179. CHOLESTEROL AND ALL-CAUSE MORTALITY

A comprehensive review on the role of cholesterol in health and a critique of the use of statins has recently been published by a team of Japanese researchers (1). This pulls together information from a range of different sources. The focus is on all-cause mortality because fundamentally that is the key parameter most people understand and wish to control. Determination of individual diseases are subject to bias and lack of objectivity, which does not apply to death. The relationship between all-cause mortality and the cholesterol in the blood has now been investigated repeatedly in many different countries and the results which are incredibly consistent may come as a surprise to many people. In this blog I will refer to a selection of what is available.

Japan

In the Ibaraki Prefecture Health Study, 91,219 men and women aged 40-79 years without any history of stroke or coronary heart disease (CHD) were followed for just over 10 years. It was found that the all-cause mortality was inversely correlated with the level of LDL cholesterol. In other words the higher the LDL cholesterol the greater the life expectancy, which of course is in direct conflict with the conventional wisdom.

In the Isehara Study, data was collected from those who had an annual check-up. The final database contained information on 8,340 men (aged 64±10 years) and 13,591 women (61±12 years). Again it was found that the level of LDL cholesterol was inversely related to the all-cause mortality rate. Interestingly it was reported that, the mortality rates due to cancer in men and to respiratory disease without cancer (mostly pneumonia) in men and women were lowest in those groups with the highest values.

The Jichi Medical School Cohort Study is one of the most recent, large epidemiological studies conducted in Japan in which 12,234 healthy adults from rural communities were followed for almost 12 years. Once again, the highest death rates from all causes was in those with the lowest TC values. In this investigation even the exclusion of deaths within the first 5 years did not alter the relationship between low TC levels and the high mortality. The exclusion of deaths caused by liver disease also made no difference to this conclusion. However in this study the relationship between the death rates and TC levels in men was U-shaped so there was some increase at the higher values. But in women it was clear that as the higher the TC, the lower the death rate.

Norway

The results of the Jichi Study are very similar to those obtained in the HUNT Study conducted in Norway, in which 52,087 men and women aged 20-74 years were followed over a 10-year period (2). TC levels were measured and details of any deaths which occurred were recorded. The results are shown in Table 1.

For both men and women, the highest all-cause mortality was in those with the TC levels below 5.0 mmol/L.

In men, there was no increase in the all-cause mortality with raised TC. Those with a TC level between 5.0 and 5.9 mmol/L had the lowest death rate, which was 23% lower than those with a TC below 5.0 mmol/L. At higher values, the rate increased again.

For women the pattern is different. The higher the TC, the lower the risk of dying from all causes. Compared with those with a TC below 5.0 mmol/L, those with the highest TC levels were 28% less likely to die from all causes.

Table 1. Variation in mortality due to all causes and to cardiovascular diseases (CVD) with TC in men and women

TC, Mmol/L (mg/100ml)                          MEN                    WOMEN
All-cause CVD All-cause CVD
<5.0          (<194) 1.00 1.00 1.00 1.00
5.0-5.9     (194-228) 0.77 0.80 0.92 0.90
6.0-6.9     (232-267) 0.84 0.87 0.84 0.81
>7.0          (>270) 0.98 1.05 0.72 0.74

 

In a subsequent paper the research team provided the information for the different age ranges (3). This detailed break-down shows that as expected most of the deaths occur after the age of 60 years (Table 2). Although the optimum TC level for men aged 60-69 is in TC range 5.0 to 5.9 mmol/L, for those over 70 the lowest death rate is in the higher TC level of 6.0 to 6.9 mmol/L. For women it is very clear that the death rate for the over 60s decreases as the TC increases. For this age range it is evident that the highest death rates are for those with a TC level which is below 5.9 mmol/L. The relatively high death rates for those aged 60+ years at low TC values should also be noted.

Table 2. All-cause mortality rates (per 1000 person years) and TC levels at different age ranges

                                               MEN
Age ranges                               TC LEVELS, mmol/L(mg/100ml)
<5.0(<194) 5.0-5.9(194-228) 6.0-6.9(232-267) >7.0(>270)
20-29 1.10 0.38 0.30 0.00
30-39 0.80 0.57 0.72 0.47
40-49 2.22 1.38 2.27 3.37
50-59 4.54 4.93 6.22 5.74
60-69 20.31 16.20 17.37 18.47
70-74 49.18 40.37 37.93 41.25
                                           WOMEN
20-29 0.35 0.30 0.24 0.60
30-39 0.31 0.43 0.82 0.69
40-49 0.89 1.85 1.69 1.12
50-59 2.95 3.59 3.53 3.79
60-69 22.31 10.32 10.47 9.51
69-74 31.46 22.50 21.58 19.23

 

The authors commented as follows:

‘’If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but beneficial.’’

They went on to conclude:

‘’Our results contradict the guidelines’ well-established demarcation line (5 mmol /L) between

‘good’ and ‘too high’ levels of cholesterol. They also contradict the popularized idea of a positive, linear relationship between cholesterol and fatal disease. Guideline-based advice regarding CVD prevention may thus be outdated and misleading, particularly regarding many women who have cholesterol levels in the range of 5–7 mmol/Litre and are currently encouraged to take better care of their health’’.

The Netherlands

In the Netherlands, a study with residents in Leiden with an average age of 89 years, it was found that those with the highest TC levels had the lowest mortality, while those with low TC values had the highest mortality (4). Those with the high life expectancy was due to particularly low incidences of cancer and infection.

Hawaii

In the Honolulu Heart Programme the TC was measured between 1965 and 1968 in 7961 men of Japanese origin who were born between 1900 and 1919. During the period of this study the men were monitored on 3 occasions and there were 2072 deaths. The results (Table 3) confirm that in this group of men the death rate attributed to coronary heart disease is directly associated with the TC level. However for deaths from stroke there are high death rates for both high and low cholesterol values. For cancer, it is evident that the death rate is inversely related to the TC levels. In this study there were twice as many deaths due to cancer at low TC levels when compared with whose TC was above 6.98 mmol/L.  For all-cause mortality the lowest death rates were found in the cholesterol range between 4.65 and 6.18 mmol/L (180 and 239 mg/100ml). The authors concluded that manipulation of TC levels below the range shown above would not be desirable if it was to result in an increased risk of death from cancer and other diseases (5).

Table 3. Relationship between death rate and total cholesterol for various causes of death 

 

AGE ADJUSTED  MORTALITIES PER 1,000 PERSON-YEARS
TC,Mmol/L(mg/100ml) CHD STROKE CANCER ALL CAUSES
<4.65      (<180) 1.68 1.80 7.32 17.46
4.65-5.40(180-209) 2.01 1.17 5.30 14.09
5.43-6.18(218-239) 2.38 1.40 5.33 14.07
6.20-6.96(249-268) 4.24 1.65 5.34 15.92
>6.98      (>269 ) 4.87 1.74 3.83 17.31

 

Austria

In Austria, 67,41men and 82,237 women aged 20–95 years were followed over a 15-year period (1985–1999) as part of the Vorarlberg Health Monitoring and Promotion Programme. It was found that in both men and women in the 50–64 and ?65 age groups, TC levels were a negative risk factor for all-cause mortality (6).

Finland

A study done in the Finnish city of Kuopio monitored 490 elderly persons aged over 75 (28% men) for 6 years. None of them were on cholesterol lowering medication. Those with TC lower than 5mmol/L had a death rate that was double that of those who whose TC was greater than 6 mmol/L (7).

In another study done in Finland 623 people aged over 75 years were monitored for 17 years (8). The TC was monitored as well as lathosterol, which indicates cholesterol synthesis and sitosterol indicates cholesterol absorption. The reults showed that TC declined in old age, and low cholesterol was associated with poor health and multi-morbidity. TC levels below 5.0 mmol/L were associated with accelerated all-cause mortality Lathosterol when they were all low it was reduced to 5.6 yearsand sitosterol both decreased with deteriorating health. Low lathosterol, sitosterol, and TC predicted mortality additively and independently of each other. When all three sterols were high the age expectancy was 9.9 years but when they were all low, it was reduced to 5.6 years. It was concluded that reduced synthesis and absorption of cholesterol, and low TC levels are associated with deteriorating health and indicate impaired survival in old age.

