217. Achieving Change: the Lessons of Hillsborough

Readers of this blog will be aware that there is an overwhelming case for changing the dietary advice on official guidelines here in the UK and in many other nations. While there are compelling arguments for a complete re-vamp of these recommendations, the barriers to change must not be under-estimated as illustrated by the aftermath of the tragedy at Hillsborough in Sheffield.

Results of the Hillsborough Inquest

The findings of the latest inquest into the events at the football match in which 96 fans from Liverpool lost their lives 27 years ago in 1989 have just been announced.

The jury reached the following decisions:

  • The match commander Chief Supt David Duckenfield was “responsible for manslaughter by gross negligence” due to a breach of his duty of care
  • Police errors caused a dangerous situation at the turnstiles
  • Failures by commanding officers caused a crush on the terraces
  • There were mistakes in the police control box over the order to open the Leppings Lane end exit gates
  • Defects at the stadium, including calculations over crowd capacity, contributed to the disaster
  • There was an error in the safety certification of the Hillsborough stadium
  • South Yorkshire Police (SYP) and South Yorkshire Ambulance Service (SYAS) delayed declaring a major incident
  • The emergency response was therefore delayed
  • Sheffield Wednesday failed to approve the plans for dedicated turnstiles for each pen
  • There was inadequate signage at the club and misleading information on match tickets
  • Club officials should have requested a delay in kick off as they were aware of a huge number of fans outside shortly before the game was due to start.

It was also highly significant that the jury decided that the fans did not contribute to the disaster in any way. The Prime Minister stated that this was “official confirmation” fans were “utterly blameless”.

These decisions are the culmination of a long and persistent battle on the part of the relatives of the deceased to have official recognition of what really happened on that April day in 1989.

This inquest clearly accepts that there was gross negligence on the part of the police in the way the crowds were controlled. Over the years there have been numerous inquiries and investigations, including an earlier inquest, which have failed to uncover the truth. However, the Inquiry by Lord Justice Taylor in the immediate aftermath of the incident was pretty well spot on but I as I explain below was completely disregarded.

The fact that the truth has finally come out is due entirely to the tenacity of the relatives who refused to give up what at times might have seemed to be an impossible task.

The fundamental problem was the refusal by the SYP to accept the responsibility for negligence which has finally been exposed. In fact the police took unprecedented steps to blame the fans themselves for what went wrong.

 

The Taylor Inquiry

Within months, the interim report of the Taylor Inquiry was presented to the Home Secretary, Douglas Hurd.

Here is how one of his aides described her perception of the Taylor report:

“The criticism of the police is very damning. The Chief Superintendent in charge is shown to have behaved in an indecisive fashion. To make matters worse, the senior officers involved sought to duck all responsibility when giving evidence to the Inquiry. Their defensiveness apparently infuriated the Judge”. (1)

In a briefing to Prime Minister Margaret Thatcher, Hurd stated that:

 “But the most severe criticism is directed at the South Yorkshire Police; Taylor concludes that the main reason for the disaster was the failure of police control. The actions of individual senior officers, especially Chief Superintendent Duckenfield, are criticised; reference is made to poor operational orders, lack of leadership, and evidence of senior officers given to the Inquiry is described as defensive and evasive. It would be for the Chief Constable, and perhaps the Director of Public Prosecutions and the Police Complaints Authority, to act on the conduct of individual officers.”

He also noted that:

“Liverpool fans – who have caused trouble in the past – will feel vindicated’ and ‘[a]ggressive behaviour by fans towards the police may be encouraged’. While being ‘a very sorry episode … there seems no reason to think that the report’s conclusions are wrong”. (2)

Margaret Thatcher’s response

It is extremely revealing to note the Prime Minister’s response:

“What do we mean by ‘welcoming the broad thrust of the report’? The broad thrust is devastating criticism of the police. Is that for us to welcome? … Surely we welcome the thoroughness of the report and its recommendations” – M.T. [Margaret Thatcher] (3).

South Yorkshire Police continue to blame the fans

As a result, any criticisms of the police which Douglas Hurd was prepared to accept were effectively quashed by Margaret Thatcher. Essentially this got the SYF off the hook and even in this last inquest they have been able to maintain their original stance.

According the report of the inquest in The Guardian:

“The present-day South Yorkshire police force itself and the Police Federation also argued that Liverpool supporters outside the Leppings Lane end could be found to have contributed to the disaster because “a significant minority” were alleged to have been drunk and “non-compliant” with police orders to move back. Yet survivors gave evidence of chaos at the Leppings Lane approach, no atmosphere of drunkenness or misbehaviour, and no meaningful police activity to make orderly queueing possible in that nasty space.

Many officers who made such allegations against supporters in their original 1989 accounts, which the force notoriously vetted and altered, maintained that stance under scathing challenge by the families’ barristers. For periods, these inquests felt like an inversion of a criminal prosecution, in which police officers were repeatedly accused of lying, covering up and perverting the course of justice, while sticking insistently to their stories”(4).

Essentially the Taylor report got it right but the intervention of Margaret Thatcher has meant that what should have been resolved has been allowed to drag on for many years. Despite heroic efforts by the campaigners, the establishment continued to defend the indefensible for many years.

Implications for nutrition policy

There are very definite lessons here for those who advocate a wholesale alteration on nutrition policies. It must be emphasised that Hillsborough is not an isolated case. It is exactly the same story with several different child abuse cases and in Stafford Hospital where there were systematic failures resulting in the deaths of up to 1200 patients.

The common theme is that those directly involved use every trick in the book to avoid accepting responsibility and if at all possible blame those who have a grievance. However, where the system breaks down is the failure of those charged with ensuring the maintenance of high standards, especially senior civil servants and politicians.

Those of us who wish to see an alteration in nutrition policies are faced with exactly the same obstacles. The position can be illustrated very neatly by those who suffer from Type 2 Diabetes (T2D). The official advice is to reduce the intake of fat and to increase that of carbohydrates. It is established that this is not effective and actually makes the condition worse.

This means that here in the UK, millions of patients are being denied the advice, which would help them to cope with their T2D. As a consequence, very many of them are suffering unnecessarily and dying prematurely. The number of people involved is enormous compared to those lost at Hillsborough. Because of the failure to address the issue, the problem continues.

When I wrote to my MP, Julian Smith, he passed my letter to the Department of Health and I received the following response from Minister Jane Ellison:

“Preventing diabetes and promoting the best possible care for people with diabetes is of great concern to the Government. The NHS Five Year Forward View set out a commitment to implement the National Diabetes Prevention Programme to provide lifestyle programmes to pre-diabetic patients in order to reduce the risk of their developing diabetes. The Department is also building on the Diabetes Prevention Programme to improve the outcomes of people with and at risk of diabetes and will put forward our plans in due course.”

In other words:

“we will carry on what we are doing already”. She did not even have the courtesy to explain why I was wrong. Perhaps an official has scribbled a damning comment on my letter which the Minster (or whoever drafted the reply) has used to justify her response. Unfortunately this is probably locked away for 30 years.

Which is exactly the response the Hillsborough campaigners got for many years. One of the weaknesses of the T2D issue is that there is no group with the dedication, persistence and resources of those concerned with the Hillsborough incident. So if any progress is to be achieved, then this may well be an essential requirement. Because so relatively few understand what is wrong, it is crucial to disseminate our current knowledge and insight as widely as possible. Hopefully as more and more appreciate what is really happening, the pressure for a totally new approach will build up so that government will be forced to act. But be prepared for a long and difficult battle.

References

Note: for the first 3 references it is necessary to go to the report of the independent inquiry and then click on the appropriate link at the bottom of the page. These are all to government documents released prior to the usual 30-year embargo which provide fascinating insight into the views of Ministers and their advisers.

  1. http://hillsborough.independent.gov.uk/report/main-section/part-2/chapter-6/page-8/ (73)
  2. http://hillsborough.independent.gov.uk/report/main-section/part-2/chapter-6/page-8/ (74)
  3. http://hillsborough.independent.gov.uk/report/main-section/part-2/chapter-6/page-8/ (75)
  4. http://www.theguardian.com/football/2016/apr/26/hillsborough-disaster-deadly-mistakes-and-lies-that-lasted-decades

216. Faith in Medicine: Is this a Religion?

As I was sorting out some old books, I came across this one entitled: “Confessions of a Medical Heretic” written by Dr Robert S Mendelsohn, which was first published in 1979 (1). This is an absolutely damning account of medicine and although it is based on the author’s experience in the USA, there are elements which apply to most other developed countries. While it is almost 40 years since it appeared, the critique is still valid. Arguably things have got even worse since then. The position in the UK is still some way behind that of the USA but all the indications are that it is moving in the same direction.

