Pure Healthy Diet Score: The diet that lets you eat everything

The Pure Healthy Diet Score is a science-backed plan that demonstrates a diet of carbs, dairy and meat could be just the ticket to maintaining a healthy weight. Photo / Getty Images

I’m a dietitian’s nightmare. A typical week for me might include three meals out, trying new restaurants or having meetings over lunch. Then there’s developing new recipes, which all need tasting, tweaking and re-cooking. I also test products for my Telegraph column, Mrs Clay (a guide to thrifty living), which could mean 34 different burgers or a couple of dozen strawberry jams in one sitting – yup, I really do taste them all. That’s over and above the usual family meals and meet-ups with friends.

Keeping myself at a healthy weight, then, is a challenge. I’ve tried fasting (it works but makes me bad-tempered), var­i­ously cutting out fat or carbs (which just made me sad), and sticking to plain vegetables when I’m not actually eating for work. Balanced diet? Hardly.

It’s been at the back of my mind for some time that I need to get my nutritional act together. But I love food, and healthy intentions keep getting pushed to the back of my mind like that jar of chutney from last Christmas.

A new way to eat

When I heard about the new Pure Healthy Diet Score, announced in July, I was intrigued. Let’s be clear: it doesn’t claim to be a diet to lose weight, but rather a simple way to eat more healthily, backed by solid science. Sounds like a winner.

The diet works using a score system. It takes six core food groups and specifies an optimum amount to eat. Daily, that means two to three portions each of fruit and vegetables, a portion of nuts, and two portions of full-fat dairy (cheese, milk or yogurt, although sadly not cream or butter). Fish comes in at two to three portions a week, and pulses three to four portions a week.

The diet recommends two portions of full-fat dairy (cheese, milk or yogurt, although sadly not cream or butter). Photo / Getty Images

For every box we tick, we score a point: so one point (rather than three) for managing three portions of pulses in a week, and one point for eating three portions of fruit daily for a week.

The aim is to score four points a week, although if you can manage five, according to Professor Andrew Mente, a ­Pop­ulation Health Research Institute (PHRI) scientist and the lead author on the Pure Healthy Diet Score study, there is a “modest additional health gain”.

In addition to the six groups I have already listed, the Pure diet guidelines reckon it’s fine to have a portion of whole grains (brown rice, say, or wholemeal bread) daily and – fanfare, please – a small portion (85 grams, or three pounds) of meat. That’s right – although processed meat such as bacon still has to stay in the “occasional treat” category, meat (even red meat) can go back on the ­regular menu.

Notice something different? While most diets these days tell you what not to eat – no carbs or dairy, say – this diet is about what you should eat. It feels refreshing.

Backed by science

The background to the Pure Healthy Diet Score is impressive. It came out of the Pure (Prospective Urban and Rural Epidemiological) study, a massive project over the past 20 years ­co-ordinated by the Canadian PHRI, working with universities around the world.

Using data from 166,000 people from 21 countries, it measures changing lifestyles, risk factors and chronic disease in both cities and the countryside. Its main focus is to compare the health of people in rich countries with those in poorer ones, and work out improvements that can be made straightforwardly. Much of the focus is around the issue of malnutrition in deprived areas of the world. But it’s also turned up some very interesting results that are significant to all of us.

By looking at what people eat and how healthy they are over the subsequent years, it shows how likely our diet is to lead to a raft of conditions, in particular cardiovascular ­disease, but also diabetes, lung disease, cancers, kidney disease and brain issues. There are valuable clues about the kind of foods which, if we eat them, tend to mean we are more hale and hearty as we age.

The diet has had qualified support from dietitians. Nichola Ludlam-Raine, of the British Dietetic Association, tells me she was generally pos­itive about it. “It aligns with many principles of a balanced and nutritious diet, promoting foods that are rich in essential nutrients, fibre and healthy fats, with an emphasis on whole, unprocessed foods,” she says, although she emphasises the need to tailor it to the individual.

As Mente tells me by email, “Our message is that diets of variety and mod­eration are better than highly res­trictive diets.” And that includes fat. Low-fat diets, first proposed in the 1960s, have been the nutrition mantra since the 1980s, but the Pure study shows categorically that they are bad for our health, with the lowest all-cause mortality rate – or, more cheerfully, the long­est life – among people who eat the most fat, about 45 per cent of their total calories. Mente notes that since a low-fat diet has been promoted, obesity levels worldwide have soared.

