About this paper
Published in May 2016, this was PHC's inaugural evidence report — the document that effectively announced the charity's mission to inform and implement healthier dietary decisions in the UK. Written under the direction of Sam Feltham and a clinical advisory board of GPs, a cardiologist, a dietitian, a psychiatrist and a clinical psychologist, it was drafted in direct response to Public Health England's then-new Eatwell Guide.
The report takes issue with the premise of current guidance. It argues that the Eatwell Guide is structurally biased toward starchy carbohydrates (potatoes, bread, rice, pasta), low-fat dairy and processed vegetable-oil spreads, while treating fat as a food group to be minimised. PHC contends this directly contradicts decades of RCT evidence on weight, glycaemia and cardiovascular risk.
The authors present a UK-specific paradox: the 2014 National Diet and Nutrition Survey shows the population broadly following official advice — eating 383 calories below recommended intake and below the 35% total-fat ceiling — yet obesity and type 2 diabetes keep climbing. PHC uses this gap to argue that the guidelines themselves, not public adherence, are the problem.
To support the case, the report reviews four meta-analyses (2008, 2012, 2013 and 2016) and the Harvard-led 2015 Lancet review covering 53 RCTs and 68,128 participants. Each concludes that ad-libitum low-carbohydrate, higher-fat eating produces at least as much — usually more — weight loss than calorie-restricted low-fat diets, with favourable changes in triglycerides and HDL.
In place of the Eatwell Guide, PHC proposes 'The Real Food Lifestyle': minimum intakes of essential nutrients (protein at 1 g per kg bodyweight per day, fat providing at least 25% of calories, following the BMA's original 1950 recommendation), no upper limits on real-food fat, carbohydrates treated as non-essential but permitted from whole-food sources, and a parallel 'Real Food Lifestyle for Weight Loss' that caps carbs at under 130 g/day (or under 50 g/day for non-responders).
The report also spotlights Dr David Unwin's Southport practice as a real-world proof of concept: annual practice savings of £45,000 on diabetes drugs, with extrapolated national savings over £400 million/year. It closes with a call for the NHS to adopt low-carbohydrate eating as an officially recommended option.