Conclusion

Without exception all-cause mortality is highest in those with the lowest levels of TC. In older people those with the highest cholesterol have the highest survival rates, irrespective of where they live in the world. The picture which emerges is totally consistent. The research which triggered the concern about heart disease was based almost entirely on middle-aged men and was restricted to heart disease. But what is so striking about all the studies cited here is that when the focus is on older people, which is when the vast majority deaths occur, and on all-cause mortality the perception of the risks associated with cholesterol are reversed. It is also highly significant that these results do NOT conflict with the research on middle-aged men and heart disease. The data from Honolulu confirm that in those involved in the study with low cholesterol there was a low death rate from heart disease but crucially the incidence of cancer was relatively high and demonstrates why it is vital to consider the big picture. The emphasis on TC and LDL cholesterol as risk factors was based on a complete failure to do so. There is absolutely no logical justification for advising people to lower their TC or their LDL cholesterol. On the contrary all the evidence which is now available indicates that that the higher the better. The results for women are quite exceptional and show consistently that those with the highest TC values invariably have the greatest life expectancy.

By contrast, we can be reasonably certain that the cholesterol lowering strategies which have been applied have not resulted in any benefit and probably have been damaging to health. In particular, the rationale for the use of drugs such as statins is totally destroyed by the evidence presented here. All the indications are that cholesterol is beneficial and the higher the better!

It really is astonishing and irresponsible for the authorities to continue the various programmes which still use TC as a risk factor for heart disease and push cholesterol-lowering strategies. It is time they were abandoned because they are not achieving anything positive and are almost certainly doing more harm than good, not to mention that there are a sheer waste of valuable resources.

REFERENCES

  1. https://www.karger.com/Article/Pdf/381654
  2. H Petursson et al (2012). Journal of Evaluation in Clinical Practice 18 (1) pp 159-168.
  3. H Petursson et al (2012). Journal of Evaluation in Clinical Practice 18 (1) pp 170-171.
  4. A W Weverling-Rijnsburger et al (1997) Lancet 350 pp 1119-1123
  5. G.Stemmerman et al (1991) Archives of Internal Medicine 151 pp.969-972
  6. Ulmer et al (2004) Journal of Womens Health 13 pp 41–53
  7. P Tuikkala et al (2010) Scandinavian Journal of Primary health Care 28 (2) pp 121-127
  8. R S Tivlis et al (2011) Annals Medicine 43 pp 292-301

178. Time to Control the Drug Companies

I have recently been writing letters to our local newspaper “The Craven Herald” (1) in which I have advocated a fundamental shift in NHS policies. My stance is that pouring more and more money into the system is a dead end approach. In particular, there needs to be a switch in emphasis towards prevention at the expense of the current curative approach. A good start would be to evaluate the expenditure on drugs. Many of those currently in use are totally ineffective and when allowance is made for the impact of adverse side effects, most patients would be better off without them. Statins are a very good example because the benefits are minimal. NICE has accepted that for those who have heart problems, 77 individuals have to be treated for one to benefit (2). Dr Malcolm Kendrick has worked out that this benefit equates to an extra 6 months of life for 1.8%. For the remaining 98.2% there will be no life extension and of course many will have deal with the side effects.

Another example is Type 2 Diabetes (T2D) which currently costs the NHS £10Bn per annum to treat, of which about £1Bn is for drugs. The official position is that if you are diagnosed with T2D you cannot be cured, the disease will get worse and you may expect to be on drugs for the rest of your life. This is absolute rubbish because there is convincing extensive evidence to show that it can be cured by simple changes to diet (3). All that is necessary is to reduce sugar and other sources of carbohydrates, such as potatoes, bread, rice and pasta. These can be replaced by healthy fats such as olive oil, coconut oil and the fats in meat and milk, ideally from animals which have been fed on grass. There are also hundreds, if not thousands, who have successfully cured their own T2D by using this approach and most of these have been able to come off drugs completely. Others have reduced the amount needed. It is therefore absolutely bizarre that the official advice is usually to reduce fat intake and increase the amount of carbohydrates. So it is no great surprise to discover that the rather dire prognosis is fulfilled. If people were given the correct advice the disease could be cured for many of those currently afflicted and the savings would be immense. By contrast, the present trends are expected to continue, which means that the number with T2D will double again within the next 15-20 years.

During 2013, in England alone the total expenditure on medicinal drugs was about £15Bn, although many of these were of very limited value (4).

I was somewhat surprised to be challenged by the candidate for the Green Party in this constituency (Skipton & Ripon) on the grounds that some drugs do work. In particular he claimed that;

“Cancer survival rates are massively improved and much of this is down to expensive new drugs”.

First of all, the conclusion that survival rates have improved is questionable. 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” (5).

Secondly there is widespread concern in the medical profession about the very high charges for drugs generally. In the USA, the average price of 1 year of treatment with a new cancer drug now exceeds $100,000, and the benefits of many of these therapies — often improvement in median survival of the order of weeks to months — do not appear commensurate with their prices (6). It is very common for new drugs to be introduced which are no more effective than those already available but are much more expensive. There is genuine concern that the drug companies exploit the systems to overcharge by huge amounts.

For example in 2008, the drug cetuximab was hailed as a major breakthrough in cancer treatment but actually when used in conjunction with other drugs to treat lung cancer it was found that the benefit was just an extra 5 weeks of life which was accompanied by some nasty side effects. The cost of treatment of lung cancer with this drug is $80,000 for 18 weeks (7).

Despite the claims by the pharmaceutical companies that they make a huge contribution to society, the reality is that they are developing drugs that are mostly little better than existing products but have the potential to cause widespread adverse reactions even when appropriately prescribed. The fundamental objective of the industry is to maximise profits by developing lots of drugs which have clinically minor additional benefits.

In fact the Food and Drugs Administration (FDA) in the USA can actually approve drugs even if they are inferior to those which are already on the market. An evaluation conducted in France concluded that of all the new drugs approved between 1981 and 2001, about 12% offered therapeutic advantages. However between 2002 and 2011, only 8% were assessed as genuinely better than existing ones. In addition almost 16% were judged to be more harmful than beneficial. As few as 1.6% were considered to be substantially better. Assessments by the Canadian advisory panel to the Patented Medicine Prices Review Board and by a Dutch general practice drug bulletin have come to similar conclusions (8).

Two studies have found that 80% of the increase in drug expenditures was to pay for these minor-variation new drugs, rather than for important advances. Companies claim that R&D costs are “unsustainable.” But the reality is that revenues have increased six times faster than has investment in R&D over the past 15 years. The drug industry has been able to manipulate decisions taken by government for the following reasons:

  • Because politicians are dependent on drug companies for financial support to get elected as public representative, there has been a reluctance on their part to ensure that the regulatory process is completely thorough and effective. This can be demonstrated as follows:
  1. New drugs are often tested against placebos rather than against established effective treatments.
  2. Surrogate or substitute end-points instead of the actual effects on patients’ health are often used to assess the effectiveness of new drugs.
  3. Noninferiority trials which show that the product is not worse than another drug used to treat the same condition by more than a specified margin are accepted. Ideally there should be a requirement to show that the new drug is significantly better than one already on the market. These criteria do not conform to international ethical standards because they provide no useful information for prescribing.
  • Companies are allowed to test their own products. Hence the trials are designed in such ways that they minimise the detection and reporting of harms and maximise evidence of benefits. They are permitted to exclude patients who are most likely to have adverse drug reactions, while including those most likely to experience benefit. Therefore drugs can be marketed as safe and more effective than they are in the real world.

As a consequence it is approving drugs which are little better than those available, is failing to ensure there is sufficient testing to control serious risks in order that the public is protected from harmful side effects. Essentially these failings serve commercial interests well and public health suffers.

Although the industry justifies its high costs on the grounds that the research is expensive, it is revealed that net of government subsidies, only 1.3% of revenues is spent on discovering genuine innovations, which contrasts with the 25% spent on promotion.

In recent years there have been various exposures of how the drug companies operate and it is evident that they are not genuinely interested in improving health. It is somewhat ironic that in the USA drugs are the third leading cause of deaths after heart disease and cancer, which is horrendous. The position in Europe is much the same. Anyone who is interested in understanding what is actually going on should read the excellent exposé by the distinguished Danish scientist, Peter Gøtzsche, entitled:

Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” (9).

