William Banting

The first popularized weight loss diet was published by William Banting in 1863.

It was a low carbohydrate (low sugar) diet.

William Banting ( December 1796 – March 1878) was a notable English undertaker. Formerly obese, he is also known for being the first to popularise a weight loss diet based on limiting the intake of carbohydrates, especially those of a starchy or sugary nature.

He undertook his dietary changes at the suggestion of Soho Square physician Dr William Harvey, who in turn had learned of this type of diet, but in the context of diabetes management, from attending lectures in Paris by Claude Bernard.

The Banting Diet (click for full text)

William Banting:

“For the sake of argument and illustration I will presume that certain articles of ordinary diet, however beneficial in youth, are prejudicial in advanced life, like beans to a horse, whose common ordinary food is hay and corn. It may be useful food occasionally, under peculiar circumstances, but detrimental as a constancy. I will, therefore, adopt the analogy, and call such food human beans.

The items from which I was advised to abstain as much as possible were: Bread, butter, milk, sugar, beer, and potatoes, which had been the main (and, I thought, innocent) elements of my existence, or at all events they had for many years been adopted freely.

These, said my excellent adviser, contain starch and saccharine matter, tending to create fat, and should be avoided altogether. At the first blush it seemed to me that I had little left to live upon, but my kind friend soon showed me there was ample, and I was only too happy to give the plan a fair trial, and, within a very few days, found immense benefit from it. It may better elucidate the dietary plan if I describe generally what I have sanction to take, and that man must be an extraordinary person who would desire a better table:

For Breakfast, I take four or five ounces of beef, muton, kidneys, broiled fish, bacon, or cold meat of any kind except pork; a large cup of tea (without milk or sugar), a little biscuit, or one ounce of dry toast.

For Lunch, five or six ounces of any fish except salmon, any meat except pork, any vegetable except potato, one ounce of dry toast, fruit out of a pudding, ‘any kind of poultry or game, and two or three glasses of good claret, sherry, or Madeira-Champagne, Port and Beer forbidden.

For Tea, two or three ounces of fruit, a rusk or two, and a cup of tea without milk or sugar.

For Supper, three or four ounces of meat or fish, similar to dinner, with a glass or two of claret.

For a Nightcap, if required, a tumbler of grog (gin, whisky, or brandy, without sugar) -or a glass or two of claret or sherry.

This plan leads to an excellent night’s rest, with from six to eight hours’ sound sleep. The dry toast or rusk may have a table spoonful of spirit to soften it, which will prove acceptable. Perhaps I did not wholly escape starchy or saccharine matter, but scrupulously avoided those beans, such as milk, sugar, beer, butter, & c., which were known to contain them.

Experience has taught me to believe that these human beans are the most insidious enemies man, with a tendency to corpulence in advanced life, can possess, though eminently friendly to youth. He may very prudently mount guard against such an enemy if he is not a fool to himself, and I fervently hope this truthful unvarnished tale may lead him to make a trial of my plan, which I sincerely recommend to public notice,-not with any ambitious motive, but in sincere good faith to help my fellow-creatures to obtain the marvellous blessings I have found within the short period of a few months.

I do not recommend every corpulent man to rush headlong into such a change of diet, (certainly not), but to act advisedly and after full consideration with a physician.

My former dietary table was bread and milk for breakfast, or a pint of tea with plenty of milk and sugar, and buttered toast; meat, beer, much bread (of which I was always very fond) and pastry for dinner, the meal of tea similar to that of breakfast, and generally a fruit tart or bread and milk for supper. I had little comfort and far less sound sleep.

It certainly appears to me that my present dietary table is far superior to the former-more luxurious and liberal, independent of its blessed effect-but when it is proved to be more healthful, comparisons are simply ridiculous, and I can hardly imagine any man, even in sound health, would choose the former, even if it were not an enemy; but, when it is shown to be, as in my case, inimical both to health and comfort, I can hardly conceive there is any man who would not willingly avoid it.

I can conscientiously assert I never lived so well as under the new plan of dietary, which I should have formerly thought a dangerous extravagant trespass upon health; I am very much better, bodily and mentally, and pleased to believe that I hold the reins of health and comfort in my own hands.”

Banting’s Diet was an enormous hit in Vistorian England.

Claude Bernard, (July 1813 – February 1878), was a French physiologist. Among many other accomplishments, he was one of the first to suggest the use of a blinded experiment to ensure the objectivity of scientific observations.

