The obesity expert who doesn’t believe in diets – and says we should exercise less

“I’m not a controversial person. At least, I don’t try to be.” Famous last words?

Prof Fredrik Nyström has spent his 25 year career at Linköping University in Sweden dismantling health myths, challenging preconceptions and turning what we think we know about health on its head. “I want to diminish people’s anxiety about health,” he says. “You will live longer and better if you stop worrying.”

“As a physician of internal medicine, specialising in endocrinology, I treat patients with obesity, Type 2 diabetes, sleep apnoea, high cholesterol and so on. So many open their consultations by telling me they’ve sinned,” says Prof Nyström. “People feel terrible because they can’t live up to the expectations that Western healthcare asks of them. That’s not fair.”

Despite his mild-mannered tone, Prof Nyström’s findings have proved incendiary. In the wake of the late Morgan Spurlock’s infamous 2004 Super Size Me experiment, wherein the documentary-maker ate exclusively at McDonald’s for a month, Prof Nyström repeated the trial in laboratory conditions.

But where Spurlock had been warned by physicians that if he continued eating at the fast food chain, he would die, the participants in Prof Nyström’s trial gained some weight, but overall were fine.

“The more saturated fat participants consumed, the better their cholesterol levels became – the exact opposite of what people thought,” explains Prof Nyström, of his study. His finding flew in the face of received wisdom and countless other studies, which have consistently shown that saturated fat increases the risk of heart attacks and strokes. (However, the study only observed participants over four weeks, so it’s probably best not to reach for the burgers and milkshakes too readily).

“Our other big finding was that sugar created a much bigger risk of steatosis [fatty liver disease] than eating saturated fat. Those findings were controversial, but other experiments confirm them.”

In his controversial new book Lighten The Load On Your Shoulders, Prof Nyström takes a swipe at health proclamations to blow apart what we think we know about health.

His central premise expressed in his preface is that “happy people live longer than those who are more often gloomy, even when all cardiovascular risk markers are set on the same level.” He hopes that by busting our anxieties around health, we’ll be a bit happier about the subject. Citing 113 studies from the past two decades, often conducted by Prof Nyström himself, but taking in the whole sweep of modern science from dieting to exercise to drinking, the book is an often maverick, but always upbeat take down of the mistruths and half-truths which have festered in popular health science.

“I want to lighten the load on people’s shoulders and let them know that it’s okay if they are struggling with health advice,” Prof Nyström explains. “I did a big study of 756 patients and found those that feel happier, are healthy. Being happy and feeling good is a huge indicator of good health.”

With a core of common sense but an absolute focus on the research, Lighten The Load On Your Shoulders is a rallying cry for those who find diets never work for them, struggle to find time to exercise, and want to indulge in a few vices every now and then.

These are some of his most interesting insights.

The Med diet is the only diet that really works

“The standard advice over the past 40 years boils down to ‘eat more vegetables, eat more fruit, and avoid fat’, but in the few long-term trials on the subject of dieting, nobody follows the advice for long and then in a few years they gain weight again,” Prof Nyström says. “I see it with my patients, but it’s also been shown in studies: obese people never return to normal weight. They might lose a couple of kilos, but it’s vanishingly rare to see someone lose it all. I’ve had two such patients in 35 years of being a doctor.”

Contrary to standard advice (and a major 2021 review published in the Obesity research journal) he believes there’s no real proof that losing weight leads to better health.

“Numerous studies [most notably an influential 2004 study from the University of California Berkeley] have shown this ‘obesity paradox’,” Prof Nyström says. “If you’re overweight and you manage to lose weight, you die earlier than people who stayed overweight.” While this anomaly could be explained by the fact that weight loss itself can be a sign of a life-shortening illness, like cancer, Prof Nyström has other ideas.

He believes the reason is that dieting is soul-crushing. “If you’re starving yourself, feel hungry all the time, deny yourself a glass of wine or chocolate, it crushes you. That’s what kills you,” he opines.

“New weight loss drugs like Wegovy could be a solution. That weight loss works and reduces cardiovascular disease,” he concedes. “I suspect because it stops you feeling hungry so you don’t feel so miserable all the time.”

Prof Nyström concedes that becoming overweight in the first place is bad for you. Numerous health problems are caused by being overweight, from heart attacks to strokes to dementia. “Find a diet for the long-term rather than changing what you eat,” he advises.

“The Mediterranean diet is literally the only diet which has been proved to work in reducing cardiovascular illness,” says Prof Nyström. “That’s all we have. Follow a Mediterranean diet and you’re 30 per cent less likely to suffer cardiovascular disease in the next five years.”

Stop exercising so hard

While we tend to think marathon runners and gym bunnies are bastions of good health, it could be more dangerous than we realise.

Exercise is good for you, but we should all calm down and do less. “I absolutely believe in exercise,” says Prof Nyström. “Go for a walk. Walk a few kilometres every day. If that’s easy, walk faster. If it’s hard, walk slower and get faster in future. Walking decreases glucose levels, helps you with insulin resistance, and to some extent increases your metabolic rate.