Here are just a few of the points he makes:

  • In 2004-5, the House of Commons Health Committee examined the drug industry in detail and found that its influence was enormous and out of control. It was revealed that the industry buys influence over doctors, charities, patient groups, journalists and politicians, and whose regulation is sometimes weak or ambiguous. It found that the Department of Health (DoH) was responsible for representing the interests of the drug industry. The government did nothing and the DoH even defended the industry. As Gøtzsche commented:
  • With a governmental attitude of total denial it’s no great wonder that crime flourishes in the drug industry and spreads like weeds”.
  • Erlotinib is a drug which is used to treat pancreatic cancer which has been approved in Europe and in the USA, although it only prolongs life by 10 days. It is toxic and has very unpleasant side effects. For one extra year of life (36 patients in all) the cost would be $500,000.
  • Peter Rost is a whistle blower who used to be in a senior position with Pfizer and has described the industry as follows:
  • “It is scary how many similarities there are between this industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the side effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry …”

The extent of the illegal activities of the pharmaceutical companies is shown by the penalties levied on them by the authorities in the USA (10). Between 1991 and 2010, there were at least 165 settlements for offences which included illegal off-label promotion of pharmaceuticals and deliberatively overcharging. The total amount paid was almost $20Bn of which 75% was in the period 2005-2010. An update has found that in the 21 months ending in July 2012, a further $10Bn was paid (11).

Conclusion

It is clear that this industry is totally out of control. It is making enormous profits and has been extremely effective in using its resources to gain unfair advantage in the market place. It does not hesitate to use unethical, unscrupulous and illegal activities in the course of its business. Given the large number of deaths which can be attributed to drugs, it is doubtful if this industry makes any positive net contribution to improved public health.

 

REFERENCES

  1. http://www.cravenherald.co.uk/
  2. http://linkis.com/drmalcolmkendrick.org/EWaOW
  3. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext
  4. http://vernerwheelock.com/?p=667
  5. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60059-8/fulltext
  6. http://www.nejm.org/doi/full/10.1056/NEJMp1400104#t=article
  7. T Fojo and J Grady (2009) Journal of National Cancer Institute 101 (15) pp 1044-1048
  8. D W Light, J Lexchin & J J Darrow (2013) Journal of Law, Medicine and Ethics 14 (3) pp 590-610
  9. Peter Gøtzsche(2013). “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” Radcliffe Publishing London
  10. http://www.citizen.org/hrg1924
  11. http://www.citizen.org/hrg2073 

177. Statins: A Disturbing Study about Adverse Side Effects

I have just discovered a fascinating paper which describes the results of gathering and collating information from self-reported accounts of adverse reactions to statins (1). It has been published on the internet by the Journal of Independent Medical Researchers, which enables individuals to present their thoughts and ideas. All those involved give their time free so that no money changes hands.

The experience of patients

The report is based on information contained in self-reported accounts from patients who had signed an e-petition which will be sent to the World Health Organisation (WHO). About half of them were from the USA and most of the remainder were from Europe. In total 888 people had signed the petition. Of these, reports from 351 were considered to provide useful information.

All of these had experienced adverse reactions to treatments with statins. Of these, 61% stated that they had stopped taking the statins because they were unable to cope with the severity of the side effects. Sixty three patients reported they had sustained permanent damage and 120 continued to experience adverse reactions which were still not resolved. Eighteen patients were suffering from amyotrophic lateral sclerosis (ALS)/motor neurone disease, with one case of ALS being diagnosed within six weeks of starting statin therapy. There were 29 cases of major neurodegenerative disorders including Parkinson?s disease, Alzheimer?s disease (AD), multiple system atrophy, progressive supra-nuclear polyneuropathy, chronic inflammatory demyelinating polyneuropathy and ALS/motor neurone disease. Sixty nine patients experienced memory loss and 18 patients complained of cognitive impairment, and 6 experienced transient global amnesia.

The clinicians’ perspective

The comments from the patients reveal some valuable insight into the attitudes and approaches by the clinicians. Here are some examples:

  • Patients who experience difficulties while taking their prescribed statin medication find that it is not easy to persuade their treating clinicians that it is the statins which are responsible for causing their adverse reaction symptoms.
  • It was found that there were 82 clinicians who did not associate their patients’ symptoms with an adverse reaction to statin therapy.
  • There were actually a number who would not accept that statins could be the cause of the adverse reactions.
  • Several of the respondents had described how statins had been prescribed without any clinical consultation. When the results of routine analysis of blood samples became available, clinicians instructed the practice receptionist to ask the patient to call for the prescription. This means there was no opportunity to provide the relevant advice or explain about the potential adverse side effects. If this description of events is accurate then it means that no consent to the treatment would have been given.

The report notes that it is a particularly worrying time for a patient when an adverse reaction is experienced. The person is likely to have fears about damages to his/her health and even premature mortality. If these concerns are met by ridicule on the part of the clinician, then it is likely that the patient will begin to have serious doubts about the competence of the clinician, not only with respect to statins but more generally.

When complaints were made about adverse side effects it was revealed that the response was to prescribe some different statins in addition, which provoked the comment:

The prescribing of two or three different agents, on the back of complaints about unwanted effects that were caused by the initial prescription, betrays a lack of knowledge about the action of statins. The prescribing of six different agents under precisely the same circumstances displays an unexpected indifference to the healthcare needs of patients.”

This study also shows that there was a very high incidence of major degenerative diseases. To find 18 cases of ALS from 351 reports is extremely worrying and about 10,000 times greater than would have been expected, based on the accepted norms.

It is established that treatment with statins lower cholesterol by inhibiting the mevalonate metabolic pathway (MMP) which also means that the synthesis of Ubiquinone (Coenzyme Q10) is also inhibited. Ubiquinone plays a vital role in the body and if the level is reduced it is likely to cause myopathy, which is one of the established side effects of statin therapy. In the light of this, it would be expected that anyone prescribed statins would automatically also be prescribed with ubiquinone. But the reality is that this just happen regularly.

Other important biochemicals which are synthesised in the MMP are Heme A and dolichols.

A reduction in Heme A interferes with the efficient functioning of the mitochondria, which are the “powerhouses” of the cells. Reductions in Heme A may also cause damage to the nerves and to DNA. Any reduction in Heme A may lead to the accelerated decay of mitochondria. . The inhibition of the MMP also has implications for the production of other substances which have a critical role in the body.

Dolichols are required for cell identification, cell communication and immune system functionality.

Memory loss was reported in almost 20% of the respondents. Unfortunately many doctors do not take this seriously and often just shrug it off as an inevitable consequence of the aging process. Nevertheless it has finally been recognised as likely side effect.

Just under 10% reported that they had suffered from depression and this is quite consistent with research which shows that this is one of the consequences which can arise with low levels of blood cholesterol.

Over half of the respondents had not been able to resolve the statin-induced side effects, while just less than one fifth claimed that the damage was permanent.

CONCLUSION

No doubt there will be those who dismiss this study on the grounds that it is based on individuals who have prepared their own reports and that they cannot be validated and may be biased. Even allowing for some inaccuracies, the information here provides valuable insight into what is happening in the real world. There is plenty of evidence to demonstrate that the reporting of adverse side effects to drugs is minimal. This report confirms that many clinicians are not interested and may even be in denial when it comes to identifying these reactions. The rather widespread failure to recognise the impact of statins on the normal and essential metabolic pathways is unbelievable.

Many people who are being prescribed statins would be shocked to learn about the information in this report. NICE accepts that 77 people have to be on statins for 3 years for one person to benefit (2), which according to Malcolm Kendrick is an extra 6 months of life (3). This only applies to those who have had previous heart disease. For others the benefits are even less but the side effects are the same are the same. How many patients would agree to statins if they were made aware of this information at the outset?

REFERENCES

  1. http://www.joimr.org/JOIMR_Vol7_No1_Dec2009.pdf
  2. http://www.bmj.com/content/349/bmj.g4694
  3. http://drmalcolmkendrick.org/2014/12/01/what-is-t/

176. Are GM Foods Safe?

Steven Drucker, who is a public interest lawyer in the USA, has written a thorough, fascinating and disturbing account of the recent history of the development of GM foods entitled “Altered Genes, Twisted Truth” (1). In this he presents a compelling case which explains not just the failure of the regulatory systems but also the ways in which apparently reputable scientists have manipulated and distorted the evidence to ensure that genuine concerns about the safety of these products are brushed aside.

To quote from the introduction, this is:

“fundamentally a story about the corruption of science and its concomitant corruption of government, not through the machinations of a scientific fringe group in league with a pack of powerful political ideologues, but through the workings of the mainstream scientific establishment in concert with large multi-national corporations – and their co-optation of government officials across the globe. Further, by the time the story ends, it will be clear that the degradation of science it depicts has not only been unsavoury but unprecedented: that in no other instance have so many scientists seriously subverted the standards, they were trained to uphold, misled so many people, and imposed such magnitude of risk on both human health and the health of the environment.”

I can understand why this may come across as somewhat outlandish to many people. To this I would reply that you should read the book yourself in a dispassionate frame of mind. There is no question that Drucker has presented an extremely well-argued case, which is totally supported with credible evidence. Furthermore those in favour of GM foods have totally failed to provide effective answers to a wide range of genuine concerns which have been raised. They have also had to employ tactics which are flimsy, illogical and unethical in desperate measures to maintain support for the technology.