He originated the term milieu intérieur, – the stability of the internal environment [the milieu intérieur] is the condition for the free and independent life. This is the underlying principle of what would later be called homeostasis, a term coined by Walter Cannon.

Claude Bernard’s first important work was on the functions of the pancreas, the juice of which he proved to be of great significance in the process of digestion.

A second investigation – perhaps his most famous – was on the glycogenic function of the liver; in the course of his study he was led to the conclusion, which throws light on the causation of diabetes mellitus, that the liver, in addition to secreting bile, is the seat of an internal secretion, by which it prepares sugar at the expense of the elements of the blood passing through it.

The academic research undertaken by Claude Bernard was the science which underpinned Banning’s diet.

On 23 September, 1955, US President Dwight Eisenhower suffered a heart attack. Rather than pretend it hadn’t happened, Eisenhower insisted on making details of his illness public. The next day, his chief physician, Dr Paul Dudley White, gave a press conference at which he instructed Americans on how to avoid heart disease: stop smoking, and cut down on fat and cholesterol. In a follow-up article, White cited the research of a nutritionist at the University of Minnesota, Ancel Keys.

Ancel Keys

Heart disease, which had been a relative rarity in the 1920s, was now felling middle-aged men at a frightening rate, and Americans were casting around for cause and cure. Ancel Keys provided an answer: the “diet-heart hypothesis” (for simplicity’s sake, the “fat hypothesis”). This is the idea, now familiar, that an excess of saturated fats in the diet, from red meat, cheese, butter, and eggs, raises cholesterol, which congeals on the inside of coronary arteries, causing them to harden and narrow, until the flow of blood is staunched and the heart seizes up.

From 1958 to 1964, he and his fellow researchers gathered data on the diets, lifestyles and health of 12,770 middle-aged men, in Italy, Greece, Yugoslavia, Finland, Netherlands, Japan and the United States. The Seven Countries Study was finally published as a 211-page monograph in 1970. It showed a correlation between intake of saturated fats and deaths from heart disease, just as Keys had predicted. The scientific debate swung decisively behind the fat hypothesis.

The study’s biggest limitation was inherent to its method. Epidemiological research involves the collection of data on people’s behaviour and health, and a search for patterns. Originally developed to study infection, Keys and his successors adapted it to the study of chronic diseases, which, unlike most infections, take decades to develop, and are entangled with hundreds of dietary and lifestyle factors, effectively impossible to separate.

To reliably identify causes, as opposed to correlations, a higher standard of evidence is required: the controlled trial. In its simplest form: recruit a group of subjects, and assign half of them a diet for, say, 15 years. At the end of the trial, assess the health of those in the intervention group, versus the control group. This method is also problematic: it is virtually impossible to closely supervise the diets of large groups of people. But a properly conducted trial is the only way to conclude with any confidence that X is responsible for Y.

(Although Keys had shown a correlation between heart disease and saturated fat, he had not excluded the possibility that heart disease was being caused by something else. Years later, the Seven Countries study’s lead Italian researcher, Alessandro Menotti, went back to the data, and found that the food that correlated most closely with deaths from heart disease was not saturated fat, but sugar.)

The Seven Countries study had become canonical, and the fat hypothesis was enshrined in official advice. The congressional committee responsible for the original Dietary Guidelines was chaired by Senator George McGovern. It took most of its evidence from America’s nutritional elite: men from a handful of prestigious universities, most of whom knew or worked with each other, all of whom agreed that fat was the problem – an assumption that McGovern and his fellow senators never seriously questioned.

After it was discovered inside the arteries of men who had suffered heart attacks, public health officials, advised by scientists, put eggs, whose yolks are rich in cholesterol, on the danger list. But it is a biological error to confuse what a person puts in their mouth with what it becomes after it is swallowed. The human body, far from being a passive vessel for whatever we choose to fill it with, is a busy chemical plant, transforming and redistributing the energy it receives. Its governing principle is homeostasis, or the maintenance of energy equilibrium (when exercise heats us up, sweat cools us down). Cholesterol, present in all of our cells, is created by the liver. Biochemists had long known that the more cholesterol you eat, the less your liver produces.

Unsurprisingly, then, repeated attempts to prove a correlation between dietary cholesterol and blood cholesterol failed. For the vast majority of people, eating two eggs a day, does not significantly raise cholesterol levels. One of the most nutrient-dense, versatile and delicious foods was needlessly stigmatised. The health authorities have spent the last few years slowly backing away from this mistake, presumably in the hope that if no sudden movements are made, nobody will notice. In a sense, they have succeeded: a survey carried out in 2014 by Credit Suisse found that 54% of US doctors believe that dietary cholesterol raises blood cholesterol.