Not all fats are necessarily bad for us. Photo / Getty Images

Sure, there’s been talk for years on the fringes of nutrition circles that fat has positive benefits, but the mainstream has yet to take notice. Take a look at the UK National Health Service’s “Better Health – Healthier Families” website, where none of the recipes use proper cheddar or butter, preferring “reduced-fat hard cheese” or “lower-fat spread”.

As for that red meat and cheese, saturated fat – which the focus of the anti-fat campaign has shifted to in recent decades – is not the baddy, either, according to the Pure study, and may not raise our risk of heart attack or stroke. Not only that - by banishing saturated fat from our diet, Mente argues, we also exclude many valuable nutrients contained in those foods, which outweighs any potential negative effects.

Other links are less controversial: fish is good, for example, and so are nuts and pulses. But is it okay to eat just four portions a day of fruit and veg? That seems to fly in the face of not just the five-a-day campaign, but also the advice from many dietitians that we should be eating more: a study by Imperial College London recommended 10 a day.

But while Mente believes fruit and vegetables are healthy, he points to a previous paper which found “the biggest gains are attained at three to four servings”.

Within this diet, he adds, “I’d say four to five servings is a nice target, but you can go a bit higher, as well.” He also recommends mostly raw or lightly cooked vegetables, as another of his papers (Mente’s output is impressive) shows there is higher pro­tection against heart disease from raw vegetables.

My week on the Pure diet

So, meat, cheese, a bit of veg, mostly salad – sounds like a reasonable plan. But settling down to work out my meals for the diet, I came up against another issue: what else? Adding up a day’s worth of food, including a portion of rib-eye steak and some wholemeal toast for my grain, I got to just under 1,200 calories. Even for the strictest dieter, that’s not enough – and the aim here was not to lose weight.

“How am I going to make up the rest of the calories,” I asked Mente ­plaintively, “and are the portion sizes minimums or maximums, or just sweet spots?”

He replied that the amounts specified are also a general guide and not meant to be followed slavishly to the exact gram. “The amounts would also largely depend on energy needs and body size. I would try to minimise refined grains and sweets, though the occasional serving is probably fine.”

Fattier cuts of steak such as ribeye are encouraged by the diet. Photo / Getty Images

A bit more digging into the Pure study data revealed that the healthiest people get less than 60 per cent of their calories from carbohydrates (including the carbohydrates in vegetables) – so restraint there seems in order. Sticking to 85g of meat a day seems sensible for climate reasons, as much as anything, but Mente tells me there is some benefit in going up to three portions of dairy a day.

Ah, yes, full-fat milk. I’m firmly a child of the low-fat mantra, and subsisted on skimmed milk for most of the 1980s and 1990s, only graduating to semi-skimmed at the turn of the millennium.

Looking at the freckles of fat floating on my tea on the first morning of my Pure diet made me feel slightly bilious. But I adapted to the buttery flavour more quickly than I imagined, and found I didn’t need as many cups of tea and coffee as usual to get me through the day.

The compulsory daily helping of 30g of nuts was also counterintuitive. I know they are good for me, but they are also calorific and I’ve never felt they filled me up much – how would I manage to cling on to my hard-won just-about-healthy BMI while eating a handful of nuts every day?

The diet includes a compulsory daily helping of 30g of nuts. Photo / 123rf

But it proved a success – I added them to dressings and found that salads became amazingly filling. Or I snacked on them instead of biscuits mid-morning and found it easier to plough through to lunch. I rather enjoyed having to eat something I’ve always regarded as a treat.

Fish three times a week was surprisingly challenging. I don’t have space in my freezer and shopping on the day just isn’t always feasible. Tinned fish came to the rescue – sustainable and convenient.

As for sticking to the 85g of meat, it was hard, oddly harder than going meat-free, especially in restaurants, which serve up huge slabs. But I became rather good at asking for a doggy bag, and stretched a whopping pork chop over three days.

So, how did I feel at the end of my experiment? The answer is: good. I’ll need to stick to this for a couple of decades to know whether there’s been a health benefit. But it reminded me of the power of protein and fat to keep you full, and that’s revelation enough to keep me on the plan. And while weight loss was not the goal, after a week on Pure, I’ve lost a pound without noticing, which feels like a score in itself.