4Refined carbohydrates, especially sugars, were found to be the most dangerous to health. The studies showed that people who get 77 % of their energy from carbohydrates had a 28 % greater chance of dying. The main function of refined carbs is to supply the body with quick energy for physical activity. When a person leads a sedentary way of life, refined carbohydrates that aren’ t expended by exercise are converted into fat stores. Muffins, white bread, cream of wheat, macaroni products, sweets, jams, sweetened beverages, and juices have large amounts of sugar and other refined carbs. Diabetes, ischaemic heart disease, peripheral vascular disease, chronic fatigue syndrome, obesity, impotence, heart attack— all were associated with an unbalanced diet in which carbohydrates predominate.

So what does a healthy diet based on the PURE study look like?

Actually, it largely coincides with the so-called Mediterranean diet. It includes complex carbohydrates— found in grains, legumes, fruits, and vegetables— and lesser amounts of high-quality protein in eggs, chicken, fish, and fish roe; oils are preferred to fats; refined carbohydrates are kept to a minimum. A portion is considered to be two handfuls. Five or six smaller meals are recommended: breakfast; a light snack of fruit, especially berries; lunch; another light fruit snack; supper; and a sour milk product with live bifidus cultures like yoghurt or kefir before bedtime. The interval between meals is three or four hours. Water is drunk before meals and in the intervals between meals.

Some scientists have expressed concern about methodological flaws in the PURE study. For example, a review of the PURE report on The Nutrition Source, a Harvard School of Public Health service, pointed out that carbohydrates were not differentiated as to quality and quantity, complex and simple, and the different health effects of the different types. They also made the point that a diet high in carbs is also often a poverty diet, and that the effects of poverty could also play a role in the higher mortality of those who ate the most carbs. They also said that while types of fat were assessed, they were not consistently compared to each other, and trans fat, which is widely used in South Asia, was not evaluated at all. Reliability of the data was also questioned, given that they did not jibe with data from other surveys of similar populations.

Further studies are needed to corroborate PURE and other recent results indicating that the villain of the play may be sugar rather than fat.

For further reading and to see our sources: Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents( PURE): a prospective cohort study www. thelancet. com / pdfs / journals / lancet / PIIS0140-6736( 17) 32252-3. pdf PURE study makes headlines, but the conclusions are misleading www. hsph. harvard. edu / nutritionsource / 2017 / 09 / 08 / pure-study-makes-headlines-but-theconclusions-are-misleading / PURE study challenges the definition of a healthy diet: but key questions remain www. thelancet. com / journals / lancet / article / PIIS0140-6736( 17) 32241-9 / references

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