BBC Radio Oxford broadcast an infomercial for Patrick Holford’s books and his commercial diet programme (transcript below). BBC i) did not invite any experts to discuss Holford’s diet or claims, ii) question whether the ‘free diet trial’ involved purchasing supplements or blood tests iii) ask for details of the ‘science’ that he claims supports his advice.
BBC Oxford Radio has just donated some air time (Tues, Jan 19, Louisa Hannan show, iplayer for 1 week: listen from around 1.06:10) for Former Visiting Professor of University of Teesside Patrick Holford to discuss and promote his work under the guise of alerting listeners to an ostensibly free diet trial. Free advertising from the BBC is invaluable as so many listeners trust the BBC to have conducted some form of due diligence or fact-checking before increasing a pundit’s brand equity or awarding advertising equivalence units to a commercial product (and that is what Patrick Holford was promoting on this programme).
Below is the transcript of BBC Radio Oxford’s Louisa Hannan Show and the interview with Patrick Holford (Tues, Jan 19, Louisa Hannan show. We have annotated some of the transcript in green text but there are so many canards and assertions that it wasn’t practical to highlight all of them. [Emphases are added by the transcriber, this is not a verified transcript.]
LH = Louisa Hannan
PH = Patrick Holford
LH [1:06.10] Now, although the weather over the past few weeks might have meant that your New Year’s resolution to lose a bit of weight has gone out of the window, (any excuse, eh?), well now there’s a chance to get back into it, alongside one of the country’s leading nutritionists.
Actually, Louisa is entitled to call herself a nutritionist if she should so wish. As Catherine Collins, RD, of the BDA has frequently pointed out, ‘nutritionist’, unlike dietitian, is not a protected term. It’s rather a shame that the BBC lost an opportunity to teach its listeners about the difference between evidence-based dietitians and people who may be no more qualified than the average “enthusiastic amateur”.
And it seems that since losing the once, over-used (and inaccurate) title of Visiting Professor of Mental Health and Nutrition,[a] Patrick Holford doesn’t care about labels but sees himself as a psychologist who others refer to as a nutritionist. He is, of course, Head of Science and Education at Biocare, a supplement company, and the might be relevant if the diet programme recommends supplements. Unfortunately, Louisa failed to ask if supplements were recommended as part of the diet programme.
Patrick Holford is looking for volunteers, right here in Oxfordshire, for a new, free, diet trial. Now, I caught up with him a little bit earlier and asked him to tell me more about it.
PH [1:06.30] Well, basically, I mean, the science clearly shows that the most effective way to lose weight is to do what is called eating a low G L diet. And that stands for glycaemic load.
No, the science does not show this, if science is understood to mean peer-reviewed publications in leading, PubMed-listed, journals, that are either systematic reviews or clinical trials. E.g., a recent trial with 811 participants reported:
Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.
There was an interesting correspondence exchange in which it was acknowledged that the study essentially compared only small differences in macronutrient intake so might not be more generally applicable. However, the authors argued that participants are typically unable to sustain low carbohydrate intakes after a few months, and
despite best efforts, studies that compare diets for weight loss have not shown large differences in dietary macronutrient composition.
It might have been helpful if there had been a dietitian or weight loss expert present to counter some of Patrick Holford’s more exuberant assertions, given that Louisa Hannan was unable to make necessary enquiries or recognise when a statement needed to be challenged.
And to put it very simply…When your blood sugar level goes too high from eating bread, and cereal, and pasta, and fruit and sugar, the excess gets put into storage as fat. So, contrary to sort of earlier simple explanations-i.e. you get fat because you eat too much fat and therefore you must eat less calories and less fat-we’re now learning that it’s actually the increase in carbohydrates that makes you gain weight.
It might have been helpful if Patrick Holford had attempted to define what was meant by “too high” in this context. Above a certain level, and in combination with other symptoms or the medical history, “too high” a blood sugar level might be indicative of (say) diabetes type 2. Patrick Holford has not presented a well-referenced argument, either in this interview or the supporting website, that it is an increase in carbohydrate consumption that leads to weight gain (relative to what baseline?).
So, there is a way of eating that does cause you to lose weight. But as everyone knows, it’s not just knowing about what you should eat, it’s also about actually doing it.
LH Mm. [Assenting.]
PH What gets in the way of doing it are all sorts of psychological, and behavioural issues and factors and so on. Of course, exercise plays a part.
About three years ago, we started to, to…We had a project which was basically how to make weight loss really happen. And to cut a long story short, after three years investigating, we found a programme that really works.
It’s basically twelve evenings, in a row, so it takes place over twelve weeks. And it doesn’t just teach you what it is that you need to eat to lose weight but it’s also very strong on coaching, counselling, really understanding what it is that motivates people, what it is that gets in the way. It also includes exercise components.
