The Sunday Telegraph - Sunday
We’re a nation of carb lovers – and we’re paying the price
Our passion for carbohydrates has become a diabetes-ticking time bomb – but there’s still time to reverse it. By
What’s for dinner tonight? Maybe you’ve opted for a ready-made pizza – nice and easy. Or a big pile of pasta or noodles. A burger in a brioche bun with fries? Or perhaps some curry and rice? Maybe you had toast and cereal for breakfast and a sandwich with a fizzy drink for lunch. Oh, and maybe a bar of chocolate and a few crisps to fill those between-meals gaps.
Whatever your personal choice, the typical British diet has certainly changed dramatically over the past 60 years. Eggs and bacon are disappearing from our breakfast tables after years of demonisation of cholesterol and fat. One in five under-30s have never even tried a full English breakfast, preferring avocado toast or pancakes. Our busy lives mean that the traditional meat-and-twoveg dinner has been replaced by a plethora of ready meals and quick-cook pasta dishes. Plus, we are snacking more than ever.
It may feel continental to eat this way – certainly more modern. But it also means that we are eating huge amounts of often refined and processed carbohydrates.
And according to many experts, our passion for these carbs could be contributing to exploding rates of obesity and diabetes. According to World Health Authority data, Britain has the third-highest level of obesity among European nations.
The average percentage of people who are obese in Europe is 23.3 per cent. But 30 per cent of the UK population are obese, and diagnoses of Type 2 diabetes in the UK, for which obesity is a crucial factor, have doubled over the past 15 years.
When it comes to weight, we are closing in on our transatlantic cousins: 36 per cent of the US population is obese and a staggering 69 per cent is overweight or obese.
Roy Taylor is a professor of medicine and metabolism at
Newcastle University. He was awarded an MBE in the New Year’s Honours list for his work on diabetes, which showed that weight loss could put Type 2 diabetes into remission. And while he says that any calorie-cutting plan could help patients shed the pounds, a low-carb diet may be particularly useful. This is because, he says, “in the UK we get 45 per cent of calories from carbs compared to closer to 40 per cent in much of Europe”.
In the US, carbs – mostly of the low-quality, processed variety – account for over 50 per cent of the diet.
You might be surprised that the UK diet is carb heavier than that of our neighbours, given the popular image of the French tucking into baguettes and croissants, and the Italians eating pasta, but we have very different food cultures.
In Italy, pasta is often served, not in the British manner as a hefty main dish, but as a small first course, before a dish of meat or fish and vegetables. And, says Prof Taylor, “Having a pile of potatoes on a dinner plate has never been a French tradition.
“The types of carbohydrate we eat in the UK have changed profoundly,” he says. “In the 1950s and 1960s, carbs would have largely been potato, bread and cereal with some soft drinks, cake and biscuits, though these were limited by expense. Now, consumption of concealed sugar in low-cost processed and fast foods is considerable, and refined carbs in low-cost pies, pasties, bakery goods, plus sugar in soft drinks has risen enormously.”
There is, he adds wryly, “always a queue outside the local Greggs – even though a new bakery has opened next door and has its own queue”. But what about NHS guidelines that suggest we should get 50 per cent of our calories from carbs? Prof Taylor says, “Worthy food experts suggest that we should all be eating vastly more carbs. They mean the high-fibre, unprocessed, sugar-free types, but Brits hear this message and pile on potatoes, rice, pasta, pastry and sugary foods. These easy-to-eat refined carbs encourage overconsumption.”
Kim Pearson is a London-based nutritionist whose clinic specialises in weight loss. “We put a lot of clients on lower-carb diets,” she says. “Why? Because they are very effective. Many people who struggle with their weight eat a diet based on refined starchy carbohydrates and ultra-processed foods. They are low in nutrients and cause blood sugar dysregulation, with big dips and peaks. This causes cravings, hunger pangs and constant snacking.”
