NNR5 Chapter Energy

NNR5 Chapter Energy 

My answer to the NNR5 Public Consultation on Energy



The human organism is always striving for survival and homeostasis. In order to survive the person needs to eat food. Food consists of macronutrients and micronutrients.


The micronutrients are covered elsewhere.


The macronutrients are the energy suppiers as well as building material for the body.

There are three macronutrients, protein, fat and carbohydrates. They all contain carbon as an energy source.



Proteins consist of the building blocks amino acids. There are about 20 amino acids in the animal body. Humans can make about ten amino acids from scratch and the remaining about ten amino acids the person has to eat to be able to use them. So protein is an essential part of the food. Without protein we will not survive for long.


The amount of protein in the food should be at least 0.5 grams of animal protein per kg body weight. This is enough for a newborn child to increase 50 % in length during the first year and should be enough for the rest of the life [1].


We have a limited storage facility of free amino acids. Any excess of protein is deaminated and the rest is converted to short fatty acids or short alcohols that can be used in the metabolism.


Those short fatty acids and short alcohols can enter the central metabolism in the body, more about that later.


We have tens of kg of muscles with about 20 % protein.


On the cellular level cells contain a lot of different structural, signalling, building and other kinds of protein molecules, all necessary for survival. Muscle cells contain great amounts of contracting proteins to be able to move the body and parts.


No normal animal protein is toxic to humans.



The major functions of fat is energy production, energy source, energy storage and padding delicate organs in the body.


We have tens of kg of fat in the body. We can store several hundred kg of fat.


Fats consist mainly of triglycerides (three fatty acids connected to a glycerol molecule) but there are free fatty acids, monoglycerides, diglycerides, phospholipids as well as other lipids and lipid like molecules.


The major composition of fat is shy of 50 % saturated fats (SAT), shy of 50 % monounsaturated fats (MUFA) and the rest, about 5 %, is polyunsaturated animal fats (PUFA) with carbon atom numbers of at least 20 C.


The fatty acid composition is about the same for all warm blooded animals as they have the same body temperature around 37ºC. This is because fats must have a correct melting temperature for proper function. Arctic fish have much higher PUFA concentration as PUFAs have much lower melting temperature compared to animal fat.


This is shown beautifully by placing butter, olive oil and canola oil taken from the fridge on a plate and let it sit on the table. The canola oil is still liquid at fridge temperature, the olive oil is partly solid at fridge temperature and the butter is definitely solid at fridge temperature.


At room temperature both oil fats are liquid but butter is solid. When temperature rises above 30º C then also butter melts into liquid form.


So arctic fish must have higher concentration of PUFA to survive due to it’s lower organism temperature.


Salmon has 3.3 g PUFA and bacon has 2.8 g PUFA. This means that 100 g salmon can be replaced by 118 g bacon to achieve the same amount of PUFA. Also 100 g salmon can be replaced by 35 g lard.


So as long as we eat animal fat we will always get enough PUFA.


We also have to realize that vegetable PUFAs usually are nonelogable to animal long chain PUFAs in our body. Vegetable omega-6 are inflammation producing and if more than 20 g per day also causing cancer, well known by the old transplantation surgeons as well as Livsvmedelsverkets civil servants.


Animal fats in the form of phospholipids are essential to our cell membranes as they separate cells and organelles form each other and intracellular as well as extracellular environments. Also in all membranes there are about the same number of cholesterol molecules as phospholipids molecules to make the cellular and other membranes stable and supportive.


So the lipids of all kinds are essential to life.


Lipids and fats are also necessary making up the cushioning around delicate structures in the body. Fat is also an excellent energy source for the body.


Also fat tissue and fat cells in muscles is normally the major source of acetylcoenzyme A (AcCoA or activated acetic acid) which is the only energy producing molecule in the cellular mitochondria. See the Krebs cycle for more biochemical and energy details.


This means that all animal fat are essential to us and they are nontoxic as they consist of the same fats in the same proportions as our own fat. The animal fats also requires the least remodeling and exchange due to the same reason.


Fat is also the most energy dense macronutrient so persons can eat smaller portions to have enough energy. Also, fat is the most satisfying macronutrient.