So far, this is sounding like an amalgam of Weight Watchers, Slimming World, Rosemary Conley, the counselling support package that accompanies Lighter Life or several other commercial weight-loss programmes.
And the real proof for us was, just recently, we looked at the first one year results. Because you probably know that over 90% of people who lose weight have gained it all again within a year.
Despite the popularity of this stark figure, there is little evidence to support it in this form.[4,5] Mann et al’s review indicates that weight regain occurs over time (longer than Holford’s “one year”).
Even in the studies with the longest follow-up times (four or five years post-diet), the weight regain trajectories did not typically appear to level off. It is important for policymakers to remember that weight regain does not necessarily end when researchers stop following study participants.
Weiss et al:
Compared to their weight 1 year ago, 7.6% had continued to lose weight (>5%), 58.9% had maintained their weight (within 5%), and 33.5% had regained weight (>5%).
However, it is agreed that weight loss is frequently followed by a weight gain trajectory over several years.
LH Yes. [Overlaps with last part of the above.]
PH And our first results show that 93% of people who’ve been on this 12 week programme had actually maintained their weight loss one year later which is really good news.
This is less remarkable than Holford implies, given the erroneous nature of the’ 90% regain all their weight in a year’ claim. Nonetheless, this is an interesting assertion and it is regrettable that Holford has not identified/published this in a form that can be readily scrutinised. Unfortunately, Holford’s previous publication on the topics of GL diets was unsatisfactory, both in the description of methodology and reporting of results. If the follow-up was performed on this same group (it may not have been) then it may be inappropriate and premature to generalise from 16 participants.
So, we are starting up a programme, a pilot programme, in Banbury, on 25th January, on Monday evenings. And in Woodstock, just outside Oxford, from 26th January on Tuesday mornings, and we’re looking for volunteers who want to take part, lose weight and feel great.
LH [1:08.55] So, is this less about a diet, a quick fix, and more about healthy eating and understanding what we should be eating, when, and how to continue it?
PH [1:09.02] Yeah, absolutely. Because at the end of the day, the only approach that’s going to work is something that literally becomes your lifestyle. So, short fixes don’t work. We absolutely know that.
And the thing is, this this low GL way of eating is actually very easy once you get the knack of it. I mean, for example, one of the principles is to always eat protein with carbohydrate. Now, if you’re hungry, and I give you an apple, does it satisfy you?
LH Huh. No. [Laughter.]
PH And if I offered you another apple, you’d probably say, “No, thanks. I’ve had enough apple”. But if you eat an apple with a few almonds or a few pumpkin seeds-and, by the way, anything you plant in the ground that grows, is protein-so now you’re combining carbohydrate with protein, the effect is different. You literally don’t have that sort of emptiness that makes you want to eat.
It is difficult to disentangle these statements to comment on them but the ‘seeds – ground’ protein assertion is too broad and inexact to be helpful or educational. It is, again, unfortunate that Holford does not refer to any evidence to support the assertion about the impact of combining undefined amounts of protein and carbohydrate on the perception of ’emptiness’.
It is particularly confusing as, reading elsewhere, Holford’s GL Diet involves eating no more than 45 GLs a day, and apples are listed in Holford’s database as a good, low GL choice.
So, really, where we’ve got to in the science of losing weight is turning it into very, very simple principles that do work. I mean, we have people, one lady recently contacted us and she’d lost five stones in five months. Never felt hungry. Her energy had gone through the roof, her mood had improved.
It is unsatisfactory to rely upon the power of the vague testimonial: particularly one that reinforces rapid weight loss rather than the more typically supported approximately 2lb a week.
And the other thing that’s really exciting is that the, the perfect way of eating, the low GL way of eating, is also completely consistent with reducing risk for heart disease, diabetes, even breast cancer. So, we knew that if you ate in the Atkins style, lots of protein and fat…
LH Yes. [overlapping]
PH …it does work but you get constipated, you don’t smell great. And it’s actually not good news, down the track, for things like your bones, your kidneys, and, even possibly, cancer risks.
So, I think we’ve got to the point now where we not only have a way that works-Fast!-is safe, but is more than safe because all the side-effects, things like more energy, better mood, better skin, better digestion. So, if you like, as a nutritionist, I think we’ve found the Holy Grail.
Betsy Mason’s fine observations on 5 Atrocious Science Clichés to Throw Down a Black Hole identified “Holy Grail” as, “the mother of all bad science clichés, the worst offender.” HolfordWatch has no reason to disagree with Mason in this matter of taste.
But the question, that is why we’ve started to do these Zest for Life programmes So, how do you really deliver it? And, for that, what we’ve found works really well is having a group of twenty, twenty-five people, who come once a week, for twelve weeks. They share their experiences, they share their failures as well. Because every time we do something that doesn’t work, it’s a learning. And, gradually, you know, you can get on track. And, for us, the proof is our recent research that found over 90% of people maintained their weight loss one year later.