The nutritional establishment wasn’t greatly discomfited by the absence of definitive proof, but by 1993 it found that it couldn’t evade another criticism: while a low-fat diet had been recommended to women, it had never been tested on them (a fact that is astonishing only if you are not a nutrition scientist). The National Heart, Lung and Blood Institute decided to go all in, commissioning the largest controlled trial of diets ever undertaken. At the end of the trial, it was found that women on the low-fat diet were no less likely than the control group to contract cancer or heart disease.

In 2008, researchers from Oxford University undertook a Europe-wide study of the causes of heart disease. Its data shows an inverse correlation between saturated fat and heart disease, across the continent. France, the country with the highest intake of saturated fat, has the lowest rate of heart disease; Ukraine, the country with the lowest intake of saturated fat, has the highest. When the British obesity researcher Zoë Harcombe performed an analysis of the data on cholesterol levels for 192 countries around the world, she found that lower cholesterol correlated with higher rates of death from heart disease.

The UN’s Food and Agriculture Organisation, in a 2008 analysis of all studies of the low-fat diet, found “no probable or convincing evidence” that a high level of dietary fat causes heart disease or cancer. Another landmark review, published in 2010, in the American Society for Nutrition, and authored by, among others, Ronald Krauss, a highly respected researcher and physician at the University of California, stated “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD [coronary heart disease and cardiovascular disease]”.

John Yudkin  (August 1910 – July 1995) was a British physiologist and nutritionist, and the founding Professor of the Department of Nutrition at Queen Elizabeth College, London.

John Yudkin

Yudkin wrote several books recommending low-carbohydrate diets for weight loss, including This Slimming Business (1958). He gained an international reputation for his book Pure, White and Deadly (1972), which warned that the consumption of sugar (sucrose, which consists of fructose and glucose) is dangerous to health, an argument he had made since at least 1957. Specifically, he wrote that sugar consumption was a factor in the development of conditions such as dental caries, obesity, diabetes, and heart attack. His concern became increasingly focused on two topics: the treatment of overweight and the harmful effects of excessive sugar (sucrose) consumption.

The end of food rationing early in the 1950s brought with it an increase in the number of people who were suffering from obesity, and by 1958 slimming diets had proliferated, many of them with no scientific basis. Yudkin showed that in most patients weight could be well controlled by restricting dietary carbohydrate.

Yudkin’s interest in sugar arose indirectly from his studies of the alarming increase in many countries during the first half of the twentieth century in the incidence of coronary thrombosis. This increase was of great concern to health professionals, and it was widely attributed to an increase in the amount of fat, or of a particular type of fat, in the diet. In a paper published in 1957,  Yudkin analysed diets and coronary mortality in different countries for the year 1952, and also analysed trends in diet, and trends in coronary mortality, in the UK between 1928 and 1954.

The first of these analyses produced no evidence for the view that total fat, or animal fat, or hydrogenated fat, was the direct cause of coronary thrombosis; in fact the closest relationship between coronary deaths and any single dietary factor was with sugar. The second analysis, that of historical trends in the UK, found no good relationship with any single dietary factor. Instead, it suggested that some change or changes in lifestyle during the past several decades was contributing to the increased incidence of coronary deaths. One obvious change was reduced exercise, and another was alterations in diet.

Given the dramatic increase in sugar consumption during the first half of the century, Yudkin started to suspect that excessive sugar in the diet might contribute not only to obesity but also to coronary heart disease. Studying historical data from many different countries, he found that increasing prosperity leads to an increase in sugar consumption, particularly in manufactured foods, and also that the ready availability of sugar-containing manufactured foods even in the poorer countries may lead to their being bought in preference to more nutritious food. In 1964 he wrote ‘In the wealthier countries, there is evidence that sugar and sugar-containing foods contribute to several diseases, including obesity, dental caries, diabetes mellitus and myocardial infarction [heart attack].

Investigating whether any link between sugar consumption and disease could be shown in individual patients, he and his associates in the Department of Nutrition found that patients with atherosclerotic disease (a frequent precursor of coronary heart disease) consumed significantly more sucrose than control patients.

An obstacle to the acceptance of these ideas was the belief at the time that sugar and starch were metabolised in the same way, so that one would expect no difference in their effects. Yudkin and his associates, however, fed both experimental animals and human volunteers with differing quantities of sugar and starch, and found major differences between the two carbohydrates in their metabolic effects.