Carbohydrates are the third kind of macronutrients. Carbohydrates consists of sugars. So carbohydrates are equivalent to sugars.


Fibers consists of polymers of glucose that no warm blooded animal can digest. Herbivores are using microbes to digest fibers like cellulose to short chain fatty acids, less than 7 carbon atom long chains. Those short or volatile fatty acids are completely water soluble and can thus be taken up directly in the blood and then transported directly to the liver for further use and can enter the central metabolism in the body, more about that later.


Humans are unable to digest fibers as we lack the fermenting microbes and fermentation tank like the 1 hL four parted ventricle of a normal cow.


So fibers lack energy in humans, easily contolled by eating pure fibers and check the lack of hydrogen gas production the digestion of fibres always cause.


Starches all consists of polymers of glucose easily degraded in the intestinal tract by a lot of enzymes down to single units of glucose.


Other common disaccarides are sucrose (consists of glucose and fructose), lactose (glucose and galactose), maltose (glucose and glucose). Disaccarides can not be absorbed by the intestines, so they have to be digested by common enzymes to their monosaccarides. Those monosaccharides like glucose (most abundant), galactose (animal sugar) and fructose (vegetable sugar).


A human of 70 kg has a low glucose concentration of 3-6 mmol/L in the blood to supply the Red Blood Cells (RBC) with energy as RBC lack mitochondria.


The normal blood concentration of 3-6 mmol/L is equal to the amount of 1.5 to 3 grams of glucose in the total blood volume of 5.6 L.


The RBC utilize glucose anaerobically via the RBC-specific Rapoport-Luebring pathway including 2,3-diphosphoglycerate (2,3-DPG) that is required to release oxygen from the hemoglobin molecule. Then the 2,3-DPG is transformed to lactic acid and 2 molecules energy rich ATP.


When having 5 g glucose, without insulin and a theoretical immediate uptake, the glucose level will increase to around 15 mmol/L which is a toxic concentration of glucose.


By having more than 15 to 25 g glucose in the blood (>30-50 mmol/L) the normal person will very shortly die from acute glucose intoxication.


Glucose and fructose are toxic at higher concentrations than 6 mmol/L the monosackarides are nonenzymatically glycating the lysine amino acid residue in proteins and thus changing the morphology and may change the function of the protein.


The most famous glycated protein is HbA1c where the attached glucose/fructose molecule destroys the oxygen transport function of hemoglobin.


This glycation of proteins is the major problem with carbohydrates.


When the person has carbohydrates the blood glucose rises immediately which releases insulin. The insulin has a lot of actions in order to normalize the blood glucose level. The insulin slows down the intestinal uptake of nutrients, inhibits the AcCoA production from fat and protein because the monosaccaride concentration just has to be normalized as the body otherwise will die from acute monosaccaride intoxication.


Read more about the wonderful insulin molecule and functions at reference below [2] .


There are no essentiality of eating carbohydrates. All sugars the human body needs is happily produced by the liver. And the liver can always produce enough sugar.


The logic behind NNR4 recommendation to have 50-60 % of the energy (%) is totally missing. As excess of carbohydrates increase the insulin level for long times thus decreasing the fat energy expenditure and that carbohydrates are partly converted to fat and thus increasing body weight the amount of carbohydrates has to be minimized.


It is also after the introduction of NNR with a in the 1980-ies that the epidemy of diabetes and obesity rose inexplicably. The only change in the environment is the exchange of fat to carbohydrate as major energy source.


It’s OK to have vegetables ad libitum as they do contain small absolute amounts of carbohydrates.


The amount of fruit should be limited due to the fact that most fruit contains the same amount of sugars as soft drinks, about 10-12 grams per 100 g


The amount of grain and grain products like bread, pizza, pasta contains 30-90 g carbohydrates per 100 g of grain product. Thus grain products should be restricted to small amounts realizing that many persons are gluten intolerant and should then be totally excluded.




The intake of energy is recommended by NNR4 to 2.5 Mcal (2 500 kcal) for women and 3.2 Mcal for men. As long as the carbohydrate intake is less than 100 g per day the population will normalize the body weight. So this recommendation can be propagated to NNR5.