Again, i) this claim is less remarkable than Holford implies, given the actual state of the literature on this matter ii) it would be useful if this “proof” were to be identified/published in a form that is open to scrutiny.
LH [1:11.33] Is this something, a sort of a diet that will suit everyone? Because everybody’s metabolism is different. And people that I know that are overweight that have tried to lose weight have tried it in so many different ways and they say, “Oh, that diet doesn’t work for me“.
PH [1:11.45] Well, I think we’re not that different, so, the broad principle do apply to everyone. One of the nice things about the programme is that you do get quite a lot of one on one and, you know, we’re not that different and we are different. So there are certain sort of flexibilities there.
It is impractical for HolfordWatch to disentangle these statements. However, rhetorically, it is an interesting variation on the rainbow ruse and may allow an interviewee to evade disagreement with an interviewer.
I mean, sometimes, it’s just a matter of choice. In other words, some people are vegetarian and how do they do these diets? Doing something like the Atkins diet as a vegetarian
LH Mm. [Overlapping.]
PH …is virtually impossible. You have to sort of marry mountains of tofu…
PH So, you know, we are different. And we can learn from our own experiences and I think that’s very important.
The contradictions with the above resemble an example of both trance and the confusion technique of Ericksonian Hypnosis.[b]
For example, we had one guy recently, and his big downfall which is true for a lot of people. He’d come home from work and once he’d started eating, he wouldn’t stop. And he learned that what really worked for him was to have a low GL snack. So, he’d eat something, late afternoon, and what that meant was that by the time he got to thinking about dinner and preparing dinner, his blood sugar level wasn’t on the floor.
Because, basically, when your blood sugar level dips, it doesn’t matter what you’ve sworn you’ll do, you’re going to, just gravitate, to carbohydrates or sugar or snacks. And you can’t stop eating, because the major driver of hunger, the major driver of hunger, is low blood sugar.
So, listeners learn that a snack can mitigate hunger. The ready availability of snack foods that contain carbohydrates or sugar might be as strong an influence on snack choice as any putative impact of an unspecified dip in blood sugar levels.
So, everything we teach is really about learning. For example, when your blood sugar is low, your energy is low and you get a bit more irritable, maybe more grumpy, maybe more moody. You start hunting
LH [Overlapping laughter.]
PH …for sugar, or hunting for caffeine, and…
LH [1:13.18] [Laughing.] You’ve had a secret camera on me, haven’t you?
[Both LH and PH laugh.]
PH [1:13.20] It’s all sounding very familiar is it?
Possibly another interesting example of interview management and may illustrate both warm reading and a variation on Barnum statements.
You know, we teach people when those things are happening, you know it sets off a light bulb in their head and they go, “Aha, my blood sugar is dipping. Now I need to do something about that”.
Because you can’t beat your biology. You have to work with your biology and, I mean it’s very, very exciting, I think, and you may know that this week, I have a book out, called The Ten Secrets of 100% Healthy People…
LH [Enthusiastically] Yes!
PH And this is quite extraordinary. Because we have a website, and people who go there can fill out a free questionnaire and, as a result, you get a 100% Health Check, and it tells you where your strengths and weaknesses are and what your score is out of 100%.
Note that neither Holford nor Hannan highlight that I) the survey has not been independently validated as a useful instrument for any topic relating to wellbeing, health or lifestyle ii) survey respondents are self-selected and that it is not practical to verify the responses. HolfordWatch has commented on this questionnaire and the strongly likely outcome of recommended tests (few of which are uncontroversial) and supplements (for which there is little supporting evidence) for suggested diagnoses of controversial conditions.
And basically, if you’ve got no symptoms, you feel fantastic, and you leap out of bed in the morning and no weight issues and so on…you score close to 100%. And over 60,000 people have done this since we started in 2000 and we’ve analysed the results and-By the way, the biggest ever government survey on health and diet is 1700 people.
LH Goodness. [Portmanteau expression to cover admiration of size of survey and the comparative paucity of the government’s efforts.]
This claim is wrong or disingenuous. Holford is comparing a non-validated survey, with non-validated participants and non-validated responses to rigorously validated, controlled and conducted surveys of which the Health Surveys for England are an example. The number of participants are greater than Holford claims and some of them involve objective measurements such as blood tests or body measurements in addition to self-reported data. See the FSA summary of the Low Income Diet and Nutrition Survey that collected data from 3,728 people and included: “a face-to-face interview and self-completed questionnaire; four 24-hour recalls of diet on random days (including at least one weekend day) within a 10-day period; physical measurements, indicating height, weight and blood pressure; a blood sample was requested for those aged eight years old and over, to measure indicators of nutritional status”.
