Mozaffarian et al. [10] reported
that postmenopausal women with relatively low total fat
intake and a greater saturated fat intake were associated
with less progression of coronary atherosclerosis. A re-
cent meta-analysis [25] reviewing 347,747 people re-
ported that there was no significant evidence for con-
cluding that saturated fat is associated with an increased
risk of CHD. The authors were of the opinion that more
evidence should be gathered on the nutrients that would
replace saturated fat. A prime candidate for this is sugar,
which has tripled in consumption worldwide over the last
50 years and is implicated in the rapid rise in obesity. It
is recommended that government intervention should be
directed towards “added sugar”. This is defined as any
sweetener containing the molecule fructose that is added
in food processing [26].
THoMP [24] refers to the COMA report [3], which
recommends a ratio of polyunsaturated fats to saturated
fat that is a P/S ratio of 0.45. The egg is the only natural
food with this ratio. Of the 10 g of fat per 100 g of egg,
37% is saturated, 46% is monounsaturated, and 17% is
polyunsaturated [27]. Precise daily dietary recommenda-
tions are required to demonstrate how total fat, saturated
fat and the P/S ratio can be met in parallel with micronu-
trient recommended daily allowances [RDAs].
7. Swapping Dietary Fats—The Limitations
and the Consequences
The THoMP [24] report also recommended that the pop u-
lation goals should be to replace dietary saturated fats
with small amounts of unsaturated fats. There are two
ways in which this can be done; one has no impact on
macronutrients but both methods will influence micronu-
trients. Sunflower oil, for example could replace olive oil
and slightly reduce saturated fat while increasing poly-
unsaturated fat at the expense of monounsaturated fat
(Table 1). Very little saturated fat (4 g/100g) would be
replaced by unsaturated fat. Vitamin E would increase
from 14 mg to 41 mg while Vitamin K would fall from
60 mcg to 5 mcg [22,23]; these are the only two nutrients
of small value in olive oil and sunflower oil. Oils gener-
ally, are deficient in vitamins and devoid of minerals.
Substituting foods other than oils, changes the relative
amounts of saturated and unsaturated fat, calorie intake
and the macro and micronutrients. Replacing 100 g of
cheese with 100 g of olive oil will reduce saturated fats
[SFAs] by 7 g and increase monounsaturated fats [MU-
FAs] eight fold (64 g) and PUFAs twelvefold. Calorie
intake doubles while losing: 25 g of protein; 33% of vi-
tamin A and B12 RDAs; 70% of the calcium and phos-
phorus RDAs and all zinc [28]. If whole milk is replaced
with the same oil, all protein and minerals are lost, calo-
ries increase 15 fold and all three fats increase substan-
tially SFAs seven fold, MUFAs 91 fold and PUFAs 55
fold [29].
Despite a vast amount of nutritional research over
many decades we are still surrounded by confusion, rap-
idly changing advice and substantial mythology. Many of
the contemporary eating habits are harmless but some,
particularly in the young, can be a threat to good health.
For instance a reduction in the consumption of dairy
foods would seriously challenge the daily prerequisite
levels of vitamin A and D and the key minerals calcium
and phosphorus. There is evidence of a re-emergence of
rickets and osteoporosis is rising [30]. The most recent
Family Food survey has reported that the present UK diet
is deficient in retinol and vitamin D, providing less than
one third of the UK Reference Nutrient Intake and barely
a fifth of the recently revised American RDA for vitamin
D [31].
The consumption of oily fish is now considered a must
and caution is given over red meat. However if 100 g of
pork is replaced with the same quantity of mackerel we
double the intak e of calories and saturated fat. The intak e
of MUFAs would triple and PUFAs increase almost
seven fold [32,33] with the protein remaining the same.
Vitamins are gained and some minerals are gained and
others lost.
8. Conclusion
Nutritional science despite many years of enquiry is in a
state of equivocation, resulting in many false promises
being given with reference to a diet which will keep the
majority of the population fit lean and healthy. Despite
the influence of epigenetics we remain hunter gatherers
surrounded by a preponderance of food and automation.
This presents us with many problems of adjustment but it
is not as complicated to solve as some would have us
believe, albeit with ulterior motives mostly financial.

Food for Thought: Have We Been Giving the Wrong Dietary Advice? 243
Table 1. Nutritional content of foods in article.
(All per 100 g) Sirloin steak Eggs Sunflower oilOlive oilCheese Milk (whole) Pork Mackerel
Water (g) 71 76 0 0 37 88 75 64
Carbohydrate ( g) 0 1 0 0 1 5 0 0
Protein (g) 21 13 0 0 25 3 21 19
Fat (g) 5.4 8.3 100 100 31 2.9 3.8 12.1
SFA/MUFA/PUFA (g) 2.1/3/0.3 3.1/3.8/1.4 10/45/40 14/73/1121/9/0.91.9/0.8/0.2 1.5/1.8/0.5 3.3/5.5/3.3
Calories 154 143 884 884 403 60 123 205
Vitamins USA RDA
A (3000 IU) 0 487 0 0 1002 102 0 167
B1 (1.2 mg) 0.1 0.1 0 0 0 0 0.5 0.2
B2 (1.3 mg) 0.1 0.5 0 0 0.4 0.2 0.2 0.3
B3 (16 mg) 7.2 0.1 0 0 0.1 0.1 8.6 9.1
B5 (5 mg) 0.6 1.4 0 0 0.4 0.4 0.7 0.9
B6 (1.7 mg) 0.6 0.1 0 0 0.1 0 0.7 0.4
Folic Acid (400 mcg) 13 47 0 0 18 5 0 1
B12 (2.4 mcg) 1.2 1.3 0 0 0.8 0.4 0.5 8.7
C (90 mg) 0 0 0 0 0 0 0 0.4
D (600 IU) 0 35 0 0 12 40 0 360
E (15 mg) 0.3 1 41 14 0.3 0.1 0.1 1.5
K (120 mcg) 1.2 0.3 5.4 60 2.8 0.2 0.1 5
Minerals (Macro)
Calcium (1000 - 1200 mg) 27 53 0 0 721 113 5 12
Magnesium (420 mg) 22 12 0 0 28 10 23 76
Phosphorus (700 mg) 193 191 0 0 512 91 290 217
Potassium (4700 mg) 323 134 0 0 98 143 479 314
Sodium (1500 mg) 54 140 0 0 621 40 226 90
Minerals (Trace)
Copper (0.9 mg) 0.1 0.1 0 0 0 0 0.1 0.1
Iron (18 mg) 1.5 1.8 0 0 0.7 0 0.4 1.6
Selenium (55 mcg) 24.1 31.7 0 0 14 3.7 39.6 44
Zinc (11 mg) 3.9 1.1 0 0 3.1 0.4 1.4 0.6
The highest value is highlighted for each macro and micro nutrient for prima facie observation.
There is a need to return to eating natural foods such as
meat, eggs and dairy from grazing animals, fish, vegeta-
bles, nuts, seeds and local seasonal fruits. These were a
feature of the British diet prior to a myriad of dietary
advice based on questionable research, resulting in two
thirds of the population becoming overweight/obese and
sick within three decades.
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