All weight reduction diets have a common denominator:

Carbohydrate reduction.


Just compare a NNR4 diet with 50 E% carbohydrates and 0.8 Mcal to a low carbohydrate diet with 2.5 Mcal and 16 E% carbohydrates.


This means that the NNR4 starvation diet contains 100 g carbohydrates, the person loses weight, is always hungry and the person will starve to death, usually within a year.


On the other hand the low carbohydrate diet contains 100 g carbohydrates, the person loses weight, is always satisfied and the person can eat that kind of food for decades.


Both diets are shown to give the same weight decrease in the short term but the famine dieter is unable to continue for more than a few months or the diet will be lethal. The lowcarber can have delicious food for decades and keep the weight loss.


The first law thermodynamics tells us that in an isolated system energy in equals energy out.


But the human body is not an isolated system. And we have to realize that we also have to obey the second law of thermodynamics as well as the hormonal control of the body. This means that the body can regulate the efficiency between 0 and up to less than 100 %. The most part will be heat.


We also have to realize that fat does not increase the insulin level. Excess protein may and carbohydrates always increase the insulin level to normalize the glucose level. So insulin changes the normal fat burning metabolism to carbohydrate burning and fat generating metabolism to survive.


The obesity care have tried to have obese patient to eat less and run more. This hypothesis has been disproven many times during the last 35 years. But it seems that the obesity care units were unable to realize these results.


So by having ad libitum food consisting of normal amounts of protein, maximum 100 g of carbohydrates and 70-90 E% mostly animal fat the population will in a few years regain normal weight, decrease disease burden and a better general health.


NNR5 macronutrient recommendation


Proposal of NNR5 nutrition recommendations to healthy individuals based on the old trustworthy sciences physiology, biochemistry and endocrinology:


Summary of NNR 2012 recommendations to healthy individuals


NNR 2012 recommend an adequate intake of essential nutrients of protein, fat, minerals and vitamins.


NNR 2012 recommends a normal daily intake of essential animal protein of at least 0,5 g/kg bodyweight.


NNR 2012 recommends an upper limit of 100 g of carbohydrates/sugars per day [3].


NNR 2012 recommends a sufficient intake of essential fats to satisfy the energy and metabolic requirements.


NNR 2012 recommends an upper limit of 20 g per day of vegetable omega-6 polyunsaturated fats. [4], [5].


NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.


NNR 2012 recommends an upper limit of one fruit per day.




The conclusion of food consumption changes between NNR4 and NNR5 to promote health in Nordic populations


Increase............................Unchanged.......................Limit to per day

Fat, preferably animal......Protein from meat..........Limit Carbohydrates to 100 g.

.............................................Vegetables.......................Limit Omega-6 PUFA to 20 g.

.........................................................................................Limit fiber to 25 g                  .

.........................................................................................Limit fruit to one                    .






Background information for NNR 2012 recommendations

From NNR5

Recommendation for carbohydrates, fibre and added sugar



...............Mikael Fogelholm

................The data on health effects of dietary fibre and fibre-rich foods are very strong.[6]

................Recommendations in NNR 2012:

................Adults: Intake of dietary fibre should be at least 25-35 g/d,

.................i.e. approximately 3 g/MJ.

.................Children: An intake corresponding to 2-3 g/MJ is appropriate for children from

.................2 years of age.

..................From school age the intake should gradually increase to reach the recommended

..................adult level during adolescence.


Comment by BH

According to present recommendations in NNR4 children should have about double the amount of fiber per kg bodyweight as an adult. Adults are recommended about 30 g/day or 0,4 to 0,6g/kg while children are supposed to have 3 g/MJ which will be 12 g fiber per day or 1,2 g/kg. This is due to recommendations are associated to the amount of energy eaten instead of kg bodyweight. Children have a higher energy intake per kg bodyweight due to the fact that they need more energy to grow and need more energy to compensate for a larger skin surface heat loss per kg bodyweight than adults.


As fibers are associated to an increased risk of colon cancer [7], [8], there is an increased risk that children and adults get colon cancer with the present recommendations.


So the new recommendations should be:


NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.


...................Mikael Fogelholm

...................Intake of added sugars should be kept below 10 E%.