In this blog, I will just highlight some of the main themes covered in the book. I fully appreciate that there are many who will not accept the analysis and conclusions. However many important questions are raised which deserve to be considered and answered. The author introduces himself as follows:

“I do not believe in Modern Medicine. I am a medical heretic. My aim in this book is to persuade you to become a heretic, too.”

Doubts about modern medicine

He goes on to explain that when he was at medical school he believed what he had been taught and went along with the rest of the profession. Gradually he came to realise that many of the procedures which are widely used are not only ineffective but positively harmful. One example he cites is the use of radiation to treat a thyroid condition which clearly was responsible for the development of tumours. In his own words:

“I believe the Modern Medicine’s treatments for disease are seldom effective, and that they’re often more dangerous than the diseases they’re designed to treat.”

Dangerous procedures

To make matters even worse, there is are numerous dangerous procedures which are widely used for non-diseases. It would be possible to dispense with 90% of Modern Medicine and the result would be an immediate improvement in public health standards. In one clinic in Cleveland over a one-year period, there were 2,980 open-heart operations, 1.3 million laboratory tests, 73,320 electrocardiograms, 7,770 full-body X-ray scans, 210,378 other radiological studies, 24,368 surgical procedures. The author states quite bluntly that none of these procedures has been proved to maintain or improve health. No doubt many would challenge this conclusion but there have been enough examples in recent years to indicate that he has a very valid viewpoint.

Modern medicine is a religion

The argument is presented that most people have faith in their doctors and Dr Mendelsohn concludes that Modern Medicine is neither an art nor a science but is essentially a religion. His justification is that this is the only possible explanation why so many people submit themselves to all sorts of treatments and procedures. He poses the following question:

“Would people allow themselves to be artificially put to sleep and then cut to pieces in a process they couldn’t have the slightest notion about—-if they did not have faith?”

There are many examples of procedures which according to Dr Mendelsohn do more harm than good. These include:

  • Laboratory tests. In 1975, a nationwide survey by the Centers for Disease Control (CDC) reported that up to 40% of bacteriological testing was unsatisfactory and over one quarter of all tests were not accurate. The CDC only regulates 10% of laboratories which means there is even less control over the others. A study in New Jersey found that only 20% of laboratories produced reliable results more than 90% of the time.
  • Although this book was written before statins appeared, “cholesterol lowering” was already established. The drugs in use at the time could cause all sorts of adverse side effects (ADRs) including fatigue, weakness, headache, dizziness, muscle ache, loss of hair, drowsiness, blurred vision, tremors, perspiration, impotence, decreased sex drive and rheumatoid arthritis. That time the following information was also supplied with the drug:
  • “It has not been established whether drug-induced lowering of cholesterol is detrimental, beneficial, or has no effect on morbidity or mortality due to atherosclerotic coronary heart disease. Several years will be required before scientific investigations will yield the answer to this question.”
  • Blood pressure (BP) measurement. Even though raised BP may be just a temporary blip drugs may be prescribed. Many of these have ADRs. However a study conducted in 1970 found that these drugs can cause non-fatal heart attacks and pulmonary embolisms, which were not outweighed by any reduction in mortality.
  • Many women are subjected to breast X-rays despite the fact that this procedure is not justified for women under 50 years old with no symptoms and with no family history of breast cancer. This procedure is also of dubious value for women over 50 because the breasts are particularly sensitive to X-rays.
  • The widespread use of antibiotics. Very often penicillin is prescribed for conditions such as the common cold even though this is a viral infection which is not affected by the treatment. Nevertheless it can cause reactions including skin rash, vomiting and diarrhoea. Tetracycline was being overused so much in the 1970s that the FDA had to issue a warning because of the damage it could cause during the development of teeth during pregnancy and early childhood. We are now having to cope with the extensive resistance to many antibiotics which has occurred which means that many antibiotics are no longer effective to deal with the genuine threats of bacterial infections.
  • Many drugs have ADRs and many individuals have suffered because of their use. For example, there was a high rate of vaginal cancer in the daughters of women taking diethylstilbesterol (DES) and the women themselves had an increased death rate from cancer.

Cozy relationship

One specific issue highlighted is the cozy relationship which existed between the drug companies and the doctors. At that time the companies were spending an average of $6,000 per annum on every doctor in the USA in order to influence them to use their drugs. Since most of the information on the efficacy and ADRs of these drugs is based on information generated by the companies themselves, there has to be serious doubts about the quality and reliability of the data. An investigation by the FDA found that 205 of physicians doing clinical trials were guilty of unethical practices, including giving incorrect doses and falsifying records. In one third of the reports checked the trial had not actually been conducted. In another third, the correct protocol had not been followed.

Dr Mendelsohn is highly critical of the medical profession. In his view they have allowed themselves to be corrupted and are much more interested in making money than in protecting and helping their patients.

Things are no better to-day

Although it is well over 30 years since this book was written, there have been numerous reports which not only confirm what Dr Mendelsohn has described but conclude that things have deteriorated since. For example, in his Reith lectures, delivered in 2014, Dr Atul Gawande described a comparison he made between the medical facilities in 2 Texas communities (2). One was McAllen and the other was El Paso County. Both of these counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006, Medicare expenditures which is the best approximation of the costs of health care in El Paso was $7,504 per enrollee—half as much as in McAllen (3). There was no evidence to indicate that the treatments and technologies available at McAllen were any better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. In fact Mc Allen actually has fewer specialists than the national average.

Dr Gawande eventually gained access to commercial insurance data which revealed that compared with patients in El Paso and the country as a whole, patients in McAllen were given more diagnostic testing, more hospital treatment, more surgery and more home care. More detailed information was obtained from Medicare payment data. This showed that between 2001 and 2005, critically ill patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received 20% more abdominal ultrasounds, 30% more bone-density studies, 60% more stress tests with echocardiography, 200% cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and 530% more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. So Dr Gawande had absolutely no doubt that the primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Conclusion

Clearly Dr Mendelsohn takes an extreme view. If a person is involved in a motor vehicle accident or is having difficulty breathing then medical assistance is definitely required and can make a big difference. So there are times when it is essential. However, this does not mean that much of what is presented here can be discounted.

All the indications are that much of what he says is correct. The current approach is so deeply embedded and reinforced by powerful vested interests that it will not be changed easily.

References

  1. Robert S Mendelsohn (1979) “Confessions of a Medical Heretic”. Warner Books: New York
  2. http://downloads.bbc.co.uk/radio4/open-book/2014_reith_lecture3_edinburgh.pdf
  3. http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum?currentPage=all

 

215.The Shaky Foundations of the Case for Statins

Currently there is widespread use of statins which is justified on the grounds that those who receive regular treatment will have a reduced risk of developing heart disease. Ideally there should be thorough evaluations which demonstrate the extent of the benefits as well as comprehensive knowledge of the adverse side effects which may arise. However in the real world, doubts persistently arise about both of these sides of the equation.

About 2 years ago, NICE decided to go ahead with its proposal to recommend that those with a 10% risk of developing heart disease should be considered for treatment with statins. In an article in the BMJ, Professor Mark Baker, the director of the Centre for Clinical Practice at the NICE, stated that 77 people would need to take statins for 3 years for one to benefit (1). He justified this on the grounds that with blood pressure lowering drugs, 104 patients would have to be treated for one to benefit.

The figures quoted only apply to those who have heart disease in the past. However when statins are used for primary prevention, which effectively is what is being proposed, there is no benefit in terms of improvement in life expectancy.

I strongly suspect that most people who are being advised to have statins, usually very strongly, they would be very surprised at that their personal chances of a benefit is so small. About a year ago, Sir Rory Collins who is a powerful advocate of statins and runs an organization at the University of Oxford to analyse drug company data on statins admitted that the information on side effects was incomplete (2). In particular they had ignored reports from doctors and patients of serious muscle pains, diabetes, cataracts, memory loss, brain fog and declining libido.