A high-carb diet can become more of a problem as we get older. Dr Sarah Berry is an associate professor in nutritional sciences at King’s College London and lead nutritional scientist at the health science company Zoe. Her
research on 1,002 women, published in The Lancet, looks at the way that the menopause changes the way carbohydrates are handled by the body.
Carbohydrates break down to glucose in the blood, which in normal healthy people triggers the release of the hormone insulin so that the glucose from food can enter the body’s cells. From here, the cells can use the glucose for energy.
On average, the Predict study found that post-menopausal women had worse blood sugar markers like fasting glucose, insulin and greater insulin insensitivity, a sign of a higher risk of pre-diabetes. In someone with diabetes, glucose remains in the bloodstream at higher levels than in people without diabetes.
But that doesn’t mean it’s necessarily healthy to adopt an extreme keto diet, which is high in animal fats and proteins and low in fibre. This month, a new study, presented at the American College of Cardiology’s annual meeting, suggested that adopting an extremely low-carb keto diet could raise cholesterol levels and more than double the risk of heart attacks and strokes. A keto diet was considered one with 45 per cent of total daily calories coming from fat and 25 per cent from carbohydrates.
On the other hand, a recent study published in Diabetes Care found that following a low-carbohydrate diet may cut death rates from heart disease and cancer in people with Type 2 diabetes.
Study author Dr Yang Hu explained that a low-carbohydrate diet was linked to lower death rates from any cause, but the best results came from a lowcarbohydrate diet that emphasised “plant-sourced fats, plant-based protein and high-quality carbohydrates, such as those found in whole-grains, fruits and vegetables”.
Tim Spector is a professor of genetics, founder of the health app Zoe and a campaigner for “real food”. He says, “We eat more highly processed food than any other country in Europe.” He says that advice from GPs that people with Type 2 diabetes should eat “low-fat, high-carb diets” is “plain wrong”.
But he adds that we all react differently to different diets. While studies show no overall differences in weight reduction after different diets, there can be huge individual differences. This means that personalised diets are in the spotlight. Spector’s Zoe plan, which costs around £300 plus a monthly fee of about £25, offers people a chance to test their tolerance of carbs and fat, and they are given a blood-sugar monitor to wear temporarily so they can test their individual responses to food. Pearson has started offering her clients a metabolic DNA test that looks at the genetic markers for fat and carbohydrate metabolism.
Those of us who haven’t the time or money for testing can still benefit from changing the amount and type of carbohydrates we eat.
Pearson says, “Structure your meals around high-quality protein, healthy fats and vegetables. Part of the problem of a diet high in carbohydrates is that carbs take up a lot of space on the plate, leaving less room for vegetables. If people want to lose weight, I suggest they swap starchy carbs for vegetables,” says Pearson.
“Roasted Mediterranean vegetables, vegetable stews, and stir-fries are all delicious, healthy comfort foods. People worry that if they don’t have enough carbs they won’t feel full, but we know protein is much more satiating than carbs.”
Weight-loss methods are always prominent in the news, most recently the drug Wegovy – which is to be offered to thousands of NHS patients in England. But the benefits of carb reduction extend beyond weight management.
Clare Thornton-Wood is a registered dietician and spokesman for the British Dietetic Association. She agrees that cutting back on refined carbs can help us lose weight and that protein and fat slow down the speed with which carbs hit the bloodstream. But she says, “In general we need to increase our intake of fibre, and complex and whole-grain carbs, such as seeded bread, whole-grain cereals, fruit and vegetables can help. Eating the skin of potatoes and opting for whole-grain rice also means you will be getting more fibre, vitamins and minerals.”
Think, too, about the balance of your meals. “If you combine pasta with a vegetable and lentil-based sauce and a side salad it becomes a completely different meal to something like a huge cheesy spaghetti carbonara,” says Thornton-Wood. In addition, she says, we need to “cut our intake of added sugars” so fruit is in and biscuits are out.
Thornton-Wood adds, “Portions have got bigger over the years. A fist size of carbs is a suitable serving. Many of us are less physical than we were in the 1960s, when we’d walk to school and have no central heating. We often just don’t need to eat as much as we do.”