Yudkin believed sugar was more harmful than refined grains and refused to use the term “refined carbohydrates” because it gave “the impression that white flour has the same ill effects as sugar”. As early as 1967 Yudkin suggested that the excessive consumption of sugar might result in a disturbance in the secretion of insulin, and that this in turn might contribute to atherosclerosis and diabetes.

Yudkin’s views on the cause of obesity (sugar) was directly opposite to those of Ancel Keys (dietary fats) – see above, the Fat Versus Sugar Debate – but at the time Yudkin’s theories lost out to those of Ancel Keys.

Despite the criticism that he had “no theoretical basis” to support his claims, following a successful publication of his book in America, the McGovern Guidelines for US dietary goals recommended, in 1977, a reduction in sugar intake “by 40 percent,” and the US-published guidelines in 1980 prominently advised “don’t eat too much sugar.”

In  2015 the World Health Organization’s published its  “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020” (GAP). It recommended the reduced use of salt, saturated fat and sugars; and the substitution of healthy foods for energy-dense micronutrient poor foods.

Since its publication, 20 governmental bodies have introduced taxation ( a sugar tax) intended to reduce obesity and the rising levels of diabetes, most often by targeting sugar sweetened beverages (SSBs).

By mid-2018, 39 countries, states and cities had introduced nutritional taxation with more working toward voluntary sugar reduction approaches to encourage optimised nutrition.

Robert H. Lustig (born 1957) is an American paediatric endocrinologist. He is Professor emeritus of Paediatrics in the Division of Endocrinology at the University of California, San Francisco (UCSF), where he specializes in neuroendocrinology and childhood obesity.

He advanced the research work started by John Yudkin on the impact of sugar on obesity in modern times.

Lustig’s research examines links between excess consumption of fructose—a component of sucrose (table sugar), honey, fruit and some vegetables—and the development of metabolic syndrome. Metabolic syndrome can include type 2 diabetes, high blood pressure, cardiovascular disease, non-alcoholic fatty liver disease, obesity and the phenomenon “TOFI” (“thin-outside-fat-inside”).

Lustig argues that fructose can be consumed safely within whole fruits and vegetables because of the role played by the accompanying dietary fiber. But he maintains that the liver is damaged by the fructose in table sugar and high-fructose corn syrup that are added to food and beverages (particularly convenience food and soft drinks), and by the fructose in fruit juice and vegetable juice. His position is that sugars are not simply empty calories; he rejects the idea that “a calorie is a calorie.”

Lustig was a co-author in 2009 of the American Heart Association’s guidelines on sugar intake, which recommended that women consume no more than 100 calories daily from added sugars and men no more than 150.

Gary Taubes (1956) is an American journalist, writer, and low-carbohydrate / high-fat (LCHF) diet advocate.  He has advocated for a focus on sugar as a principal cause of obesity.

His central claim is that carbohydrates, especially sugar and high-fructose corn syrup, over-stimulate the secretion of insulin, causing the body to store fat in fat cells and the liver, and that it is primarily a high level of dietary carbohydrate consumption that accounts for obesity and other metabolic syndrome conditions. Taubes’s work often goes against accepted scientific, governmental, and popular tenets such as that obesity is caused by eating too much and exercising too little and that excessive consumption of fat, especially saturated fat in animal products, leads to cardiovascular disease.

In 2007, Taubes published his book Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease . This book proposed that a hypothesis — that dietary fat is the cause of obesity and heart disease — became dogma, and claims to show how the scientific method was circumvented so a contestable hypothesis could remain unchallenged.

Taubes’ argument is that the medical community and the U.S. federal government have relied upon misinterpreted scientific data on nutrition to build the prevailing paradigm about what constitutes healthful eating. Taubes argues that — contrary to conventional nutritional science — it is a carbohydrate-laced diet, augmented with sugar, that leads to heart disease, type 2 diabetes, obesity, cancer, and other “maladies of civilization.” In the Epilogue to Good Calories, Bad Calories on page 454, Taubes sets out ten “inescapable” conclusions, the first of which is, “Dietary fat, whether saturated or not, is not a cause of obesity, heart disease, or any other chronic disease of civilization.”