“People die in big marathons all the time. Of course it’s not good for people to exercise hard. That’s been tough for the medical community to accept,” he adds.

Research from The Mayo Clinic found that people who’ve run a marathon have a threefold risk of having scars on the heart muscle compared to those who never have. “You push the heart so far that part of it dies,” says Prof Nyström. “You can see those scars on MRIs. That creates a risk of atrial fibrillation [irregular heartbeat] which can lead to blood clots and even heart failure.”

This isn’t just in older exercisers. “I did a trial where we asked a bunch of 25-year-olds to run 5km as fast as possible. Seventy per cent of them had minor heart damage,” says Prof Nyström.

That’s not to say that there isn’t plenty of counter research to show that high-intensity exercise can improve fitness and shift fat, but even young, fit athletes should take adequate rest days. The key message it seems, is don’t over do it.

The other reason to exercise is weight loss, though again, Prof Nyström says it’s more complex. “If you increase physical exercise to a large extent, your metabolic rate [the calories you’re burning] slows down, it becomes less effective for weight loss,” he explains. “That was important when we were hunter-gatherers: if we could not slow down our metabolic rate when chasing prey we would have had to eat obscene amounts or die.”

Strength workouts can increase your metabolic rate too (because it burns more calories for the body to maintain muscle than other tissues) but don’t strain your heart while doing them.

Prof Nyström believes healthcare systems “waste money” by telling people to exercise, which “basically doesn’t work,” he says. “Nobody has ever proven that if you ask somebody to exercise more, that will increase longevity. There is no effect whatsoever of telling people to increase exercise habits when you follow up the patient for more than a year.” In short, he believes moderate exercise can be good, but the most important thing is doing it to a level you can keep up with and do consistently.

Alcohol can be good for you in moderation (and not just red wine)

“We have a specific system to break down alcohol. Why would we have evolved that if we weren’t supposed to drink it?” asks Prof Nyström. “Drinking alcohol in moderate quantities is OK, and probably even good for you.”

Research has shown that moderate amounts of alcohol (one small glass of wine per day for women or two per day for men) helps lower glucose levels and balances cholesterol levels within three months. There’s also evidence that a glass of wine in the evening reduces blood pressure. But it might not just be red wine.

“In the major Mediterranean diet study, red wine was recommended, so we have evidence for that,” says Prof Nyström. However, other alcohol may have the same effect.

“I did a study where participants drank either red wine or de-alcoholised red wine,” Prof Nyström explains. “The same thing, except one had alcohol and the other didn’t. Those who drank the alcohol had lower blood glucose levels than those who drank the alcohol-free version. That suggests you could drink vodka or another alcohol, as long as [doesn’t contain more units] than the set amount of wine.”

He doesn’t mention the rather less jolly studies linking alcohol to cancer and dementia.

Breakfast is not the most important meal of the day, drink coffee instead

While breakfast is often cited as the most important meal of the day, modern science goes back and forth on the subject. Prof Nyström is firmly on the anti-breakfast side of the fence. “As I say, the Mediterranean diet is the only provably healthy diet, and traditionally that would be without breakfast but with a large lunch and evening meal.”

“My research has shown that eating large and few meals, avoiding carbohydrates, helps you burn the calories more efficiently,” he adds. “Lots of data has shown that we’re designed for large meals, so don’t snack and have two big meals per day with plenty of time in between. That lowers your risk of gaining weight and helps you lose weight.”

You can have a morning coffee without worry though. Old research led to panic that coffee increased levels of cortisol (the stress hormone) which scientists suspected would cause atrial fibrillation and potentially lead to strokes.

Newer research has found these risks to be exaggerated. In fact, coffee increases focus and lends people who drink it some of that crucial ‘pep’. “Yes, there’s an increase in cortisol when you drink coffee, but it’s not much and is probably linked to increased focus,” says Prof Nyström. “When people drink coffee, they perform better. Just do it early so it doesn’t affect sleep.”

But if coffee makes you jittery, delay your first coffee until mid or late morning, which is when cortisol levels start to fall naturally.

The most important health measure is the pep in your step

Ultimately, according to one Prof Nyström’s studies looking at the health outcomes of 756 participants, the key to being healthy is feeling healthy. And you can’t feel healthy if you’re constantly being told that you’re doing the wrong thing.

“I did a paper comparing the health outcomes of a large group of patients with Type 2 diabetes based on how they felt,” Prof Nyström explains. “We put people on a scale of one to five based on how peppy they felt. Those who felt peppier, despite having the same or even worse physical health markers, lived longer and suffered less cardiovascular disease.

“We don’t know why, but there is a strong association between wellbeing and your sense of wellbeing, going beyond what we can physically measure,” he says. “That motivates me. If I can make people feel less bad about the things they do wrong, some lives might be saved and people will have a higher quality of life.”

Lighten The Load On Your Shoulders by Prof Friedrik H Nystrom is available in English as an eBook from Amazon or BookBeat.