...................Limitation of the intake of added sugars from particularly sugar-sweetened

...................beverages and sugar–rich foods is recommended in order to reduce the risk for

...................type 2 diabetes, weight gain and dental caries.

....................•A limitation of the intake of added sugars is also necessary to ensure an

....................adequate intake of essential nutrients and dietary fibre, especially in children

....................and adults with a low energy intake.


Comment by BH

In NNR4 there is a recommendation to keep intake of added sugars to below 10 E%.


It seems that the NNR4 have disregarded that carbohydrates and sugar are synonyms as they recommend a limit of carbohydrates in the form of “added sugar” but recommend 50-60 E% of carbohydrates in a day.


 It is good that NNR 2012 will limit the intake of sugar to ensure an adequate intake of essential nutrients. All kinds of carbohydrates consists of sugar which are nonessential and contains 1 to 1/1 000th (or less) of minerals and vitamins compared to food of animal origin [9]. Then we have to re-establish what the essential nutrients are.


So the new recommendations should be:


NNR 2012 recommend an adequate intake of essential nutrients of protein, fat, minerals and vitamins, preferable in the form of animal proteins and fats which contain enough minerals and vitamins.


Vegetables are insufficient in amino acids, all fatty acids including long chain polyunsaturated fatty acids, minerals and vitamins [10] but vegetables are excellent to improve the visual impression of food. Fruit with 10 % sugar content may decrease to maximum one fruit per day


......................Also, the NNR 2012 finds no justifications to include a diet-based

......................recommendation for GI in NNR.


Comment by BH

This is correct as GI is a partial and indirect measurement of carbohydrates, we are just measuring the glucose level in the blood, we are not measuring all other sugars like fructose, galactose nor are we measuring the continuous insulin level that delays the uptake of sugars in an attempt to normalize a too high blood glucose level.


Also, the SBU report Mat vid diabetes of 2010 found no justification to include a diet-based recommendation for GI


So an added recommendations should be:


NNR 2012 finds no justifications to include a diet-based recommendation for GI in NNR.


......................Also, NNR4 recommends specific “quality” of fat.


Comment by BH

As all mammals have the same temperature of 37ºC, they all have the same animal fat composition with the same melting temperature for correct function. This means animal fat has shy of 50 % saturated fat, shy of 50 % monounsaturated fat and about 5 % polyunsaturated fat. This is the ideal mixture of fats and the fat has a correct melting temperature to support correct function of fat in tissues and cell membranes.. 


 Conflict of Interest

Mikael Fogelholm is Editor-in-Chief for the publication Food & Nutrition Research where all the research behind the NNR5 is published. Food & Nutrition Research is owned by Swedish Nutrition Foundation (SNF) whose members are the food industries.


So all the research is published in a publication that has serious Conflict of Interests. And Fogelholm has not declared his Conflict of Interest as an Editor-in-Chief in his CoI decaration to NNR5.



Mora 2013-04-08


Björn Hammarskjöld

M.D., Ph.D.

Independent scientist in Nutrition

[1] Livsmedelsverkets databas modersmjölk

[3] Based on old fashioned physiology, biochemistry and endocrinology, e.g. Lagerholm, J., Hemmets Läkarebok, Fröléen & Comp, Stockholm, 1921 and Ganong, W., Medical physiology, Lange Medical Publications, Los Altos, CA, USA 1971.

[4] Wirfält, Mattisson et al Postmenopausal breast cancer is associated with high intakes of omega6 fatty acids (Sweden). Cancer Causes Control. 2002 Dec;13(10):883-93.

[5] Ramsden, Zamora et al Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 2013;346:e8707 http://www.bmj.com/highwire/filestream/629053/field_highwire_article_pdf/0/bmj.e8707

[6] SBU rapport Mat vid diabetes 2010. No scientific support for NNR4 recommendations.

[7] Park Y, et al. Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies. JAMA 2005; 294: 2849-2857.

[8] Fuchs CS, et al. Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women. New Engl J Med 1999; 340: 169-176, 223-224.

[9] Livsmedelsverkets databas http://www7.slv.se/Naringssok/

[10] Livsmedelsverkets näringssök http://www7.slv.se/Naringssok/