In 2007, New York Times science writer John Tierney cited Taubes’s book Good Calories, Bad Calories and discussed information cascades and the role of physiologist Ancel Keys in widely held beliefs related to diet and fat. Tierney follows Taubes in noting that a 2001 Cochrane meta-analysis of low-fat diets found that they had “no significant effect on mortality”. Harriet A. Hall, however, has criticized Taubes for selectively quoting the meta-analysis, and, writing for Science-Based Medicine, states that although it is possible some of Taubes’ hypotheses may be borne out by subsequent evidence, his idea that carbohydrate restriction can lead to weight loss independently of calorie restriction is “simply wrong”. Harriet Hall who is known as a sceptic in the medical community wrote that Taubes made a compelling case against sugar but the evidence was inconclusive.

Taubes authored The Case Against Sugar in 2016. The book argues that sugar is an addictive drug and is the cause of obesity and many health-related problems.

The National Food Strategy is the first independent review of England’s entire food system for 75 years.

UK-National-Food-Strategy-The-Plan

It aims to ensure that our food system:

• Delivers safe, healthy, affordable food, regardless of where people live or how much they earn;
• Is robust in the face of future shocks;
• Restores and enhances the natural environment for the next generation in this country;
• Is built upon a resilient, sustainable and humane agriculture sector; and
• Is a thriving contributor to our urban and rural economies, delivering well paid jobs and supporting innovative producers and manufacturers across the country;
• Delivers all this in an efficient and cost-effective way.

Part 1 of the analysis was published in June 2020, focusing on urgent recommendations to support the country through the turbulence caused by the COVID-19 pandemic, and to prepare for the end of the EU exit transition period on 31 December 2020. Early in 2021, part 2 of the evidence-based analysis of the current food system was published . This included examinations of the various existing outcomes – good and bad – and the power structures and economics that deliver them.

The National Food Strategy proposes a raft of measures to shake up how food is produced and the kinds of diets most people eat The need for action is laid out in stark terms. Poor diets contribute to around 64,000 deaths every year in England, and the government spends £18 billion a year treating obesity-related conditions. How we grow food accounts for a quarter of greenhouse gas emissions and is the leading cause of biodiversity destruction.

To meet these challenges, the report calls for “escaping the junk food cycle” to improve general health and reduce the strain on the NHS, reducing the gap in good diets between high- and low-income areas, using space more efficiently to grow food so that more land can return to nature, and creating a long-term shift in food culture.

The strategy is, in parts, highly ambitious, particularly in its framing of the challenge as a systemic issue, and in some of the more innovative measures it proposes.

These include the world’s first sugar and salt reformulation tax, aimed at forcing manufacturers to make the foods they sell healthier – by reformulating recipes to remove sugar and salt – and raising around £3 billion for the Treasury in the process. Companies would also have to report how healthy and sustainable their food sales are. Cannily, the strategy team persuaded some companies to come out in favour of the proposals, which suggests they’re serious about seeing their ideas implemented and attuned to the government’s nervousness around upsetting the food industry.

The tax is designed to reduce the salt and sugar content of processed foods. 

The Eatwell Guide, which shows what proportion of our diet should come from each food group, would be based not only on the healthiness of certain foods, but their environmental sustainability too. This reference diet would underpin government decisions, and help ensure food policies are consistent with what is good for people and the planet.

At the same time, the strategy is politically pragmatic, clearly crafted with an eye on what what is likely to be winnable within the current government. As such, some politically-contentious issues are sidestepped The strategy sets a goal of reducing meat consumption by 30% over ten years, but shies away from interventions to tackle this head on, with a meat tax discounted as “politically impossible”.

Recent scientific studies have shown that most individuals have different nutritional responses to different foods, depending on the proportions of protein, fat and carbohydrates in the food consumed. Most of the metabolic responses to food are due to individual factors including genes, circadian rhythms, exercise, body clocks, sleep and microbiome.

Most people do not confirm to an average, or standard, nutritional response to food.

Therefore, a standard, or recommended, diet does not work as it does not take into account an individual’s tastes and metabolic response to food

The facts about dieting:

• 98% of people who lose weight gain it back within 5 years
• 90% of people who lose weight gain back more weight than they originally lost
• Only 5 -10% of dieters maintain weight loss > 10% of baseline weight

A list of over 100 “diets”, categorized by approach, can be reviewed here.

Why do diets fail?

1. People revert back to old habits after diet ends
2. Many diets are not sustainable
3. Deprivation leads to bingeing
4. Dieters continue to rely on internal cues.

Sustainable weight loss is the result of a lifestyle change and not a “diet” with a start and end date connected to it.