An issue of special interest to those in Europe is the affair in 1998 involving Arpad Pusztai, a scientist working at the Rowett Institute, located just outside Aberdeen. The details in the book provide insight which is somewhat at odds with that presented in the media at the time and subsequently.

Pusztai was leading a team of scientists which was working on a major project to check the safety of potatoes which had been engineered to incorporate a gene from the snowdrop plant which would increase the concentration of the protein lectin which is toxic to aphids and various insects which feed on potatoes. The GM potatoes and the controls were grown under identical conditions and then fed to rats. It should be emphasised that they did not anticipate that there would be any adverse effects from the GM per se and there was already evidence to indicate that the rats would be able to tolerate the higher levels of lectin, so the expectation was that problems were unlikely to occur.

However when the results started to come through there was cause for concern. Chemical analysis revealed that there were substantial differences in the nutritional composition the GW potatoes compared with the parent stock. However the feeding trials showed that there were major physiological changes relating to general metabolism and organ development in those rats fed the GM potatoes. The fact that their immune system had been weakened was obviously a matter for serious concern. These differences were apparent within 10 days. Because these changes were not found in controls which had lectin added to their diet it followed that the adverse effects must have been due to other changes in the potatoes caused by the GM process.

In the usual course of events this information would have been written up as a scientific paper, submitted to a suitable scientific journal, where it would be reviewed by referees and perhaps returned to the authors for revision before eventual acceptance and publication. This process may take years. So Pusztai decided that it would be sensible to make this information available more quickly because of the doubts it raised about the safety of GM foods generally. With the support of the Director of the Institute, Professor Philip James, he gave a short interview to a television programme “World in Action”.

Two days later he was fired, the research was terminated and all the data confiscated. Pusztai was given a gagging order and threatened with legal action if he spoke out on the subject. So what was going on the background to trigger such a drastic turn of events?

Some years later an article in the Daily Mail claimed that James received phone calls from the Prime Minister, Tony Blair who got involved because of direct pressure from President Bill Clinton. At that time the USA was heavily promoting GM technology and actively pressurising other nations to follow suit.

CONCLUSION

There can be little doubt that the indication of safety concerns related to a staple foodstuff certainly struck a nerve. Even if it was eventually proved that the potential dangers raised by the Pustzai research were groundless there can be absolutely no possible justification for the way in which he was treated, which was scandalous. It is important to appreciate that the scientist had an excellent track record and that the research contract had been awarded in the face of stiff competition. Had the authorities behaved in a reasonable and logical way, then it was imperative that another study should have been initiated. As it is, we are left with the very strong impression that there was already so much momentum behind the drive to create a new industry with powerful government support that any impediment would not be tolerated.

The reality is that there has been a failure to ensure that the GM products are safe to eat and do not harm the environment. The position adopted in the USA is that the any products are substantially the same as the original organisms, hence the GM products do not need to be evaluated independently. In my opinion this is stretching credibility to the limit. Essentially we are now in uncharted territory and if it turns that these assumptions are false, the damage to public health and the environment could be enormous.

REFERENCES

  1. S M Drucker (2014) “Altered Genes, Twisted Truth” Clear River Press, Salt Lake City ISBN 978-0-9856169-0-8

 

175. A Case History of How Diet Can Overcome Inflammatory Arthritis

Jo Bellas is a mother of 3 children who works with her husband George in the family company based in Skipton which supplies all the essentials required in an office. In her early years she lived in Australia and was very active, playing lots of sports, enjoying life in the outdoors. A few years ago she noticed some pain in her knee. This got progressively worse with severe swelling and eventually reached the point where it was absolute agony to walk. After doing the usual rounds with the NHS she decide to consult a private specialist who told her that there was damage to one of the ligaments plus general “wear and tear”.

He suggested that an operation might be possible but this was not a particularly attractive option. The consultant could do the operation but it would not fix what he then believed to be a rheumatology issue, and Jo would need to get that under control before any operation. Consequently Jo consulted a rheumatologist who diagnosed inflammatory arthritis. The prognosis was that it was not curable, that it would get worse and the best hope was to “manage” the condition using drugs to address the symptoms to help Jo live a “normal” life.

This led to a succession of treatments with a variety of drugs which were designed to suppress the immune system. Some of these apparently worked for a while and then a different one would be tried. But there were side effects which included “brain fog”, fatigue, headaches and a general feeling of being “fed up”. In addition Jo was taking “loads of painkillers”. There was certainly no improvement in her state of health, rather the reverse as her elbows and shoulders became stiff and sore.

For a person on the right side of 40, the prospects looked pretty grim. In desperation, Jo got onto the internet and started doing research to see if there were any other possible options. She discovered the work of Dr Amy Myers, who is a trained MD, and has specialised in complementary medicine or what the Americans call “functional” medicine. As a student Dr Myers had suffered from Graves’ Disease, which is an overactive thyroid. She tried various alternative methods including Chinese Medicine and powdered herbs which tasted awful. When this did not work, she resorted to conventional medicine. This culminated in a procedure called “ablation” in which some or all of the thyroid function is destroyed using radioactive iodine. Eventually Dr Myers discovered complementary treatments which proved to be effective. This was so successful, she continued to develop her interests and expertise in functional medicine. She has established a very successful practice in Texas. Further information is available on her website (1).

Among other activities she had written a book entitled “The Autoimmune Solution: Prevent and Reverse the Full Spectrum of Inflammatory Symptoms and Diseases”. Jo purchased this book and followed the advice presented which has been used by many patients to cure or alleviate a whole range of auto-immune diseases which include allergies, Crohn’s Disease, Irritable Bowel Disease and asthma. To begin with Dr Myers recommends drastic changes to the typical American or British diet for a period of 30 days. The purpose of this protocol is to enable the body to recover and repair the damage which has occurred. Those who follow it must exclude the following from their diet:

  • Sugar
  • Gluten
  • Dairy
  • Grain
  • Caffeine
  • Alcohol

For Jo this meant making wholesale changes to her regular diet. In order to provide moral support her husband George volunteered to do exactly the same.

The beginning was not easy because she suffered severe caffeine and sugar withdrawal symptoms because her body was screaming out for carbohydrates. The good news is that after a few days the worst was over and then she started to improve. Within a very short time she felt very much better and was able to come off all the drugs with the exception of painkillers, which had been reduced substantially. This article is being written just before the end of the 30-day period. All the aches and pains have gone. All the issues with her stomach have disappeared. She used to have problems with acne but her skin has improved significantly. Various supplements are being taken which should help to repair any damage to the gut. Jo is sleeping much better.

It has not been straight forward to prepare the meals, because of the restrictions. There are also difficulties because the book has been written for an American audience. She spent a lot of time on “googling” the English names for many of the foods recommended. It turns out that many of the speciality vegetables and squashes which are common place in the US just do not exist here in the UK. A good example is Spaghetti Squash which can be used as a suitable substitute for traditional pasta.

The key ingredients which are allowed include:

  • All meat, ideally from grass-fed animals. Sausages are fine provided they are gluten-free. Fish is recommended.
  • Leafy green vegetables, especially those from the cabbage family, preferably organic. Legumes are not allowed.
  • Butter is banned because it is dairy but olive oil and coconut oil are absolutely fine. Avocadoes are another good source of fats.

For breakfast, Jo and George usually have burgers made from turkey or chicken mince or sausages fried in coconut oil. Although carbohydrate-containing foods such as rice and pasta are not allowed, a good substitute can be prepared from cauliflower. Sweet potatoes are one of the staples which are allowed so chips can be made using coconut oil. For a special dessert coconut milk can be whipped and flavoured with cinnamon and used to pour over berries. The spices which can be used include:

  • Cinnamon
  • Nutmeg
  • Cumin
  • Ginger
  • Turmeric

Sea salt and black pepper are also allowed.

They usually prepare double rations so save on preparation time.

Because Jo is so much better as she approaches the end of the initial 30-day period, she will be able to introduce some of the “banned” foods into her diet to see if she can cope with some of these such as eggs. However she considers herself to be relatively lucky to have made such excellent progress so quickly. Dr Myers emphasises that this must not be attempted until a complete recovery has been achieved, which may actually take many months. She also insists that gluten and dairy must be ruled out totally.

There is no question that in Jo’s case this has worked and she is very confident that it will continue to be effective in the long term. In fact her brother (in Australia) who has severe IBS felt better immediately after cutting out dairy and gluten. He no longer has stomach problems and his skin is healing very well. Jo’s mother who has several problems including diverticulitis also found a huge improvement in her health by making similar changes to her diet.