With this background a recent critical review by Michel de Lorgeril and Mikael Rabaeus provides valuable insight into the relevant background (3).

One of the fundamental points made by these authors is that there are serious doubts about the reliability of Randomized Controlled Trials (RCTs) to evaluate drugs prior to 2005/6. This arose because of the scandals related to a number of drugs including Vioxx. This was a painkiller produced by Merck, which was responsible for at least 55,000 deaths and resulted in compensation of almost $5 billion. As a consequence new regulations were introduced in both Europe and the USA which required much greater transparency about the investigations into drugs in order to gain approval. The authors of this review conclude that we cannot be completely confident of the validity of any data on statins which originated before 2005/6.

In the light of this, they have considered the trials which have been conducted since the new regulations came into force. It was decided that the only trials which were acceptable were those in which the statin was tested against a placebo. There were only 4, all of which used rosavustatin, which complied with this criterion, namely:

  • The JUPITER trial, in which the patients were considered free from cardiovascular disease but had a rather moderate risk of cardiac death.
  • The CORONA trial, in which patients were survivors of a previous acute myocardial infarction (AMI) and were at high risk of AMI recurrence and cardiac death.
  • The GISSI-HF trial, in which all patients had cardiac dysfunction, 50% had a previous AMI and 50% suffered another heart disease.
  • The AURORA trial, in which patients presented with severe renal failure. 50% had previously suffered an AMI or other heart complications.

JUPITER

This trial has been the subject of considerable controversy because of the fact that it was stopped early. This is indirect conflict with accepted best practice because the effects may vary with time. In particular, the impact may diminish as the trial progresses. I have discussed the JUPITER trial in an earlier blog (4). The publication of the results was an absolute shambles. There were errors in the initial mortality data released and there were at least 5 different versions of the cardiovascular mortality reported. It turned out that there was no difference between the placebo and the statin groups in cardiovascular mortality. There was actually a small difference in the all-cause mortality but this was not validated by the FDA statisticians. It is not possible for independent researchers to investigate this any further because the raw clinical data have not been released by the drug company. There was also a significant increase in the incidence of Type 2 Diabetes (T2D) in those treated with rosavustatin.

CORONA

Although those on the rosavustatin showed a marked reduction in blood cholesterol levels, there was no clinical benefit whatsoever, especially in terms of survival. There was no difference between the groups in the incidence of cardiac death, AMI, and other nonlethal ischemic complications. In an attempt to explain the failure it was postulated that the statin would not be expected to protect “elderly heart-failure” patients, presumably on the grounds that the damage had already progressed too far. However when the data were analysed according to age and degree of cardiac dysfunction at the outset, no benefit was found in any cohort which effectively destroys that excuse.

GISSI-HF

This trial produced exactly the same results as the CORONA one and confirmed that rosavustatin did not provide any benefit for those who already suffered from heart disease.

AURORA

These patients with renal failure have a high risk of an AMI and so would be expected to benefit from treatment with a statin. In fact, the results provided further confirmation that there no clinical benefit from the statin treatment despite a marked reduction in the blood cholesterol level.

Conclusions

It is now abundantly clear that we do not have good quality research to justify the use of stains for either primary or secondary prevention. Even though new regulations have been introduced the degree of transparency is still not adequate and the drug companies continue to deny access to the raw data by independent researchers. It is essential that this happens if we are to be confident in the conclusions which are crucial for decisions made by health professionals and governments on statin usage. The review summarises the present position as follows:

“The obvious final conclusion for physicians is that the present claims about the efficacy and safety of statins are not evidence-based.”

In this blog I have only been able to highlight some of the key points in the review, which is very well worth studying carefully, especially if you are being advised to be treated with statins.

References

  1. http://www.bmj.com/content/349/bmj.g4694
  2. http://healthinsightuk.org/2015/02/19/keep-statin-supremo-away-from-the-missing-side-effect-data/
  3. http://jcbmr.com/index.php/jcbmr/article/view/11/26
  4. http://vernerwheelock.com/144-more-about-statins-the-jupiter-trial/

214.Immunotherapy: Why It Is Not the Answer to Cancer

I have just been reading the current issue of “Time” magazine (4th April 2016) which has a long feature on the subject of immunotherapy. Essentially this approach to the treatment of cancer is based on developing drugs, which have the objective of improving the immune system and therefore have the capability of attacking the cancer cells. It is claimed that one of these drugs, pembrolizumab, was used successfully to treat former President Jimmy Carter’s cancer of the brain. Currently there are 3,400 trials being conducted in the USA to evaluate this type of drug.  Much of the article is about patients suffering from cancer who are desperately trying to sign up for these trials in the hope that the treatment will provide a cure.

It is clear that this approach is being pushed by pharmaceutical companies. It has been estimated that these immune-based treatments would generate sales of between $35 and $70 billion per year, which would exceed that of statins. The costs of treating a single patient for one year with one of these drugs is about $200,000, which obviously is not feasible for treating the 14 million cancer patients in the USA.

So while this approach may be more effective than most of the drugs already in use, it is evident that the impact will be limited. This is yet another example of a strategy in which the prime objective is to make huge profits for drug companies but there will be no significant gain in terms of tackling the disease of cancer.

The article makes it very clear that those who have cancer and their friends are looking for the “magic bullet” solution, which almost certainly does not exist.

Although there may be some success with this approach, I am highly sceptical that it will make will make a major contribution to the solving the cancer epidemic. The fundamental problem is that like all the other conventional treatments for cancer there is an almost total failure to identify the primary cause and address it. I recently wrote a blog in which I compared Type 2 Diabetes (T2D) to a flood of water in a house caused by a burst pipe (1). The only difference is that the body is flooded with glucose not water. It is obvious that the first action must be fix the burst pipe so that the flow of water is stopped. Logically the same approach should be applied to T2D which means that the supply of glucose to the blood must be reduced substantially, by lowering the consumption of sugar and carbohydrates. This is rarely done and unbelievably, patients are advised to reduce the intake of fat and INCREASE consumption of carbohydrates. If the same approach was applied to the flooded house, the occupants would be told:

“Sorry, the inflow of water cannot be stopped. Here are some buckets and mops. You will just have to cope as best you can as long as you live in this house.”

Clearly this is ridiculous but the fact remains that is exactly how conventional medicine is dealing with T2D! Confirmation is provided by research (2) and by the experience of many individuals who have effectively treated the T2D by altering their diet to reduce the amount of sugar and carbohydrates (3).

It is my contention that this analysis applies equally well to cancer. It is evident that most cancers are caused by environmental factors such as exposure to carcinogens and/or poor nutritional quality of the diet. So it follows that even if a tumour is removed or destroyed, the cause is still in place and is highly likely to produce other tumours. It is significant that one of the few major successes has been with lung cancer, where smoking cigarettes was found to be the major factor responsible for its development.

Less well known are the case histories of many individuals who have successfully overcome their own cancer by making radical changes to their habitual diet. This also makes sense from a scientific perspective with the recognition that cancer is a metabolic disease as advocated by Thomas Seyfried (4) and some other researchers.

The rationale is that there are fundamental differences between cancer cells and normal healthy cells in the way they function. In particular, cancer cells depend on a source of glucose for their energy requirements which is referred to as the “Warburg effect” after the distinguished German scientist who made the discovery. By contrast, normal cells can utilise ketones which are derived from fat as well as glucose. The significance of these differences is that if the cancer cells are starved of glucose then it will be impossible for them to survive and thrive. It follows that this is what would happen if the diet is altered so that the amount of sugar and carbohydrates is kept to a minimum or ideally not present at all. This is precisely what Archie Robertson did and he tells his story in a recent blog (5). Archie developed oesophageal cancer and was told by his specialist that surgery would be essential. However he and his wife devised a diet which was very low in sugar/carbohydrates but had a relatively high content of fat so that the body was geared up to producing ketones (ketogenic diet). Within a few months it was evident that surgery was not necessary and CT scans showed that the tumours had gone.

It must be emphasised that this is by no means an isolated case. Other examples are Raymond Francis (6) and David Servan-Schreiber(7).