Government funding is involved in the long-established Whitehall Prospective Cohort studies through the Medical Research Council, Dept. of Health and others. (See the funding acknowledgements.)
PH So when we hear about protestations of what a ‘well-balanced diet’ really is, then it’s actually based on very little evidence.
As above: plus, regular readers might recall that Holford once proffered to usurp the findings of a Cochrane Review covering more than 250,000 trial participants with an uncontrolled, TV experiment involving 2 participants.
And, eh, we’ve analysed this evidence and really gone close-up to look at what are the secrets of 100% Healthy and what’s different between them and the rest of us, who I call the ‘Vertically Ill’, that is, upright, but not feeling great.
And, by the way, the point there is that some of the ‘Vertically Ill’ tip over and become ‘horizonatally ill’ and develop diseases like diabetes and heart disease and so on.
The “Vertically Ill” to “horizontally ill” trope is a cliché that HolfordWatch would like to banish.
And our job, in my organisation, is to help people to stay vertically well, so they never tip over into ‘horizontal illness’.
LH [1:15.10] So, Patrick, for people listening to this and who would like to get involved with this trial – it’s free, isn’t it?
PH It’s free.
LH What do they have to do? What do they have to commit to?
PH Uh, all they have to do is commit to coming. So, it’s literally either an evening a week or a morning a week. But at this point, they don’t even need to make that commitment, they just need to contact Zest for Life and find out what’s going on.
It might have been helpful if Holford or Hannan had stated how many places were available for volunteers. HolfordWatch is aware that when Holford and Zest4Life offered a ‘free diet trial’ in Leeds in April, 2009 it was over-subscribed. Those who were unsuccessful in obtaining a free place were invited to join the pay-to-participate programme: this might be a persuasive ‘sell-through’ if interested people had already learned the promoted benefits of this programme. For those who do not succeed in obtaining a free place, the 12 week course costs £180 with individual weight loss or nutrition motivational coaching available at £ 50.00 per 60 minute session.
Holford refers several times to this being a 12 week programme, however, the Bristol version of this same pilot trial offers a 6 week programme as does the Hinckley trial. Surely, if this is to be a properly conducted trial, it is essential that the length and content of the course should be standardised if the analysis is to have any value at all. Further, despite Holford’s indications to the contrary, it seems that there is only a single one-on-one session, and that this is available only as part of the 12 week course.
If there is no standardisation, it seems that no lessons have been learned from the poor management of the Food for the Brain trials and the lamentable report of the results. Regular readers will recall that this quality of these trials were so poor that even the head of Food for the Brain’s Scientific Advisory Board had to acknowledge that the work had not been rigorous and was not a “proper job”.
From the available information, it seems that the Zest4Life programme involves taking supplements (judging by the information about the GL diet in the JOM paper.) It might have been useful if a cost estimate for this, or the way of eating had been elucidated as part of the ‘commitment’.
I have a phone no.
LH Yeah, that would be great.
PH And the phone no. is 01295 780887. And if you want to have a look at this new approach to weight loss, which is called Zest for Life there is a site, called Zest 4 Life but the four is the number 4 so, Z E S T number 4, L I F E dot eu
Have a look there but this is, this is, us starting in Banbury and Woodford, uh, literally next week, so, as I say to many of the people who attend this, “I’m looking forward to seeing less of you”.
LH [1:16.23] Fantastic. Patrick, it’s been a pleasure to talk to you. Thank you very much indeed for joining me.
PH A pleasure.
Patrick Holford spoke for approximately 9 minutes in a 10 minute interview.
HolfordWatch would be surprised if anyone has managed to glean useful information about eating within the principle of a low glycaemic-index diet from this interview. The interview is, effectively, a 9 minute infomercial for Patrick Holford’s commercial enterprise, Zest 4 Life, and his latest book.
The infomercial is useful for students of Ericksonian Hypnosis, Barnum Statements and students of promoting pundit brand equity. Sadly, it is useful to few others. The BBC has a reputation to protect and a branded trustworthiness to maintain – sadly, this is not the way to do it.
[a] The Holford Myths post refers to FOIA documents about the discussion at Teesside about Holford’s use of a title: “it is not normally University practice to attach a descriptor to the title of Visiting Professor”.
He developed both verbal and non-verbal techniques, and pioneered the idea that the common experiences of wonderment, engrossment and confusion are, in reality, just kinds of trance. (These phenomena are of course central to many spiritual and religious disciplines, and are regularly employed by evangelists, cult leaders and holy men of all kinds).
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 Holford, P, Torrens K, Colson D. The Effects of a Low Glycemic Load Diet on Weight Loss and Key Health Risk Indicators. Journal of Orthomolecular Medicine 2006 21:2, pp71-8.
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