Jo’s comments below provide some valuable insight into her experience in recent years:

“Two years ago I tried both Gluten Free and Dairy Free as I had heard that this could help. However Dairy Free only lasted about a week because I liked the sweet things in life too much!  Gluten Free lasted about 4-6 weeks (my stomach did feel better whilst doing this although the rheumatoid arthritis symptoms were still there). My mistake was to substitute my unusual “unhealthy” diet for Gluten Free “unhealthy” options – thus completely ignoring anything to do with my gut which is where I KNOW now the healing process needs to start.  Because I was only tackling one of the many different problems, the improvement was minimal.

I am now only too well aware that I have a full blown auto-immune disease. This means that I had to do a complete overhaul of my diet…..no sugar, no gluten, no dairy, no grains, no legumes, no alcohol, no caffeine!! I needed to make fundamental changes in my approach to food. I had to be prepared for a rough few weeks and give my gut time to start healing itself. It was necessary to provide my body with all the essential nutrients which would help me recover and cut out everything that I now believe caused this disease in the first place.  I can say this now because OMG within 24 hours of starting I couldn’t quite believe how much better I was feeling!  Honestly, no word of a lie, it was almost instant! As soon as I stopped eating all those “nasties” and started giving my body what it needed (and giving it a helping hand with the recommended natural supplements that Dr Amy Myers recommends) my body started to respond…at last in a positive way!  Then within 3-4 days I found (unbeknown to me at the time) that I had stopped limping. I walked down the stairs like a normal human being. I was dumbfounded and my family could not believe the difference either. I felt better than I had done in years. At that point I stopped taking all my immune suppressant tablets and felt well enough to not have my biological injections.  Happy just does not quite explain it enough. My head is clear. I feel great. Yes I will sometimes sniff my colleagues caramel shortbread but that is as near as I’ll get from now on, although I am hoping to have a successful reintroduction of a few foods (fingers crossed!)…mmm…. Eggs…mmmm….Potatoes. But even if I cannot manage to re-introduce these foods successfully at the moment perhaps I can try again a bit later when I hope my gut has fully healed. The important point is that I am in control. It is my choice and my decision. So I am sure that between me and my body we will find our way to the other side!

I consider myself to be lucky to be where I am now, but I think I had to be at my lowest possible place both mentally and physically before I was ready to commit to this fully. I was depressed, grumpy, fed up, I could no longer play certain games with my children.  I could not even lift my youngest up anymore. I barely had the energy to get through my working day let alone go out and socialise. In short, I was at my lowest point imaginable and I could see no way out. I knew that unless I tried to do something myself things would only get worse. I was not willing to give up on enjoying my life without a fight!  Don’t get me wrong, it’s not easy but if a sugar and carbohydrate lover like myself can do it, believe me ANYBODY can.  I consider myself lucky, because I have found what seems to be the answer my body has been looking for, and also I am so lucky because I saw the results so quickly it gave me the encouragement and will-power to continue. The results speak for themselves   no-one can argue with that!”

CONCLUSION

This is a heart-warming story, which Jo is very keen to share with others in the hope that it will inspire some of them to follow suit and achieve similar success.

Many scientists will discount this case history on the grounds that it is “anecdotal”. In their view it does not comply with the standards of a formal Randomised Controlled Trial. If there were just a few individuals involved then I would have sympathy with the critics but when the approach works very effectively with a large number of people, then that cannot be brushed aside. The fact that the dietary changes are producing positive results when the conventional treatments using various drugs have failed so abysmally simply cannot be ignored. It is scandalous that this knowledge is not being shared with those who suffer from these conditions. At the very least, patients should be given the option so that they can try it for themselves. Even if it only works for some, they will benefit by significantly improving their own personal health and the demands on a hard pressed NHS will be reduced.

REFERENCE

  1. http://www.amymyersmd.com/

174. Academy of Nutrition and Dietetics Comments on Latest version of Dietary Guidelines for Americans

.Every 5 years the Dietary Guidelines in the USA are reviewed. The latest exercise is in progress and the first draft was released in February 2015 (1). The crucial and potentially contentious aspects relate to fat, sugars and salt. The position of the Dietary Guidelines Advisory Committee (DGAC) was that it:

“…encourages the consumption of healthy dietary patterns that are low in saturated fat, added sugars, and sodium. The goals for the general population are: less than 2,300 mg dietary sodium per day (or age-appropriate Dietary Reference Intake amount), less than 10 percent of total calories from saturated fat per day, and a maximum of 10 percent of total calories from added sugars per day.”

It continues:

“Sources of saturated fat should be replaced with unsaturated fat, particularly polyunsaturated fatty acids.”

Essentially this is in line with the conventional approach which has been in place in a great many countries since the 1980s. However there are growing doubts about the validity of this strategy particularly because of the growing incidence of obesity and Type 2 Diabetes (T2D) despite the fact that the advice to reduce fat, especially the saturated fat (SFA), is actually being implemented. Furthermore a number of systematic evaluations have been conducted, which have shown that there were fundamental flaws in the original evidence used to justify these recommendations. In addition, there have been investigations which demonstrate that the level of cholesterol in the blood (TC) is not a reliable indicator of the risks of heart disease. In a recent comprehensive study in Norway the TC levels in 52,087 men and women aged 20-74 years were measured over a 10-year period and any deaths were recorded. The results showed that in both men and women there was no statistically significant increase in the risk of death at higher TC levels. In men it was found that with those low TC levels, which comply with current official advice that the total death rate was actually increased. For women the results were even more striking: the higher the TC levels, the lower the risk of dying from all causes.

The authors commented as follows:

’If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but beneficial.’’

They went on to conclude:

‘’Our results contradict the guidelines’ well-established demarcation line (5 mmol /L) between‘good’ and ‘too high’ levels of cholesterol. They also contradict the popularized idea of a positive, linear relationship between cholesterol and fatal disease. Guideline-based advice regarding CVD prevention may thus be outdated and misleading, particularly regarding many women who have cholesterol levels in the range of 5–7 mmol/Litre and are currently encouraged to take better care of their health’’(2).

The latest development is the growing acceptance and awareness that excessive consumption of sugar and carbohydrates is a critical factor contributing to T2D, heart disease and various cancers. The research which demonstrates this is convincing (3). In addition there are large numbers of individuals who have effectively cured their own T2D by switching to a diet which is low in carbohydrates and high in fat (LCHF) which is in direct contradiction of the conventional recommendations (4).

However things may be starting to change. The USA Academy of Nutrition and Dietetics has over 75,000 members made up of registered dietitian nutritionists, dietetic technicians, registered, and other dietetics professionals holding undergraduate and advanced degrees in nutrition and dietetics, and students. The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy. In a response to the latest draft version it has made a number of key points including the following:

  • Genuine doubts about the advisability of making a recommendation on sodium intake which would apply to everyone. More specifically it draws attention to studies and reviews which demonstrate an increase in mortality at the recommended intakes. In fact, the optimal ranges for sodium intake are significantly greater than the DGAC’s recommended maximum intake. In other words there is a distinct danger that those who conscientiously follow the guidelines and lower their intake of sodium may actually be damaging their health. The Academy urges the DGAC to exercise caution in drafting the recommendation on sodium intake. In particular it expresses concern that the Scientific Report’s section on sodium intake appears to use the conclusions of several studies which were limited to those “who would benefit from blood pressure lowering” as a basis for making a general recommendation that all American adults consume less than 2,300 mg/day of sodium. Clearly it would not be valid to extrapolate such results to the population as a whole.
  • The recommendation to reduce the intake of saturated fat (SFA) is based on the assumptions that TC and LDL Cholesterol are significant risk factors for heart disease and that these are raised by the SFA. The Academy comments that even if the SFAs increase the TC and LDL Cholesterol levels, this is essentially irrelevant to the question of the relationship between diet and risk for cardiovascular disease. In 2010 the USA Institute of Medicine concluded unequivocally that these markers were not suitable for use as surrogates for the impact of diet on heart disease. In the light of these conclusions the Academy was concerned that the evidence does not lead to the conclusion that saturated fats should be replaced with polyunsaturated fats (PUFAs) for the greatest health benefit. It is highly significant that the Academy should take this position because it paves the way for abandoning the advice to lower the SFA and provides an opportunity to advise an increase, which can be justified on the basis of extensive evidence (5).
  • The Academy goes on to recognize that the SFAs should not be replaced by carbohydrates but despite the above comment after a rather convoluted argument finally reaches the conclusion that:This is surprising because there has been no attempt to distinguish between the omega-3s and the omega-6s even though the difference is absolutely crucial. In fact there is extensive reliable evidence which indicates that omega-6:omega-3 ratio is far too high in many countries and can reach values as high as 50. Ideally the ratio should close to unity and certainly no higher than 4 (6). A very high omega-6:omega-3 ratio promotes the pathogenesis of many diseases, including cardiovascular disease, cancer, and inflammatory and autoimmune diseases. As most of the normally available PUFAs are omega-6s the advice to increase them will only exacerbate the current position (7, 8). The only sound advice which can be given on the basis of current knowledge is that sugar and other sources of carbohydrates should be replaced by SFAs.
  • “Therefore, it appears that the evidence summarized by the DGAC suggests that the most effective recommendation for the reduction in cardiovascular disease would be a reduction in carbohydrate intake with replacement by polyunsaturated fat.”