Clearly these results are very encouraging but there needs to be more studies done to gain further insight and provide a powerful evidence base to justify treatments based on this approach. It is also necessary to determine the optimum diet and understand how a strategy based on diet should be related, if at all, to the conventional treatments. The hard reality is that there is nothing like the same incentive for companies to conduct investigations along these lines because the financial rewards of dietary treatments are insignificant when compared with the profitability of drugs!

References

  1. http://vernerwheelock.com/170-a-flood-of-sugar/
  2. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  3. http://vernerwheelock.com/76-diabetes-can-be-conquered/
  4. https://www.youtube.com/watch?v=SEE-oU8_NSU
  5. http://vernerwheelock.com/212-recovering-from-cancer-case-history-of-archie-robertson/
  6. http://vernerwheelock.com/209-curing-and-preventing-cancer-with-diet/
  7. http://vernerwheelock.com/47-anticancer/

 

213. The New Eatwell Guide

Public Health England (PHE) has just launched the latest version of the Eatwell Guide (1). In the related PR the following points were made:

  • There is greater prominence for fruit, vegetables and starchy carbohydrates, preferably wholegrain, in the new guide. PHE recommends consuming 30 grams of fibre a day, the same as eating 5 portions of fruit and vegetables, 2 whole-wheat cereal biscuits, 2 thick slices of wholemeal bread and 1 large baked potato with the skin on. Currently people only consume around 19 grams of fibre per day, less than 2 thirds the recommendation.

 

  • Adults should have less than 6 grams of salt and 20 grams of saturated fat for women or 30 grams for men a day.

 

  • SACN recommends that the dietary reference value for total carbohydrate should be maintained at a population average of approximately 50% of dietary energy. Carbohydrates are a good source of energy and SACN recommends that we should continue to base our diets on them. Their report concludes that total carbohydrate intakes at the current recommended levels show no association with the incidence of cardiovascular disease, type 2 diabetes, glycaemia or colo-rectal cancer.

 

According to Dr Alison Tedstone, chief nutritionist at PHE:

“The evidence shows that we should continue to base our meals on starchy carbohydrates, especially wholegrain, and eat at least 5 portions of a variety of fruit and vegetables each day.

“On the whole, cutting back on foods and drinks that are high in saturated fat, salt, sugar and calories would improve our diets, helping to reduce obesity and the risk of serious illnesses such as heart disease and some cancers. A smoothie, together with fruit juice, now only counts as 1 of your 5 A Day and should be drunk with a meal as it’s high in sugar.”

Dr Lisa Jackson said:

  • “As a GP it is important that I have engaging and meaningful resources like the Eatwell Guide to support my patients to eat more healthily. I encourage professionals helping people to follow a healthy, balanced diet to use the new Eatwell Guide which will help reduce their risk of developing long term illnesses such as heart disease, Type 2 diabetes and some cancers.”

 

So although the dangers of sugar have clearly been recognised, essentially we are being bombarded with the same old rubbish that got us into the mess in the first place. An excellent detailed critique of the Guide has been done by Zoe Harcombe which explains in detail why there are fundamental flaws in the justification of the dietary advice (2).

Lots of carbs

It really is unbelievable that the official advice from PHE continues to emphasise the importance of having such a high proportion of the diet as carbohydrates. Obviously the authorities are relying very heavily on the recommendations made by the SACN group which produced a report on carbohydrates which was released in July 2015 (3). The big problem with this report is that it restricted its deliberations to those research studies which it considered relevant. There was a total failure to address current public health concerns. It is my contention that Type 2 Diabetes (T2D) is one of the best indicators…essentially it is the tip of the iceberg because those with T2D have a greatly increased risk of developing most of the serious chronic diseases/conditions including heart disease, Alzheimer’s Disease (AD) and cancer. In the past 15 years the incidence has doubled and all the projections accept that it will continue to increase. It is glaringly obvious that the present strategies are not working. So from a policy perspective it is paramount to focus on this issue.

Insulin resistance

There is now no doubt that insulin resistance is the key concept to our understanding of T2D and the many other forms of ill-health that are associated with it. This was conceived by Gerald Reaven as long ago as 1988 (4). It is caused by continued high levels of insulin in the blood. This because the insulin is needed to control excess glucose in the blood, which in turn is caused by a habitual diet which is high in sugar and carbohydrates. When this happens the various organs in the body develop insulin resistance and as a consequence the pancreas has to produce even more insulin to achieve the same effect. Ultimately there is catastrophic failure because the pancreas is unable to meet the demand for insulin. It is at this point that the blood glucose is out of control with the result that the level in the blood starts to increase. This is full-blown T2D.

The main carbohydrate in foods is starch which is broken down to glucose. It is present in bread, flour, potatoes, pasta and rice. Hence it follows that the obvious answer is to limit the intake of carbohydrates as well as sugar. There is no disputing the logic of these conclusions. We do not need complicated scientific trials to prove this. Nevertheless there is research which produces the  expected results (5) not to mention the numerous individuals who have found out for themselves that their T2D can be effectively controlled by a diet which has a low content of sugar and carbohydrates. Invariably these people have replaced the carbohydrates with fat, which includes many sources of saturated fats (SFAs) such as meat, dairy and coconut oil.

Conclusion

In the light of this knowledge, it is completely irresponsible for government and the health professions to recommend such high intakes of carbohydrates. It really is not rocket science to accept that the key to an effective policy on T2D must focus on the factors which contribute to the development of insulin resistance. Therefore instead of recommending a high intake of carbohydrates, the emphasis should be to reduce the consumption. It is somewhat disingenuous that the official view is caused by insufficient insulin production (6) but of course this suits the pharmaceutical industry very nicely. A policy based on changing the diet means that the demand for drugs would be reduced drastically.

The fundamental reason for the advice to consume plenty of carbohydrates originates with the vilification of the SFAs, which takes us back to the cholesterol fiasco. We now know that most this is nonsense. In particular we know that those who have cholesterol levels which comply with the guidelines actually have the highest death rates (7).

The present policy is an absolute scandal which appears to be in the best interests of the drug companies very much at the expense of the personal health. If we are to make any kind of progress it is imperative that more and more people understand what is actually happening so that they can exert pressure for a fundamentally different approach that will result in improved standards of public health.

References

  1. https://www.gov.uk/government/news/new-eatwell-guide-illustrates-a-healthy-balanced-diet
  2. http://www.zoeharcombe.com/2016/03/eatwell-guide/
  3. https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report
  4. G Reaven (1988) Diabetes 37 (12) pp 1595-1607
  5. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  6. http://vernerwheelock.com/?p=863
  7. http://vernerwheelock.com/?p=838

212. Recovering from Cancer. Case History of Archie Robertson

In a recent blog, I emphasised the potential for using a change of diet as a form of treatment for cancer (1). It just so happens that as I was working on that blog I heard from Archie Robertson via Facebook who has made an amazing recovery from a very nasty cancer. I am most grateful to him for this account of his experience which should provide hope and encouragement to many faced with a similar disease. Here is his story.

Background

“I’m a 60-year-old Scot who has been living in France since 1983. I’m a physics graduate, and spent over 20 years in computing, before becoming a translator of French to English in various fields, a teacher of English as a foreign language, and adapting my computer skills to the Mac. I started helping visually-impaired people with their Macs because my wife is blind. She is also a programmer and translator, and uses a Mac for all her work.

I’ve been a sceptic about medicine for many years, because of the numerous mistakes made in the treatment of my wife. But at the end of 2008, we both read Barry Groves’ “Trick and Treat: How ‘healthy eating’ is making us ill”(2), which made total sense to us. We changed to a low-carb way of eating. I lost a great deal of weight, finding renewed energy, stopping the sleep apnoea, and even snoring no more! While Anne did not slim very much, she did reverse the previous decline in her liver and kidney functions. These are monitored closely because she is a double transplant recipient. Prior to this she needed to be treated twice a year with antibiotics, but since April 2009 this has not been necessary.

The problem starts

In autumn 2013 bad lumbago forced me to take an oral anti-inflammatory (AI), which gave me gastro-œsophageal reflux disorder (GORD or GERD). This persisted long after I stopped the AI, I assume because the lower sphincter of my œsophagus was damaged. I had no idea that it could cause cancer!

