What Does The NHS Say About The Ketogenic Diet?

The NHS has long been a well-respected and relied upon institution for health and medical advice in the UK. Established more than 70 years ago, the NHS is trusted by millions as their first place for healthcare advice; many seek NHS support and information whenever they need health questions answered.

What does the NHS specifically say about healthy eating and the best diet for optimum health? Does it line up with the Ketogenic diet? If not, what does this mean for all those following a Keto diet for better health. Could the NHS have the wrong advice around healthy diets? 

Let’s take a closer look.

What Does The NHS Say About Healthy Eating?

The NHS guidance on healthy eating is to, ‘base meals on higher fibre starchy carbohydrates’₁. The NHS website states, ‘starchy carbohydrates should make up just over a third of the food you eat. They include potatoes, bread, rice, pasta and cereals₁.’

The NHS website goes on to advise, ‘Try to include at least one starchy food with each main meal. Some people think starchy foods are fattening, but gram for gram the carbohydrate they contain provides fewer than half the calories of fat₁.’

It is clear from this information, that the NHS advises the healthiest diet includes starchy carbohydrates, and that it’s ideal to include at least one with every main meal. This is in complete contrast to the Keto diet which eliminates almost all carbohydrates.

What does the NHS say about fat?

‘All types of fat are high in energy, so they should only be eaten in small amounts₁.’

Therefore, according to the NHS, the healthiest diet is to include high-fibre starchy carbohydrates with every main meal to make up over a third of the food you eat, and only eat small amounts of fat as they’re high in energy.

This directly contradicts the Keto diet which advocates minimal carbs and high fat.  It would seem the NHS does not support the Keto diet and instead promotes the opposite; a high-carb, low-fat diet.

Why Does The NHS Advise A High-Carb Diet?

The dietary advice for the UK and US shifted in the 1980s from a high-fat, low-carb diet to a low-fat, high-carb diet. Consequently, UK dietary guidelines changed in 1983, advising that a low-fat diet is best. 

From this point, high-fat diets were frowned upon, and most health professionals encouraged the idea that fat is the cause of chronic health problems and disease, including heart disease and diabetes.

The NHS still supports these dietary guidelines almost forty years later. But what have we learned in the last four decades about diet and health, and could the NHS be outdated with their dietary advice?

Current Research On Diet and Health

More recently, research has come to support low-carb diets and they have gained wider recognition for their benefits to health. 

The British Medical Journal published a research paper in 2015 titled, Historic US and UK dietary advice on fats ‘should not have been introduced. The paper states that the national dietary advice given in the 1970s and 1980s to reduce fat and increase starchy carbohydrates, should not have been given since it was absent of any evidence₂.

More reliable research has since become available thanks to advances in research methods and a greater understanding of different study designs₂. Since the 1990s, multiple large scale nutrition studies have been carried out with more thorough and progressive research methods which give more consistent evidence for diets and their outcomes₂.

Such studies have shown that a focus on total fat oversimplifies the health benefits of particular diets.  In fact it was found that, ‘foods rich in healthy fats produced benefit, while foods rich in starch and sugar caused harm’₂.

It is also clear that over the last few decades chronic diseases such as obesity, type 2 diabetes and certain cancers have become more prevalent since the popularisation of low-fat diets₂.

A report released by the National Obesity Forum in 2016, suggests the current dietary guidelines (such as those given by the NHS), are wrong₃. The report goes on to advise a diet high in fat and low in carbohydrate to prevent heart disease and type 2 diabetes₃.

Furthermore, in 2016 a new charity, Public Health Collaboration, was launched with the objection of addressing the problems associated with the current low-fat dietary guidelines advocated by the NHS. The charity’s aim is to change the current dietary guidelines, educate general practitioners and improve public health. 

Research shows that this is necessary and critical as public health continues to decline in certain areas:

The Health Survey For England 2019 reports that 28% of the UK are now obese.  Of adults aged 16 years and over, 68% of men and 60% of women are overweight or obese₄.  Worryingly, 18% of boys and 13% of girls are also obese₄.

According to data gathered by Diabetes Uk  diabetes also rises annually within the UK. They state that more people than ever have diabetes, and if nothing changes by 2030 they predict more than 5.5 million people will have diabetes in the UK₅.

It’s clear from research, surveys and lived experience that the current dietary guidelines are oversimplified and incorrect. They are based on outdated advice which was never supported by empirical evidence. Public health may have improved in certain areas over the last few decades, but it’s obvious that we have a health crisis concerning obesity and diabetes. 

Changes must be made to turn this around and improve public health in all areas, and we could start by ensuring the dietary guidelines provided by trusted health services are based on the latest and most accurate research.

Challenging the NHS Dietary Guidelines

The NHS dietary guidelines still advocate a low-fat, high-carb diet despite increases in obesity and type 2 diabetes - which cost the NHS billions of pounds per year to treat₅. In fact the NHS spends 10% of its entire budget on diabetes annually₅. In 2019/20 57.7 million items prescribed were for people with diabetes₅. 

With many health issues compounded by obesity and diabetes, it would be wise to look again at dietary guidelines and instead base them upon current and progressive research. These chronic health conditions are a great burden on the macro and micro level - affecting the NHS service and of course individual lives. 

Over the last few decades we have learned that a high-carb, low-fat diet is not the best for optimum health. Simply considering the ratio of energy in = energy out for weight maintenance and glycaemic balance is inadequate. 

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The NHS Doesn’t Support Keto - But It Should

The Keto diet considers the way the body is fuelled as well as the amount of energy absorbed and spent for weight loss and health. Ketosis is a metabolic state that the body can transition to which alters the way energy is used; when the body uses fat rather than carbohydrate for energy, the body burns fat rather than stores it. 

This completely changes the perspective on fat consumption and weight gain.  The NHS dietary guidelines still support the idea that fat is bad and should be reduced in our diets because it increases energy intake. However this position fails to understand metabolic states and the role of macros in our bodies - how we store them or use them for energy.

We’ve moved on from the knowledge of health and fitness of decades past, and now far better understand the science of our bodies and nutrition for optimum health. Energy in equals energy out, doesn’t cut it; it isn’t simply about calories or fat per gram, it’s about how our bodies operate and make use of the fuel we provide it with - in the short and long term.

The Keto diet has been shown to improve weight loss₆ and type 2 diabetes₇, thanks to its effect on metabolic state and glycaemic levels.

Such evidence should be respected and their conclusions taken seriously in order to improve public health. It could save the NHS billions of pounds per year and most importantly, many lives.  

Sources

1. nhs.co.uk, ‘8 tips for healthy eating’,
https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eight-tips-for-healthy-eating/

2. The British Medical Journal, ‘History of modern nutrition science - implications for current research, dietary guidelines, and food policy, https://www.bmj.com/content/361/bmj.k2392 

    3. The British Nutrition Foundation, ‘NOF report - Eat Fat, Cut the Carbs and Avoid Snacking, https://archive.nutrition.org.uk/nutritioninthenews/previous-facts-behind-the-headlines/nofreport.html

      4. Health Survey for England 2019,
      https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2019

      5. diabetes.org.uk, ‘Diabetes Statistics’,
      https://www.diabetes.org.uk/professionals/position-statements-reports/statistics 

      6. National Center for Biotechnology Information, ‘Long-term effects of a ketogenic diet in obese patients’, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

        7. National Center for Biotechnology Information, ‘Effects of the Ketogenic Diet on Glycaemic Control in Diabetic Patients: Meta Analysis of Clinical Trials’, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641470/

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