CONCLUSION

The Academy report certainly represents progress. The stances on salt and SFAs are an important step forward but it is particularly unfortunate that the input on PUFAs is so pedestrian and simply ignores much relevant evidence which demonstrates why recommending an increase is likely to be harmful. Nevertheless it is important to see this in a positive light. At the very least it will help to persuade more people that cholesterol can no longer be regarded as a major risk factor for heart disease.

 

REFERENCES

  1. http://www.health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf
  2. H Petursson et al (2012). Journal of Evaluation in Clinical Practice 18 (1) pp 159-168
  3. http://www.sciencedirect.com/science/article/pii/S0899900714003323
  4. http://vernerwheelock.com/?p=422
  5. http://vernerwheelock.com/?p=155
  6. A P Simonopoulos (2002) http://www.ncbi.nlm.nih.gov/pubmed/12442909
  7. http://vernerwheelock.com/?p=153
  8. http://vernerwheelock.com/?p=370

173. Australian Dietitian Expelled from Her Professional Body for Advocating a Low Carb Diet?

Jen Elliott, a dietitian with 35 years’ experience, has been expelled from the Dietitians Association of Australia (DAA) because of her recommendation to lower carbohydrate diets to people with insulin resistance and type 2 diabetes (T2D) (1). The complaint originated from another dietitian who did not agree with the approach taken by Jen who claimed that the recommendation of:

“a very low carbohydrate diet for type 2 diabetes management is inconsistent with Evidence Based Practice”.

A further complaint was that one of her clients was not happy with an interview.

In response Jen pointed out that:

  • The DAA does not give specific advice but refers to the American Diabetes Association (ADA) for this.
  • The ADA notes that there is no “one-size-fits-all” eating approach in diabetes management and that the chosen eating pattern should be designed to improve glucose, blood pressure, and lipids.
  • ADA documentation suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.
  • Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Therefore, collaborative goals should be developed with the individual with diabetes.
  • Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains a key strategy in achieving glycaemic control.
  • Evidence is insufficient to support one specific amount of carbohydrate intake for all people with diabetes.

In the light of these points it would seem that recommending a diet low in carbohydrates is consistent with the DAA policy such as it is. Jen also pointed out that there is extensive evidence to show that the quantity and type of carbohydrate in a food influence blood glucose level, and total amount of carbohydrate eaten is the primary predictor of glycaemic response. There are of course hundreds, if not thousands, of individuals who can confirm this from their own personal experience. As a consequence they have effectively cured their T2D, been able to come off drugs, and improve the quality of their lives.

Although Jen explained to the client the pathways of carbohydrate metabolism and how to determine the appropriate intake for a specific individual, the person alleged she dismissed previous evidence based advice and as a result was left confused and disgruntled. So clearly there are two very different versions of what happened at the interview.

Here is how Jen describes what took place:

“The client told me that she understood what I had explained but that it was different to what she had read and had been previously told. I should stress that what I had explained was the physiological response to carbohydrate intake and the rationale for engaging in regular exercise and monitoring carbohydrate intake. I then suggested that an eating plan that was consistent with her usual eating pattern, but which also suggested some limitation of carbohydrate foods ie the CSIRO Wellbeing diet, may be suitable. I asked if she would like to trial the eating plan, went through the guidelines with her and provided her with a copy of page 3 from the Wellbeing diet booklet. As is my practice, I said that I recommended trialling the eating plan for 2 weeks to see how it suited her and we could discuss this at a review apt in 2 weeks. The appt was made at the end of the interview and later cancelled by the client. I would also like to address specific allegations made in the letter of complaint from the patient to DX. 1. That I do not support what the Diabetic Dietitians say. My response to clients who question why my approach may be different to what they have heard or been taught, is that there is not a ‘One size fits all ’approach when it comes to managing diabetes. This is in line with ADA guidelines that state, “A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes. Personal preferences (e.g., tradition, culture, religion, health beliefs and goals, economics) and metabolic goals should be considered when recommending one eating pattern over another.” I provide people with information about the possible underlying causes of the disorder, so that they have the knowledge and tools to evaluate different diet approaches and find what works for them. If a client said to me that they had seen another dietitian and the advice given suited them, I would encourage them to follow that advice. If a client said to me that they had received advice from another dietitian but that they wanted to seek my advice as well, then I would do as I explained above. I agree with and follow the principle of not a one-size-fits-all approach; therefore I do not denigrate the practices of others. I provide information and insufficient to support one specific amount of carbohydrate intake for all people with diabetes.”

Note: CSIRO is the Commonwealth Scientific and Industrial Research Organisation of Australia.

In response to this Jen was sent a letter specifically asking her to reply to the charges that:

  • Your recommendation of a very low carbohydrate diet for T2D management being inconsistent with Evidence Based Practice
  • The patient letter indicates that I dismissed previous evidence based advice given to this patient and provided contradictory advice, resulting in a confused and disgruntled consumer.

This seems rather peculiar as Jen had already answered these allegations comprehensively in her previous letter.

Nevertheless, Jen responded this time with support from Dr Richard Feinman and Dr William Yancy.

Dr. Feinman is the lead author on the recent review:

“Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base” (2).

The review provides an evidence-based medicine perspective supporting low-carbohydrate diets. The paper has 26 authors with excellent credentials including at least one well-known former critic of low carbohydrate diets.

Dr Yancy is co-author of the ADA guidelines who included the following comment in a letter to Jen:

“The evidence supporting a low-carbohydrate diet is ample at this point. The only data we are missing is a trial with one of the ultimate disease endpoints like mortality or heart attacks. Of course, the low-fat/high-carbohydrate diet does not have evidence showing it improves those outcomes either—the trials that have been done were negative. And, in head-to-head trials with intermediate outcomes, low-carb diets quite clearly do better for improving HDL and triglycerides, and much of the time do better for improving glycemia and weight. Since we did the evidence review for the ADA guidelines, 3 more RCTs in patients with DM have shown greater benefit with the low-carb diet.”

 

Jen also provided a comprehensive response to the second charge, which included detailed comments on the complaint from the other dietitian (DX). Here is an extract:

“DX says ”The dietary advice is not that of the wider scientific community” and “A low carbohydrate diet is not best practice for diabetes care”. DX obviously is unaware of ADA guidelines, which DAA recommends dietitians follow.

 “The diet described by the client with carbohydrate once per day…….” DX should have checked her facts, as she is mistaken in what she believes I recommended to the client. If I had recommended carbs in one meal per day, which I clearly did not, it would nonetheless be supported by ADA’s guidelines.”

All the publicly available information can be accessed at (1).

A subsequent development has appeared on Facebook. In response to the following comment from George Henderson:

I am disappointed by your recent decision to expel Jennifer Elliott for recommending the lower carbohydrate CSIRO Wellbeing diet to a patient with Type 2 Diabetes” (3).

The DAA replied:

“Hi George. Please note that the former DAA member you mention was not expelled for recommending the lower carbohydrate CSIRO Wellbeing diet to a patient with Type 2 Diabetes, as you suggest. In line with DAA’s complaints procedures, we are not able to go into detail about this case – this information is confidential. What we can say is that a complaint was made against the former DAA member regarding professional competence, through DAA’s formal complaints process and this was assessed by DAA’s Complaints Committee. As a result, this person’s DAA membership has been cancelled. It is incorrect to suggest the former member is in trouble because she had certain views on nutrition and dietary approaches. DAA wishes to be clear that the outcome of the complaint against this former member relates to professional competence – and this is the reason DAA’s Complaints Committee revoked this person’s DAA membership.”