Things get worse

During May and June 2014, I found I had more and more difficulty in swallowing, so I saw a gastroenterologist and had an endoscopy on 29th July. The results showed that I had squamous-cell carcinoma of the œsophagus, and the gastrointestinal surgeon I saw on 5th August told me that I should stir a raw egg into my soup, and that I would be eating a lot of ice cream! His only dilemma was whether surgery should precede or follow the chemo- and radiotherapy that were all inevitable.

Surgery is offered

The radiation oncologist that I saw on the same day decided that surgery should come later, and prescribed a programme of chemo- and radiotherapy, intended to shrink the tumour enough to make the surgery easier. Halfway through this dual treatment, I saw the surgeon again. He told me “the good news” that he would be able to operate on me, that the treatment was working “exceptionally well” and that the tumour had “shrunk hugely”, but when I speculated as to whether surgery would prove necessary after all, he growled, “Don’t kid yourself! Œsophageal cancer always requires surgery!”

The ketogenic diet kicks in

During the treatment, I explained to the oncologist that I was following a strict ketogenic diet (low carb high fat) (LCHF) and to his credit he expressed no opposition but only mild skepticism.

On 8th December I had a CT scan. Surgery had been scheduled for 10th December, but I had never consented to it. So I cancelled it on the grounds that there would not be time to interpret the scan results properly. There was some confusion over the Christmas period, so I only received the results of the scan on 3rd February.

I saw the oncologist again on 23rd February 2015. He promptly castigated me for “only having done half the treatment”. Nevertheless, the CT scan had shown further significant shrinkage in the tumour, and that the secondary adenomas had disappeared. As I was by then eating almost normally again, I insisted that I did not want surgery if it could possibly be avoided, and we agreed that more tests should be scheduled.

On 9th March, I had another endoscopy and a PET scan, and the preliminary reports from both were encouraging. I saw the oncologist again on 30th March. He told me that the biopsies from the endoscopy were all negative, and that the PET scan showed only “echoes” of the tumour. He described me as “a right mule-headed so-and-so”, but had to admit that I’d not been wrong. Further tests were scheduled for 29th June.

 

Lessons learned

So, what did I learn from my own research into the topic? First of all, I discovered that œsophageal cancer is one of the deadliest, with an untreated five-year survival rate of 5%, and even with treatment, only 25% to 40%. According to the surgeon, that could be raised to 65%. Known associated risk factors include gastro-œsophageal reflux disorder (GORD) (40% of all cases), smoking, consumption of spirits, very hot drinks, and eating fast, all of which applied to me. And why is it so deadly? Because of the difficulty in swallowing, and the associated immense weight loss (I lost 17 kg in 3 months), most patients consume high-calorie liquid supplements, which are largely sugar. They also eat high-carb foods; tentative experiments showed me that both potato crisps and pizza went down with astonishing ease. And the net effect of such a diet is high blood sugar, which of course feeds the cancer very nicely.

The proposed surgery I wanted to avoid at all costs because it was brutal. It would have involved removing the lowest third of my oesophagus and the top end of my stomach, then sewing the two ends together, so that I would have GORD for life, controlled only with proton pump inhibitors. As I was convinced GORD was the prime cause of my cancer, I was highly sceptical that this surgery would improve the odds of my surviving at all.

The practicalities

Not long after my diagnosis, Anne suggested that I contact Drs Colin Champ and Dominic d’Agostino, to find out whether a ketogenic diet would help. Both were encouraging, and d’Agostino told me of a patient who was successfully avoiding surgery through ketogenic diet, appropriate chemotherapy, and hyperbaric oxygen. Anne was also devotedly inventing palatable soups and other soft foods that would maintain the ketotic state, and generally helped me to keep on the straight and narrow. I bought a Ketonics breath ketone meter to make sure I stayed firmly in ketosis, and a glucometer to help me determine which foods raised my blood sugar excessively. To my disappointment, it turned out that coffee was one of the worst offenders, despite the fact that I drink it black and unsweetened! So I switched to green tea instead, having learned that it is supposed to inhibit angiogenesis. I wanted to use other medications, such as Vitamin D supplements and berberine, but couldn’t swallow either.

So what did I eat? Soup by the gallon, some off-the-shelf, carefully selected for low carbohydrate content, but mostly invented and prepared by Anne: started with bone broth and featuring chicken, duck, beef, lamb, or pork, with low-carb vegetables. Lots of cream, stirred into soup or with dark-chocolate buttons as a dessert. Soft cheeses—some of them manufactured as spreads. Taramasalata and guacamole made good portable lunches. Breakfast was soup alternating with very soft and runny scrambled eggs. Pâté. And for dinner, whatever Anne was having, but put through a tiny electric mincer, then with cream or butter stirred in. I added turmeric to every dish possible, for its reputed anti-cancer effects.

A few final thoughts

Throughout this whole process, I took no time off work; in fact, my commitments in this area changed the chemotherapy prescription! In confirming my usefulness, I’m certain that work was an important boost to my morale and my resolve to beat the disease.

Things are not yet perfect… some foods still get “stuck half-way down” as there is still excess, though benign, tissue in my œsophagus. In July 2015, the oncologist said, “I don’t like to go there, but you’re cured.” In January 2016, I had another endoscopy and CT scan, and both still show negative. It’s getting easier all the time, in a “two-steps-forward, one-step-back” way, and I’m no longer afraid to eat in restaurants.”

Comment by VW

This case history should give encouragement to all cancer sufferers. There is now overwhelming evidence that the current conventional approach to the treatment of cancer is fundamentally flawed. Despite the huge resources devoted to research and treatment the results are disappointing to put it mildly (3). In addition there is an almost universal failure to identify the cause so that patients can be advised to take appropriate steps to alter lifestyle, eg, by changing diet or eliminating exposure to carcinogens. Confirmation is provided by the growing recognition that cancer is actually a metabolic disease (4). This is based on the original work of Otto Warburg who discovered that cancer cells can only survive if they have a regular supply of glucose, whereas healthy cells can utilise ketones, which are derived from fat. This means that if the amount of sugar and carbohydrates in the diet is restricted and healthy fats such as butter and coconut oil become the main energy source, there is every chance that the cancer can be conquered as Archie has demonstrated here. He is certainly not alone so while we lack the randomized controlled trials that obsesses the professionals I am sure that there are lessons which may well be helpful to those who are struggling with the disease.

 

References

  1. http://vernerwheelock.com/209-curing-and-preventing-cancer-with-diet/
  2. B Groves (2010) “Trick and Treat: how ‘healthy eating is making us ill”. Hammersmith Press Limited London. ISBN 978-1-905140-22-0
  3. T Christofferson (2014) “Tripping Over the Truth: The Return of the Metabolic Theory of Cancer Illuminates a New and Hopeful Path to a Cure” CreateSpace North Carolina ISBN 978-1-500600-31-0
  4. T N Seyfried (2012) “Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer” John Wiley New Jersey ISBN 978-0-470584-92-7

 

211. The Case Against a Low Carb High Fat (LCHF) Diet.

Those who follow this blog will be well aware that there is overwhelming evidence that there are very significant benefits to personal health by having a habitual diet which is LCHF. This has been demonstrated by many different research studies and is confirmed by hundreds, if not thousands, of personal case histories. All of this is now underpinned by sound theoretical logic which identifies the critical role played by insulin resistance in the development of a range of common chronic diseases.

Opposition to LCHF

Nevertheless there are many individuals and organisations which are not persuaded by the force of the arguments and go to considerable effort to discredit this evidence. I have just been alerted to one example, which is a presentation (1) by Dr Pamela Dyson of the Oxford Centre for Diabetes, Endocrinology & Metabolism (OCDEM) which is located at the Radcliffe Department of Medicine, University of Oxford. The title is:

 “High fat, low carbohydrate diets as the first approach in managing type 2 diabetes: Against”

At the outset it is disclosed that Pamela Dyson has received honoraria for lectures from pharmaceutical companies including Lilly, MSD, Novo Nordisk and Sanofi, and unrestricted grants from Abbot Laboratories, the Sugar Bureau, the PepsiCo Foundation and Novo Nordisk.

