The tyranny of the anti-junk food crusade

‘Forty thousand deaths a year due to junk food’, declared the UK Daily Telegraph yesterday, reporting on new policy recommendations produced by the National Institute for Clinical Excellence (NICE). But the evidence on which this claim is made is highly dubious. What the report really represents is the coming together of the same-old NGOs and health policy wonks to tell us – for the umpteenth time – how we must live our lives.

The report puts forward 12 recommendations, including:

• Introducing policies designed to cut our consumption of Bad Stuff (salt, saturated fats and trans-fats);
• restricting marketing of ‘junk’ food to children;
• introducing the ‘traffic light’ labelling of foods – green for good, amber for warning and red for unhealthy;
• assessing all government policy for its impact on cardiovascular disease;
• ensuring that EU farm spending promotes healthy foods;
• encouraging ‘physically active travel’ – for example, by scrapping subsidised car parking;
• providing ‘healthy’ meals in public-sector workplaces, schools, hospitals, etc;
• discouraging, via local authorities, the opening of takeaway food outlets near schools and in other sensitive areas.

This mish-mash of different recommendations simply reflects the wide range of groups that want to get their noses in the health trough or foist their particular hare-brained schemes upon us. The evidence that any of these policies would make any serious difference to our life expectancies – never mind save tens of thousands of lives – is flimsy to say the least.

First of all, we need to examine the claim that such measures could save the 40,000 lives apparently being destroyed by junk food. The report says: ‘Most premature deaths from CVD (cardiovascular disease) – that is, among people aged less than 75 – are preventable. In 2006, CVD accounted for around 30 per cent of premature deaths among men and 21 per cent among women, accounting for just over 40,000 premature deaths in that year.’ So actually, even on this basis, it is only most of the 40,000 premature deaths that could be prevented. But even this seems implausible. Genetics, old age, sheer luck, the quality of healthcare available, and environmental factors that aren’t preventable by lifestyle change – like air pollution – would seem to be at the very least as important as what people eat.

Above all, being a man rather than a woman makes a very substantial difference to life expectancy. The latest figures from the Office for National Statistics suggest life expectancy in the UK at birth is now 77.5 years for men and 81.8 years for women. Is this ‘preventable’? Perhaps all men over 50 should be forced to have their balls chopped off. Strangely, this policy recommendation is absent from NICE’s report.

But when we dig a little further into the various recommendations, the suggestion that the policies put forward could have any substantial impact on life expectancy is quickly revealed to be illusory. Let’s look at the evidence for the idea that if we avoid eating the wrong things we will live longer.

Salt

Poster campaigns and health professionals are forever telling us that we should reduce salt intake to lower our blood pressure and, in turn, cut cases of CVD. Yet while there may be some benefit in cutting salt intake in those who are already being medicated for high blood pressure or who have kidney disease, for most people there is no evidence that cutting salt is of any benefit at all. Indeed for some people it could be harmful.

There is a certain arrogance about the idea, repeated in the new report, that we should cut salt intake from an average of 8.5 grammes per day to six grammes per day by 2015, and then to three grammes per day by 2050. Firstly, the idea that high salt automatically equates to shortened lives is wrong: the Japanese have a very high-salt diet and enjoy longer lives than anyone else. Secondly, our bodies are incredibly sensitive to the appropriate balance of salt and water in our blood, regulating it on a minute-by-minute basis to keep it within a very narrow range. Yet the groups and researchers proposing radical changes to our diet seem to believe that salt intake should be regulated by diktat from Whitehall rather than by our internal biology evolved over millions of years.

There is no consensus that such salt-reduction policies would be beneficial. A review in the British Medical Journal on the evidence connecting salt with high blood pressure, published in 2002, concluded: ‘Intensive interventions, unsuited to primary care or population prevention programmes, provide only small reductions in blood pressure and sodium excretion, and effects on deaths and cardiovascular events are unclear.’

Saturated fat

There has been plenty of evidence for a very long time that attempts to reduce saturated fat consumption have no effect on cardiovascular disease. For example, the Multiple Risk Factor Intervention Trial (MRFIT), which reported its findings in the early 1980s, encouraged a large number of middle-aged American men with high cholesterol to change their diet in an effort to reduce their saturated-fat intake and, therefore, their cholesterol. These test subjects were also encouraged to quit smoking and to treat their high blood pressure. Meanwhile, another large group of middle-aged men were left to their own devices. The result? Slightly more men in the low-fat diet group died than in the control group, but in reality there was no practical difference in outcomes.

Trans-fats

As for trans-fats, the evidence that reducing our intake will ‘save lives’ is once again weak. Trans-fats are a by-product of adding hydrogen to vegetable fats to make them stable at room temperature and give them a longer shelf-life, particularly in things like baked goods. While they’ve been around for decades, they became particularly popular among food manufacturers as an alternative to saturated fats.

So what’s the risk from trans-fats? A review in the New England Journal of Medicine in 2006 says: ‘In a meta-analysis of four prospective cohort studies involving nearly 140,000 subjects, including updated analyses from the two largest studies, a two per cent increase in energy intake from trans fatty acids was associated with a 23 per cent increase in the incidence of [coronary heart disease].’ That figure of 23 per cent sounds impressively high, but epidemiological studies are very blunt instruments.

As the US National Cancer Institute noted in 1994, ‘in epidemiological research, [increases in risk of less than 100 per cent] are considered small and are usually difficult to interpret. Such increases may be due to chance, statistical bias, or the effects of confounding factors that are sometimes not evident.’ As a comparison, the risk of getting lung cancer from being a regular smoker (over the course of decades, usually) is in the order of 2,000 per cent compared to non-smokers. While we can be pretty confident that active smoking significantly increases your risk of a variety of diseases, the small relative risk associated with trans-fats is much more ambiguous.

The other recommendations in the NICE report are a bunch of lame old hobbyhorses or, in the case of demanding that all government policy be assessed for its effect on CVD, they add up to a demand for a health-lobby veto on all lawmaking. Thanks, but no thanks.

But regardless of the evidence, there is a more principled basis on which we should object to these kind of policy proposals – namely, that we, and not NICE or anybody else, should have control over our own lives and our own, sometimes bad habits. Let us eat our junk, slob out on our sofas, smoke our fags and drink our booze. If these things turn out to shorten our lives, so be it (though the evidence that they will is usually as feeble as an old codger who’s avoided a ‘premature’ death). That’s surely a better way to live than to be endlessly subjected to the high-fibre, low-fat, salt-free dictatorship of Those Who Know What’s Good For Us.

Rob Lyons is deputy editor of spiked and blogs about food at Panic on a Plate.