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Diet versus Dieting

Friday February 19, 2021
Diet versus Dieting

From low-fat, low calories, to low-carbohydrate, food manufacturers have often targeted consumers swayed by fad diets claiming to improve their heart health. Viridian Nutrition’s Technical Advisor Jenny Hall examines how nutritional advice has evolved.

Sugar vs fat. Just which is the root cause to the epidemic levels in obesity and cardiovascular disease?


There have been decades of research into the debate, and unsurprisingly this has prompted the wave and popularisation of diets promoting better health.

Yet, if these dietary theories proved true, the western population would have experienced a significant decrease in cardiovascular disease.  However, contrary to expectations there are millions of people in the UK living with cardiovascular disease, which commands healthcare costs in the £billions each year.

Rewind back to the 1960s. The last 40 years has seen a merry go round of nutritional advice that vilified fats and promoted a carbohydrate rich diet under the premise that fats contributed to heart disease.  This assumption became prominent based on the findings of the researcher; Ancel Keys in 1961, who authored the Seven Countries Study among other studies.

The flawed interpretation of the results led to the popularisation of carbohydrate-rich dietary advice; consequently, sugar and sugar-derivatives are cheap and non-bulky ingredients which when added to food swayed the macronutrient balance towards a high carbohydrate ratio.  Additionally, clever recipe strategies from food manufacturers found that the ultimate palate stimulation includes sugar, fats and salt, often applied in multiple layers, think donuts, in their deep-fried sugar entirety.

More support for carbs and sugars came from the concept of the calorie; it was thought that if the number of calories consumed equalled the calories expended, body composition would remain consistent without weight loss or gain.  Subsequently, calorie counting became the focus of weight management and with carbohydrates accounting for 4 calories per gram (compared to 9 calories per gram of fat), were thought to be the superior, weight-loss nutrient.


However, it is now known that the hormonal response to food dictates body composition. Specifically, insulin secretion in response to carbohydrate ingestion shuttles the subsequent blood sugar rise into the muscles and fat stores.

What went wrong?

Firstly, cardiovascular disease cannot be blamed on one single macronutrient, observational studies show that lifestyle, pollution, dietary habits and genetics all play a role. However, the belief of ‘fat makes us fat’ alongside the increase in processed food availability has led to a dependence on carbohydrates as a major source of nutrition.


Focusing on total energy consumed, as opposed to nutritional value, has been exploited by the food industry, which has added sugar to over 80% of all processed foods in place of fats.


Sugars are hidden in foods to improve palatability and costs, and succinctly encourage habitual consumption, as shown in experimental studies that investigated the dopamine-stimulating neurological response to sugar ingestion.

One can of cola contains 9 teaspoons of sugar, worryingly this trend has spread to foods and beverages perceived as healthy or a daily necessity, for example; an extra-large, coffee shop bought, café latte, made with sweetened milk weighed in at 23 teaspoons of sugar, or fast food chain 500ml smoothies that contain 13 teaspoons of sugar.


A diet high in added sugar disrupts blood sugar and stimulates insulin secretions to shuttle blood sugar into the cell for use in energy production, furthermore, excessive amounts of sugar cause the remaining blood sugar to be converted in to triglycerides by the liver, thus increasing the lipid content of the blood; which is a major risk marker for atherosclerosis and cardiovascular disease.


These findings are a complete paradigm shift from what was previously believed.

Strategic dietary changes – fats are not all created equal


Be fat clever; by reducing saturated fats in place of polyunsaturated and monounsaturated fats as inspired by the Mediterranean diet can improve CVD risk as demonstrated by the Diet and Reinfarction Trial(DART). DART observed 2,033 survivors of myocardial infarction who were advised to eat fatty fish, saw a significant 29% reduction in all-cause mortality compared to control patients.

Likewise, the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarcto Miocardico (GISSI) Prevention trial; 1 g of omega 3 fatty acids significantly reduced all-cause mortality and cardiovascular mortality in 11 324 myocardial infarction survivors. Moreover, there was a significant reduction in total mortality after just three months of treatment.


The PREvencion con DIeta MEDiterranea (PREDIMED) primary prevention randomised controlled trial found that an energy unrestricted diet supplemented with extra virgin olive oil or nuts achieved an impressive 30% reduction in major cardiovascular events within three months in over 7,500 high risk individuals initially free of CVD.



In comparison to the American Heart Association-recommended ‘low fat’ diet, a Mediterranean diet post myocardial infarction is a more powerful coronar intervention tool for mortality than aspirin, statins or coronary stents, but without any significant difference in total cholesterol, triglycerides or HDL.


However, it pays to know your trans and saturated fats from poly and monounsaturated fats. Consider oily fish, algae, olives, cold pressed oils used as dressings, avocado, nuts and seeds. Conversely, the consumption of trans-fats commonly found in fast food and processed fats can rapidly increase inflammatory markers within weeks.


Nutritional fats are necessary for the normal production of hormones, energy and facilitate the absorption of certain nutrients. & Fats have a slower digestive clearance time; around 4-6 hours, compared to carbohydrates which can be as quick as 30 minutes. Slow clearance is satiating and wards off hunger signals and premature food searching behaviours.


Overall, heart health is wholefoods-focused using Mediterranean dietary principles.  Be inspired by colourful vegetables, salads, fruit, nuts, legumes, pastured meats and eggs, fish and traditional grains.  

Aptly quoted from Malhotra et al, 2015:

"food can be the most powerful form of medicine or the slowest form of poison”.


Viridian Nutrition is the leading supplier of food supplements to specialist independent health food stores. For information about personalised solutions visit

Author: Jenny Carson is a Nutritional Practitioner and Technical Services Manager at Viridian Nutrition. She holds a BSc honours degree in Nutritional Science and is a Master of Research (MRes) in Public Health.


British Heart Foundation.  2015.  CVD STATISTICS - BHF UK FACTSHEET.  [Online] [Accessed: 20.12.2017].

Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, Elwood PC, Deadman NM. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet. 1989 Sep 30;2(8666):757-61.

Estruch R, Ros E, Salas-Salvadó J, et al, PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279–90.

Hex N, Bartlett C, Wright D, et al. Estimating the current and future costs of type 1 and type 2 diabetes in the United Kingdom, including direct health costs and indirect societal and productivity costs.  Diabet Med 2012;29:855–62.
Malhotra A, DiNicolantonio JJ, Capewell S. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart 2015;2: e000273

[No authors listed]. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della
Sopravvivenza nell’Infarto miocardico. Lancet 1999;354:447–55.

Quaas J. Mediterranean diet for secondary prevention after heart attack. The NNT, 17 Sept 2010.

Stephan J. Guyenet, Michael W. Schwartz; Regulation of Food Intake, Energy Balance, and Body Fat Mass: Implications for the Pathogenesis and Treatment of Obesity, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 3, 1 March 2012, Pages 745–755.

Wallace S, Mozaffarian D. Trans-fatty acids and non-lipid risk factors. Curr Atheroscler Rep 2009;11:423–33. 


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Spotting sugar in food labels

How sugar impacts on skin health

The information contained in this article is not intended to treat, diagnose or replace the advice of a health practitioner. Please consult a qualified health practitioner if you have a pre-existing health condition or are currently taking medication. Food supplements should not be used as a substitute for a varied and balanced diet.


TAGS: Health TrendsSugar, Fat, Diet


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