Current official advice

It is accepted that since the 1980s, diets low in saturated fat (SFA) and high in carbohydrates have been recommended in order to reduce the risk of CVD and CHD. Those with Type 2 Diabetes (T2D) should have a diet which is low in SFA. However it is recognised that the roles of SFA and carbohydrates in the management of T2D is being questioned.

Justification for the advice

With respect to the use of a diet which is low in carbohydrates and high in fat (LCHF) as a form of treatment for T2D the position is summed up by a quote:

“To recommend a low carbohydrate, high saturated fat diet in people with type 2 diabetes would be to advocate for a dietary approach that is not backed by current studies”

However the source of this is an article (2) published in Diabetic Medicine which is published by Diabetes UK entitled:

A critical review of low-carbohydrate diets in people with Type 2 diabetes”

This review is based on 12 different studies. Essentially what we have is mish-mash of different types of studies. In 5 of these studies there are no baseline data and it was not possible to determine the reduction in carbohydrate intake that was achieved. In most of the others the reduction in the intake of carbohydrates was comparatively small so these results would not have been able to provide any useful information on the impact of a low carbohydrate diet. Some were high fat and some were low fat. Some were calorie- controlled and others were not.

 

Sorting out the wheat from the chaff

In effect 2 separate issues are conflated in this review. On the one hand it is argued that many of the studies did not succeed in reducing the carbohydrate intake substantially and so it is concluded that this approach is not feasible. On the other hand, where there is a big reduction carbohydrates consumed it is argued that there was no significant improvement in T2D. In fact there is only one study which achieved a big reduction in carbohydrate intake and this is that done by Eric Westman and colleagues (3). This reduction was 196 gm, which is much greater than anything achieved in any of the other studies. Perhaps it is significant that this was the only diet which found that that there was a reduction in body weight. The review did accept that the weight loss could not be explained by calorie reduction and that a possible cause was that less insulin would be produced on a diet which is low in carbohydrates.

The crux of the issue

This is almost certainly the key to the widespread success of low carbohydrates in the treatment of T2D as demonstrated by research and by countless diabetics who have discovered for themselves, the beneficial effects of such diets. Incidentally it is also crucial to point out that one of the important results of the Westman study is that there was a dramatic reduction in the use of drugs and several individuals were able to stop using insulin completely. Unfortunately the review failed to mention this.

To any reasonable person one of the best ways to assess any type of treatment must be the amount of drugs that are being used. If this can be lowered then that is very good evidence of the effectiveness of the therapy. Therefore it is highly relevant that other studies which have provided confirmation of this result have not been mentioned in the review. Here are two examples..

A useful contribution to our understanding has been provided by a recent study conducted in Australia under the auspices of the Commonwealth Scientific and Industrial Research Organisation (CSIRO) (4). This investigation was specifically aimed at those with T2D who were overweight or obese. The participants were divided into 2 matched groups. One of these was allocated to a diet containing 14% energy (<50 g/day) of carbohydrates (Low carb, LC) and other had a diet with 53% energy as carbohydrates (High carb, HC). All participants were required to undertake vigorous exercise under supervision on 3 occasions every week. The calorie intake in both groups was similar and the study continued for a full calendar year.

Both groups lost weight and also achieved similar reductions in the HbA1c (the % glucose attached to the haemoglobin which gives a good estimate of the blood glucose over the past 3 months) However in other respects the LC group was superior. In particular, it was found that there was less variation in the blood glucose levels over a 24-hour period, which meant that there were significant reductions in medication needed for glycaemic control. This is highly important because this would equate to considerable savings in the costs of treatment coupled with less likelihood of drug-related side effects. These include hypoglycaemia, which is what happens if a drug reduces the blood glucose to levels which are too low, so that the patient loses consciousness.

In another paper written by members of the same research team it was noted that the total economic costs of T2D have been estimated as A$10.3 billion in Australia and US$174 billion in the USA (5). Referring to the results of the study described here, they comment:

“its most striking benefit is that it reduces the amount of medication someone with diabetes has to take by half. This reduction was three times greater than for people who followed the lifestyle program that incorporates a traditional high-carbohydrate diet plan”.

The outstanding work of Dr David Unwin

In Southport which is not far from Liverpool, Dr David Unwin and colleagues have successfully treated diabetics with a diet which is low in carbohydrates in their General Practice (6). In a study with over 60 people the average weight loss was 9kg, the blood sugars were normalised and most impressive of all, the fat in the liver was reduced substantially.

The case history of one patient is particularly impressive.

This was a 55-year old woman who started out with an HbA1c of 84 mmol/mol (9.8%) which is effectively out of control and a gamma-glutamyl transferase (GGT) of 103 iu/L which showed that the liver function was deranged. Essentially this is a bad case of T2D. She had been prescribed metformin. After 3 months on the LC diet the GGT was down to 12 iu/L (a reduction of almost 90 %!!) and an ultrasound scan confirmed the liver was functioning normally. She also lost 7.9 kg. In the longer term she has lost a bit more weight, the liver function is fine, her HbA1c is just about OK but she has come off the metformin. She has lost 17 cm from her waist and says she feels “10 years younger”.

(Note HbA1c is a measure of blood sugar and GGT is a marker for Non Alcoholic Fatty Liver Disease).

To cap it all, this practice has reduced its expenditure on drugs by at least £30,000 per annum.

Conclusion

We have now reached a point where there is overwhelming evidence that a diet which is low in carbohydrates is a very effective treatment for T2D. Reports that that it does not work are invariably dependent on careful selection of the data and the aspects to be considered. Even without detailed investigations, our existing knowledge of the disease and how it develops inevitably points to excessive intake of the foods which result in raised blood glucose levels as I have explained in a my blog entitled “A FLOOD OF SUGAR” (7). It is therefore no great surprise that those who are skeptical about the benefits of a low carb diet have close links with the drug industry. Surely they are not influenced by the fact that widespread adoption of treating T2D by altering the diet would result in a massive reduction in the sales of drugs such as insulin?

References

  1. http://www.dmeg.org.uk/Documents/Pamela%20Dyson.pdf
  2. http://onlinelibrary.wiley.com/doi/10.1111/dme.12964/full
  3. http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-5-36
  4. J Tay et al (2015) http://ajcn.nutrition.org/content/102/4/780.full.pdf
  5. C Proud et al (2015) https://theconversation.com/how-the-right-diet-can-control-diabetes-and-reduce-its-massive-economic-costs-42910
  6. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
  7. http://vernerwheelock.com/170-a-flood-of-sugar/

210. Getting to Grips with Health Policy

More money is not the answer

The amount of money which is being demanded for the provision of health care continues to grow. Here in the UK the various political parties compete with each other to increase expenditure on health services.

On the other hand, there is little convincing evidence that the standards of public health are improving. If anything they are deteriorating. While it is indisputable that life expectancies in many countries are increasing, this does necessarily mean better health.

Public health is deteriorating

Here in Great Britain, the incidence of type 2 diabetes (T2D) in both men and women has more than doubled in the last 15 years. It is likely that there will be 5 million cases by the year 2025 in the UK (1). The position is similar in most other countries. In the USA, in 2014 it was estimated that 29.1 million people had diabetes (2). As many as one in three people could be affected in 2050. Effectively T2D is the tip of the iceberg because it is associated with increased risk of many other diseases including heart disease, cancer and Alzheimer’s Disease (AD).

Cancer is a leading cause of death but despite the resources ploughed into research the progress is not encouraging. A recent article in the Lancet states quite bluntly:

“Current strategies to control cancer are demonstrably not working. Already one of the world’s leading causes of death, the annual death toll from cancer has risen by almost 40% since 1990 and this rate of increase is set to continue. WHO predicts deaths from cancer will rise from the current level of around 8 million lives a year to more than 13 million by 2030” (3).

Dementia is a major cause of disability and is getting progressively worse, especially as people are living longer. In the USA between 2000 and 2010, the incidence of autism in young children doubled. According to the National Institutes of Health (NIH) in the USA, about 10% of the population has autoimmune diseases. The American Autoimmune Related Diseases Association claims that the incidence is much higher because the NIH only includes those diseases for which good epidemiology studies were available (4). These diseases are amongst the 10 leading causes of death in girls and women in all age groups up to the age of 64 years.

On top of all this mental health issues affect many people which in the USA can be as high as 25% of the population.