This is in direct contradiction to what Jen herself understands which relates to her dietary advice. This must mean that her expulsion was based entirely on the complaint from the client about the way the interview was conducted and the implications of that for professional competence. This seems extraordinary as it depends entirely on who you believe. Jen has presented her account which totally disputes that of the client. So without any corroboration, the DAA decision is inexplicable.

It is obvious that there is a lot more to this than meets the eye. The DAA cannot hide behind confidentiality. On the face of it the behaviour of the DAA is irrational, unjustified and disgraceful.

REFERENCES

  1. http://linkis.com/com/2pNvU
  2. http://www.sciencedirect.com/science/article/pii/S0899900714003323
  3. https://www.facebook.com/dietitiansassociation/posts/10206562152909378?ref=notif&notif_t=like

 

172.Response to Article by Director General of the British Nutrition Foundation (BNF)

In a recent issue of “Food Science and Technology”, Professor Judith Buttriss, who is Director General of the BNF, discusses the role of sugars in diet and health (1). Based on draft reports from the World Health Organisation (WHO) and the UK Scientific Advisory Committee on Nutrition (SACN) she concludes that the calories in sugar are no more responsible for obesity than other calories consumed in excess of expenditure. She goes on to suggest that the mechanism for weight gain is likely to be the excess energy intake rather than any physiological or metabolic effect of sugars per se. This is a remarkable position, which demonstrates an apparent ignorance of current scientific knowledge.

In reality we now have very convincing evidence that obesity is not caused by consuming more calories than are being used. There is overwhelming evidence that simply reducing the intake of calories just does not work.  This is all explained by in the excellent book “The Obesity Epidemic” by Zoe Harcombe (2).What is absolutely crucial is the content of the diet NOT the amount of food consumed. It is time the nutrition world woke up to the fact that the body does not utilise food in the same way as a bomb calorimeter. All calories are not equal because the metabolic processes which deal with fat, protein and carbohydrates are all quite different.

Sugar is broken down to glucose and fructose, which is now recognised as a disastrous combination with respect to health.

Raised levels of glucose in the blood will eventually cause Type 2 Diabetes (T2D). Obviously this is the result of excessive consumption of sugar and other foods containing starch which is broken down to produce glucose. In response the pancreas is stimulated to secrete insulin. One of the functions of the insulin is to reduce the level of blood glucose which it does by directing it to the liver where it is converted into fat, which is then stored. Hence body weight is gained and if the same type of diet is maintained over a period, the inevitable result is obesity. It also means that the body is effectively overloaded with fat. One consequence of this is that the level of triglycerides in the blood, a reliable risk factor for heart disease is raised. Another is that some of the fat accumulates in the liver, which results in the “fatty liver” condition.

Because the fat is stored, satiation is not achieved, which explains why a person consuming a diet high in carbohydrates is continually hungry and therefore consumes excessive quantities of food. Conversely a person consuming a diet low in carbohydrates and high in fat will find that hunger is satisfied quite easily.

It is also important to appreciate that the continual exposure of the body to high levels of insulin causes the condition of insulin resistance (IR). There is now convincing evidence that hyperinsulinaemia and insulin resistance are all related to heart disease, stroke, hypertension and obesity or what has become known as “metabolic syndrome”.

However the picture gets even worse when we factor in the role of fructose. This is because the metabolism of glucose and fructose are different.  First of all the presence of fructose in the blood does not stimulate the secretion of insulin by the pancreas. Consequently it has been promoted as a “healthy sweetener”. On the other hand it can only be metabolised in the liver whereas glucose can be utilised throughout the body. This places a huge demand on the capacity of the liver, which means that it limits the ability to cope with other carbohydrates. One of the by-products of the fructose metabolism is uric acid which causes gout and increases blood pressure.

The fructose also causes insulin resistance in the liver so that extra insulin has to be produced, which increases the demand on the pancreas that eventually leads to the failure of the organ resulting in T2D. The extra insulin forces fat into the cells giving rise to weight gain and obesity. Over the years the increased consumption of sugar and High Fructose Corn Syrup (HFCS) which is a mixture of glucose and fructose has been closely followed by increased incidence of obesity. Confirmation of the damaging effects of fructose are shown by the following investigations:

  • The level of triglycerides in the blood was raised when young men were given a diet which was supplemented with 200 g sucrose/day but when the sucrose was replaced with starch, which breaks down to glucose only there was no change(3)
  • A comparison was done over 8 weeks in which healthy men and women consumed 25% of their energy either as fructose or glucose. Although both groups gained the same amount of weight, those consuming fructose synthesised more fat in the liver and had a greater amount of subcutaneous fat. This is consistent with the fact that virtually all the fructose has to be utilised by the liver which primarily converts it into fat that is stored. The fructose group also had more oxidised LDL Cholesterol and a higher concentration of small dense particles of LDL Cholesterol, both of which are risk factors for heart disease. Insulin sensitivity was reduced in the fructose group but not in those consuming glucose (4).

 

Excess sugars in the body react with proteins to form Advanced Glycation Endproducts (AGEs), which means that the normal functioning of the proteins is impaired. In particular they contribute to premature aging, the development of atherosclerosis and complications in long-term T2D. The affinity of fructose for proteins is about 8 times greater than that of glucose (5).

Even further confirmation is provided by the research which demonstrates that those who reduce their sugar and other carbohydrates can successfully cure T2D (6,7). On top of this they invariably lose weight and improve the risk factors for heart disease by reducing the level of triglycerides in the blood and raising the HDL Cholesterol. In spite of the fact that mainstream medicine regards T2D as incurable, hundreds if not thousands of individuals have successfully overcome the disease by reducing the amount of sugar and other carbohydrates in their diet.

Finally it is essential to explain what has happened over the past 30 years during which time obesity, T2D and kidney disease have all increased to unprecedented levels, despite the fact that the official recommendation to reduce the intake of saturated fat (SFA) by 25 % was achieved by about 2000. Although there are no detailed statistics on how the intake of sugar has altered, there can be no doubt that it has increased very substantially over this period. Between 1975 and 2000 the consumption of soft drinks increased 4-fold. There has also been a huge increase in the sales of “low fat” products. Many of these, such as yoghurts, are often devised by replacing the fat with sugar. The latest UK survey shows that for children aged 4 to 10, the average intake of sugar is 14.7% of energy for those aged 11 to 18 years it is 15.6% (8). It is clear that sugar has to implicated in the deterioration of public health.

CONCLUSION

We now have overwhelming evidence from a range of different sources and disciplines which have established beyond reasonable doubt that excessive consumption of sugar is damaging to health. It has been a major contributor to the increased incidence of obesity and T2D that has occurred in so many countries over the past 40 years. From a public health perspective there are very sound reasons that every effort should be made to reduce the consumption very substantially.

The conclusion of Professor Buttriss that:

“…evidence to support sugar as a primary cause (of obesity) is incomplete at best…”

Is somewhat disingenuous and is obviously based on the discredited concept that obesity is simply caused by consuming more energy than is expended. We now know that obesity is a disorder of the metabolism, which is primarily caused by excessive insulin production. The solution is obvious: reduce the amount of carbohydrates, especially the sugar!

REFERENCES

  1. J Buttriss (2015) Food Science and Technology 29 (1) pp14-15
  2. Zoe Harcombe (2010) “The Obesity Epidemic” Columbus
  3. P A Akinynju et al (1968) Nature 218 (5145) pp 975-977
  4. K Stanhope et al (2009) Journal of Clinical Investigation 119 (5) pp 1322-1334
  5. C G. Schalkwijk et al (2004) Diabetes/Metabolism Research and Reviews 20 (5) pp 369-382
  6. J V Nielsen et al (2005) Upsala Journal of Medical Science 1 (10) pp 69-74
  7. RD Feinman et al (2015) Nutrition 31 (1) pp 1-13
  8. https://www.gov.uk/government/news/new-national-diet-and-nutrition-survey-shows-uk-population-is-eating-too-much-sugar-saturated-fat-and-salt

171. Bad Science

In an ideal world, the various checks and balances that are applied would ensure that information presented in the scientific journals, especially those regarded as prestigious, is sound and reliable. Unfortunately there is convincing evidence that this is not the case. In an article published in the BMJ, Tricia Greenhalgh and colleagues have concluded that evidence based medicine is in crisis (1). The following reasons are cited:

  • The drug and medical devices industries increasingly set the research agenda by defining what counts as a disease. Then they specify which tests and treatments will be evaluated and choose the measures which will be used to determine the effectiveness.
  • There is just too much information so that the clinical guidelines are not manageable.
  • Most of the current work will only result in very small gains. The large scale trials which must be done to detect these marginal benefits tend to over-estimate them while at the same time the adverse side effects are played down.
  • As people age, they are more likely to suffer from several different conditions at the same time. These are very difficult to treat with the result that the management of one disease or risk state may cause or exacerbate another—most commonly through the perils of polypharmacy in the older patient.
  • As the examples above show, evidence based medicine has drifted in recent years from investigating and managing established disease to detecting and intervening in non-diseases. Risk assessment using “evidence based” scores and algorithms (for heart disease, diabetes, cancer, and osteoporosis, for example) now occurs on an industrial scale, with scant attention to the opportunity costs or unintended human and financial consequences (1).