Expenditure on health

This is an appalling state of affairs. The information in Table 1 which has been collected by the World Health Organisation (WHO) shows how expenditure on health varies between selected countries (5). The most striking feature is the USA which spends 17.1% of GDP. This is almost double that of some other developed nations. As the USA is a wealthy country, this represents a staggering amount. Even so, the USA ranks only 42nd in the life expectancy league table, lagging well behind Japan, Singapore, Australia and Norway (6). On infant mortality the USA ranks only 55th in the world with a rate which about 3 times that of those countries which are at the top of the list (7).

Table 1. Expenditure on health care as a % of GDP (5).

Country Expenditure in 2013, % GDP
Australia 9.4
Brazil 9.7
Canada 10.9
China 5.6
Ireland 8.9
Malaysia 4.0
Morocco 6.0
Netherlands 12.9
New Zealand 9.7
Peru 5.3
South Africa 8.9
Tanzania 7.3
Tunisia 7.1
UK 9.1
USA 17.1

 

It is evident from this information that spending money does not guarantee a high standard of public health. Therefore it follows that much of the resources are not achieving the expected results and are effectively being wasted. There are many reasons why this happens but in this blog I will limit myself to a few aspects of government policy with some examples from the UK which apply equally to many other countries.

Failure of government

At the end of May 2015, I sent this Daily Mail article to my MP who forwarded it to the Department of Health (DoH).

http://www.dailymail.co.uk/health/article-3096634/Why-butter-eggs-won-t-kill-Flawed-science-triggers-U-turn-cholesterol-fears.html

The headline was:

“Why butter and eggs won’t kill us after all: Flawed science triggers U-turn on cholesterol fears”

Essentially the message was that the Americans were having a re-think on the dietary guidelines and in particular on the role of cholesterol.

About a month later, there was a reply from Jane Ellison who is a junior Minister in the DoH. This included the statement that:

“There is good evidence that saturated fat consumption influences serum cholesterol levels and thereby increases the risk of cardiovascular disease. On this basis, the PHE will continue to advise people to consume a diet that is low in saturated fat”.

Defending the indefensible

Anyone who has taken an active interest in recent developments will understand that this is the justification in official recommendations to reduce the intake of saturated fat (SFA) and increase that of polyunsaturated fat (PUFA) in many different countries. However there is now overwhelming evidence that this rationale has been totally discredited and that there was never any foundation for making the recommendations in the first place. This is explained in a recent blog which summarized the extensive range of research which demonstrates convincingly that the cholesterol level in the blood is not a reliable risk factor for all-cause mortality (ACM)(8). In fact what emerges is that those with the lowest values for blood cholesterol and for LDL-Cholesterol have the highest death rates. This rather ironic since these are the people who actually comply with the official targets and many of them will be on medication (eg statins) because they have been told they need to “reduce their cholesterol”! Clearly this means that there are lower death rates at higher cholesterol levels and for men there is no changes as the cholesterol increase but for women the higher the cholesterol the greater the life expectancy. So all of this blows any case for lowering cholesterol out of the water.

Hence it is obvious that the policy is flawed and it is no surprise to find that it is not effective. If we are to make progress it is important to try to understand how and why things have gone so badly wrong. Here are some suggestions:

  • Government advisers may be fairly rigid in their thinking, not receptive to new concepts and unwilling to admit that their advice has been wrong in the past.
  • There are definite conflicts of interest in the sense that many of those who are involved in advising governments have financial links with companies which benefit from the status quo and would therefore be adversely affected by a radical change. Here is one example
  • http://www.dailymail.co.uk/debate/article-2543052/Obesity-tsars-sugar-firms-paying-fortune-VERY-unhealthy-relationship.html
  • There are powerful commercial interests such as the drug companies which depend on the cholesterol theory to justify the use of statins. There is absolutely no doubt that these companies devote huge resources to support this rationale and to throw doubt on any evidence to the contrary. The blunt truth is that institutions including government has been corrupted by the activities of these companies (9).

Conclusion

Although one might expect that the over-riding objective of any national health policy is to ensure the best possible health for the citizens, the reality is very different. There are all sorts of other factors and influences at work. In practice we have been badly let down by the politicians who whether by accident or design allow themselves to be manipulated by other forces and seem incapable of exerting any kind of authority to ensure that the highest standards of public health are achieved.

References

  1. https://www.diabetes.org.uk/Documents/Reports/State-of-the-Nation-2012.pdf
  2. http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html
  3. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60059-8/fulltext
  4. https://www.aarda.org/autoimmune-information/autoimmune-statistics/
  5. http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS/countries?display=default
  6. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.htm
  7. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
  8. http://vernerwheelock.com/179-cholesterol-and-all-cause-mortality/
  9. http://vernerwheelock.com/113-can-we-trust-the-drug-companies/

 

 

209. Curing and Preventing Cancer with Diet

Despite the enormous resources devoted to research, there has been little or no progress in devising methods for the successful treatment of cancer. Effectively we have surgery, chemotherapy and radiotherapy all of which have serious limitations. Consequently the vast majority of patients diagnosed with cancer have a very poor prognosis.

Flawed approach

The fundamental flaw in the conventional approach is that there is almost complete failure to address the actual causes. This means that even if a tumour has successfully been removed by surgery the chances of a recurrence remain high unless steps are taken to identify the basic causes and eliminate them as far as possible. As David Servan-Schrieber (1) explained it is crucial to consider the lifestyle factors.

Critical role of diet

There is absolutely no doubt that the type of habitual diet being consumed is absolutely critical with respect to the risks of developing cancers and many other diseases. The big problem for most people is to decide what foods to include in a diet which will lower the risks of and possibly even cure diseases such as cancer. Unfortunately we cannot rely on the official bodies because their record is appalling. Readers of this blog will be aware of many examples, such as the acceptance of the cholesterol “theory” which underpins the recommendations to reduce saturated fats and increase the polyunsaturated fats (2). Despite the fact that this “theory” just does not stand up to any kind of rigorous examination, the advice continues to be promoted.

Recovering from cancer

I have just been reading an excellent book by Raymond Francis which explains how to prevent and reverse cancer (3). The author was given only weeks to live by the medical establishment but as a result of his own research he discovered information which he used to alter his lifestyle and as a result recovered completely. Since then he has written the book and is now a recognised leader in the field of optimal health maintenance. I should emphasise that there are 3 main areas which relate to cancer, namely stress, toxins in the environment (including food) and nutrition. In this blog I will restrict my comments to nutrition and here is a selection of the topics covered. Francis emphasises that the cells in the body will inevitably malfunction unless they have all the nutrients they need to perform their complex tasks. In his view the Standard American Diet, which is not all that different from the UK version just will not sustain healthy life. Official US data confirm that well over half of all Americans do not consume the recommended daily allowance (RDA) for zinc, magnesium or vitamin B6. Furthermore the actual RDAs are only a minimum requirement and may not be enough for optimal health. Many of our common processed foods such as white flour, refined sugar and white rice only provide calories and very little other important nutrients. On top of this nutrients have been reduced because of the intensification of agriculture and the growth in the production of foods prepared by manufacturing processes. There are also losses incurred because of the long time between harvesting and consumption.

Which foods help to overcome cancer?

Nevertheless there are many foods which are undoubtedly beneficial. A diet composed mainly of fruit and vegetables can reduce the incidence of cancer by 50% or more. Vegetables and herbs such as broccoli, cabbage, ginkgo biloba and garlic can prevent cancer and may even stop the growth of cancer cells.

Which foods to avoid?

There are also many foods which should be avoided. It is now well established that cancer cells differ from the other cells in the body because they are totally dependent on glucose as a source of energy. Essentially this means that if the cancer cells are starved of glucose then they can no longer thrive and multiply. In order to achieve this it is necessary to avoid sugar, which is present is a wide range of foods, including fruit juices and many “low fat” products where the fat has often been replaced by sugar. Foods which contain starch which is broken down to glucose must also be restricted if not avoided altogether. Sugar is particularly damaging to health because it also releases fructose which is handled in a different way by the body and almost certainly results in obesity and heart disease (4). Excessive intake of glucose increases the production of the hormone insulin which switches on cancer.

Most processed oils including those which “lower cholesterol” should be avoided. As explained in a previous Blog (5) the ideal omega-6: omega-3 should be close to unity. However in modern day diets the ratio may be as high as 20 or even 30, because there is so little omega-3 and excessive amounts of omega-6. It certainly does not make sense to increase the omega-6s. This imbalance will initiate and perpetuate inflammation, which is involved in virtually all chronic diseases, especially cancer. As the omega-3 levels in foods produced by intensive agriculture are relatively low, Francis recommends fresh organic vegetables, fruits, raw nuts and organic fish and meats.

As a general rule, Francis argues that the American diet has too much animal protein and that wheat should not be consumed. To avoid cancer there should be a high consumption of fresh plant foods. He actually advocates that 80% of the diet should consist of raw fruits and vegetables. In particular he concludes that the cruciferous vegetables: broccoli, cabbage, Brussels sprouts, mustard greens, kale and cauliflower are the most important in reducing the risk of cancer. Others that are also beneficial include carrots, onions, beets and spinach. Good fruits include avocados, cherries, blackberries, blueberries, pineapples, melons, kiwi fruit, mangos and plums. However because fruit contains sugar these should be consumed in moderation. For the same reason, fruit juices should be avoided.

It is important to appreciate that this is just one individual’s assessment of how a healthy diet should be constructed. Because there are so many different opinions on this topic it is extremely difficult for the ordinary Joe Public to decide on his/her own diet.

Conclusion

Nevertheless certain key messages do seem to be coming through from many different sources. First of all there are compelling reasons for concluding that many of the official guidelines do not stand up to rigorous examination and are wrong. As a consequence many people are choosing foods which they have been advised are” healthy” but in reality are doing more harm than good. A good example is polyunsaturated fat which is promoted as “healthy” but as explained above actually is a cause of inflammation. Secondly, it is clear that sugar should be regarded as toxic for most people and that intake should be kept as low as possible. This is certainly not reflected in official recommendations. In fact the EU has just approved a health claim for fructose, which is likely to result in increased consumption of sugar (6).Thirdly, vegetables are a particularly valuable group of foods and their importance is certainly not being emphasised enough in the rather bland message conveyed by “Five-A-Day”.

So while I would not necessarily endorse everything in this book, it certainly makes a very valuable contribution to the debate and it is a very worthwhile read.

 

References

  1. http://vernerwheelock.com/47-anticancer/
  2. http://vernerwheelock.com/6-the-rationale-for-reducing-fat-is-fundamentally-flawed-part-2/
  3. Raymond Francis (2011) “Never Fear Cancer Again: How to Prevent and Reverse Cancer” Health Communications: Florida ISBN 13: 978-0-7573-1550-3
  4. http://vernerwheelock.com/127-beware-of-fructose/
  5. http://vernerwheelock.com/15-are-polyunsaturates-good-for-you/
  6. http://www.efsa.europa.eu/sites/default/files/scientific_output/files/main_documents/2223.pdf

 

 

 

208. The Nutritional Benefits of Milk Produced from Grass-fed Animals

Milk and milk products play an important role in the human diet. However the nutritional composition of cow’s milk can vary considerable depending on factors such breed, stage of lactation and diet of the animal. In order to increase the milk yields it has become the common practice to feed concentrates, based on grain products, and to some extent these have replaced the traditional grass products of hay and silage. However recent research indicates that this change in diet may have a detrimental impact on the content of some of the key nutrients for humans.

Milk fat is a valuable source the Essential Fatty Acids (EFAs) (1), Conjugated Linolenic Acid (CLA) (2) and vitamins (3).

There are 2 families of EFAs, namely the omega-6s and the omega-3s. Ideally the ratio of omega-6:omega-3 should be close to 1 and no higher than 4. Unfortunately in the typical Western diet this value is usually in the range 15 to 30, which means that there is an excessive amount of omega-6s and an inadequate supply of omega-3s. A relatively high intake of CLAs is associated with various health benefits including a reduced incidence of cancers and heart disease.

The fatty acid composition in beef produced with diets with varying amounts of grass and concentrates was studied in an investigation conducted in Ireland (4). The results (Table 1) show that the “Grass only” diet (22kg grass/day) had much higher contents of CLAs and omega-3 EFAs that the diet with “Concentrate only” (8kg concentrate plus 1kg hay/day ie mainly grain). It was suggested that the higher content of omega-3s in the meat from grass-fed animals was because the grass contained about 30 times more omega-3s than the concentrate. The results for CLA support the hypothesis that the relatively high levels of sugars and soluble fibre in the grass facilitate the development of the bacteria in the rumen which produce the CLA and/or discourage the development of those which utilise the CLA.

Table 1. Essential Fatty Acids in Beef from Animals Fed either Concentrate or Grain

Concentrate only Grass only
CLA 0.37 1.08
Omega-6 3.21 3.14
Omega-3 0.84 1.36
Omega-6:omega-3 ratio 4.15 2.33
     

 

These findings have been confirmed by Daley et al in a review published in 2010 (5). Grass- finished beef consistently contains a higher content of omega-3 fatty acids while the level of omega-6s remains virtually constant. This means that the ratio of omega-6:omega-3 is reduced and is therefore preferable from the perspective of human nutrition. The same review also reported that grass-fed ruminants produce 2 to 3 times more CLA than ruminants on a diet mainly consisting of grain. It was suggested that this is due to the higher rumen pH associated with grass consumption which favours the micro-organisms that produce the CLA.

This review also found that:

  • The beef from animals fed on grass contains about 7 times more ?-carotene (Vitamin A precursor) than from those fed on grain
  • There are much higher levels of Vitamin E and its precursors in the beef from animals fed on grass
  • Grass-fed beef contains high levels of the antioxidants glutathione, superoxide dismutase and catalase which are particularly effective at mopping up free radicals.

Essentially similar results have been obtained for milk. The effect of varying the grass content in the diet of dairy cows on the composition of the fatty acids in milk was studied in an investigation conducted in France (6). Four groups of 2 cows each were fed 4 different diets in which corn silage was replaced by 30, 60 and 100% grass for a period of 2 weeks. The first week was for adjustment and the measurements were done during the second week. Table 2 confirms that the composition of these important fatty acids in milk replicate those which were found in the Irish study on beef with progressive increases in the contents of both omega-3s and CLAs with the proportions of grass in the diets.

Table 2. Changes in the Essential Fatty Acids of Milk with Variation in the Grass Content of the Diet

                                      % Grass in the diet
0 30 60 100
Omega-6s 2.00 1.95 1.93 2.12
Omega-3s 0.29 0.43 0.60 0.73
CLA 0.48 0.54 1.21 1.65

 

Although there is little detailed information on sheep it is highly likely that the meat is a good source of omega-3s and CLAs since these animals have a diet which is predominantly based on grass.

Vitamin K2 (VK2)

In previous blogs (3, 7) I have described how VK2 has emerged as an important nutrient. For example epidemiological studies have shown that low intakes of this vitamin are associated with an increased incidence of chronic diseases including heart disease. One of the key functions of VK2 is to facilitate the utilisation of Vitamins A and D as well as calcium. This means it is particularly crucial for anyone who is taking these nutrients as supplements to ensure that there is an adequate intake of VK2. A person who is taking calcium supplements but lacks sufficient VK2 runs the risk of damaging the arteries by calcification.

Unfortunately as yet there is no reliable information generally available on the amounts of VK2 in different foods. However it has been established that the produce of animals which have been fed a diet that is predominantly grass-based are good sources of VK2. So this is another compelling reason why it is eminently sensible on nutritional grounds to choose milk and meat as well as the respective products from animals that have been fed a diet mainly of grass. Finally it must be emphasised that all the nutrients are present in the fat and therefore choosing low fat versions is not an option!

References

  1. http://vernerwheelock.com/15-are-polyunsaturates-good-for-you/
  2. http://vernerwheelock.com/24-conjugated-linoleic-acids-cla/
  3. http://vernerwheelock.com/21-vitamin-k2/
  4. P French et al (2000) Journal of Animal Science 78 (11) pp 2849-2855
  5. C A Daley et al (2010) Nutrition Journal 9 10
  6. S Couveur et al (2006) Journal of Dairy Science 89 pp 1956-1969
  7. http://vernerwheelock.com/22-dietary-sources-of-vitamin-k2/