John Ioannidis concluded that many published research findings are false or exaggerated, and an estimated 85% of research resources are wasted (2).

Richard Smith, a former editor of the BMJ has argued that the fundamental issue is the publication of papers in medical journals which report the results of trials on various drugs (3). These are likely to be much more effective in influencing doctors to select these drugs for treatment of patients than advertisements. Independent research has shown that studies funded by a company were four times more likely to have results favourable to the company than studies funded from other sources. This is achieved by asking the right questions. Smith describes how that approach is implemented:

  • Conduct a trial of your drug against a treatment known to be inferior
  • Trial your drugs against too low a dose of a competitor drug
  • Conduct a trial of your drug against too high a dose of a competitor drug (making your drug seem less toxic)
  • Conduct trials that are too small to show differences from competitor drugs
  • Use multiple endpoints in the trial and select for publication those that give favourable results
  • Do multicentre trials and select for publication results from centres that are favourable
  • Conduct subgroup analyses and select for publication those that are favourable
  • Present results that are most likely to impress—for example, reduction in relative rather than absolute risk.

If all this fails to produce positive results then it is rare for any negative results ever to see the light of day. In addition the impact of the favourable results are enhanced by publishing the same information in several different journals. Because the drug companies usually conduct trials in several different centres, there is huge scope for publishing different results from different centres at different times in different journals. It’s also possible to combine the results from different centres in multiple combinations. A few years ago the biotechnology firm Amgen selected 53 reports of research, many of them related to cancer, which might offer potential for subsequent development by the company. It found that the results of only 6 (11%) could actually be replicated successfully (4). In order to investigate further where possible the original authors were contacted to discuss the discrepant findings, exchange reagents and repeat experiments under the authors’ direction, occasionally even in the laboratory where the work had been done.

It was discovered that studies which could be reproduced, the authors had paid close attention to controls, reagents, investigator bias and describing the complete data set.

By contrast it was found that when this was not the case, data were not routinely analysed by investigators blinded to the experimental versus control groups. Results were often published which in agreement with working hypothesis, but which were not representative of the complete set of data. It emerged that there are no guidelines which require all data sets to be reported in the paper. In fact, original data sets are often removed during the editorial process. Essentially similar conclusions were reached by a team from Bayer Healthcare in Germany (5).

John Ioannidis and colleagues have identified a number of reasons why so much research is poor quality (6). These include:

  • Poor protocols and design. Some research is done using a rudimentary protocol or possibly no protocol at all. Even when there is a formal protocol, it may not be publicly available. Although changes may have to be made during the course of an investigation, these are often poorly documented.
  • Poor utility of information. Many studies are conducted without any attempt to assess the value or usefulness of the information that will be generated.
  • Statistical power and outcome misconceptions. In order to achieve statistical power, researchers may choose outcome measures which are clinically trivial or scientifically irrelevant. This can happen in studies on heart disease where there is no difference between treatments in death rates but there can be significant differences if other symptoms of the disease, which are assessed subjectively are included in the analysis.
  • Insufficient consideration of other evidence. Most studies are designed and conducted in isolation. In a broader context, the failure of researchers on heart disease to recognise the damage that can be caused by raised blood glucose insulin resulted in the continued emphasis on fat/cholesterol. Ultimately this led to recommendations to alter the habitual by reducing fat, especially the saturated fat, and increasing carbohydrates. It is now becoming clear that this has been an absolute disaster and is one of the main reasons why obesity and T2D has reached epidemic levels.
  • Subjective, non-standardised definitions and vibration of effects. This refers to subjective judgments which leave room for so-called vibration effects during the statistical analysis which means that the results can differ depending on how the analysis is done. This can lead to bias especially if the investigators have a preference for a particular result. This provides an opportunity for the researchers to design the study protocol in such a way that would favour the outcomes that will satisfy the sponsors. This could help to explain why the source of funding has such a strong influence on the results obtained.

He goes on to explain that many biomedical researchers have poor training in research design and analysis. Physicians who conduct research usually have a short introduction to biostatistics early in medical school, and subsequently do not receive any further formal training in clinical research. The little training that they receive often focuses on data analysis, and rarely includes study design, which is arguably the most crucial element in research methods.

Much flawed and irreproducible work has been published, even when only simple statistical tests are involved.

Research is often done by stakeholders with conflicts of interest that favour specific results. These stakeholders could be academic clinicians, laboratory scientists, or corporate scientists, with declared or undeclared financial or other conflicts of interest. Much clinical research is designed and done under the supervision of the industry, with little or no input from independent researchers. Clinicians might participate in this process simply through the recruitment of study participants, without making any meaningful contribution to the design, analysis, or even writing of the research reports, which might be done by company ghost writers.

CONCLUSION

This is a very sorry state of affairs. Enormous amounts of money and human resources are being devoted to research in the biological sciences, yet all the indications are that in many cases the results are not worth the paper they are written on. On top of all this there is the failure of the refereeing system used by the scientific journals to identify the flaws contained in the papers submitted for consideration publication. Furthermore the findings often are absolutely crucial in the determination of commercial strategies and national policies. It is somewhat salutary that these are being constructed on a foundation of sand. For example it means that it is relatively easy or the data to be manipulated to suit other agendas, such as the case submitted for official approval of a drug. The same considerations apply to the development of dietary guidelines and the poor standard of the background science is one of the reasons why it is so difficult to determine the relationship between diet and health.

There are many reasons why public health policies in many countries are failing but the lack of a sound reliable evidence base is fundamental and until this is fixed, progress will be extremely difficult to achieve.

REFERENCES

  1. http://www.bmj.com/content/348/bmj.g3725
  2. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001747
  3. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020138
  4. http://www.nature.com/nature/journal/v483/n7391/full/483531a.html
  5. http://www.nature.com/nrd/journal/v10/n9/full/nrd3439-c1.html
  6. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62227-8/fulltext

 

170. A FLOOD OF SUGAR

On return from holiday, you open the front door and discover that there is water all over the place. Obviously there has been a leak somewhere and the house is flooded. As soon as you get over the shock, you call a plumber. Just imagine your reaction if you are told that it is impossible to stop the flow of water. You must to accept that you have to cope as best you can with this excess water. There may be scope for diverting some of the water but you will have to do what you can with buckets and mops as long as the house is still standing.

This is absolutely ridiculous. There is no question that the leak can be fixed and that as a consequence the flooding can be stopped. The house can be cleaned up and the occupants can repair any damage and get on with their lives. If one plumber says the problem cannot be solved then no doubt another one will be found who can provide a satisfactory solution.

Although you may think the scenario painted here is ludicrous, the point I am trying to make is that Type 2 Diabetes (T2D) is an exact parallel. Instead of your house being flooded with water your body is being flooded with sugar. The excess water causes damage to furniture, carpets, services such as electricity and gas, and possibly even the structure. Similarly excess sugar in the blood sticks to proteins so that their function is impaired. It combines with haemoglobin so that the efficiency of oxygen transport is reduced. As a consequence the extremities may be starved of oxygen, which explains why it is sometimes necessary to amputate the limbs of those who suffer from T2D. Internal organs, especially the brain can also be damaged. The risk of developing Alzheimer’s Disease is increased very substantially in diabetics. Excess glucose in the blood stimulates the production of insulin, which is required by the body to deal with the glucose. However the high levels of insulin also cause internal damage as shown by insulin resistance in many organs.

The top priority must be to prevent the build-up of sugar inside the body. The solution is obvious. Identify the source and stop the flow in just the same way as you stop the flood in your house.

However unless you are fortunate enough to have one of the very few enlightened doctors that are about in the UK, you will be given the official line as illustrated by the NHS Choices website which tells us quite bluntly there is no cure for T2D (1). This means that if you have been diagnosed with T2D, you will need to look after your health very carefully for the rest of your life. Furthermore your GP will be able to explain your condition in detail and help you to understand your treatment. If there are any problems, you may be referred to a hospital-based diabetes care team, which will closely monitor your condition to identify any health problems that may occur.

It goes on to say that T2D usually gets worse over time and although lifestyle changes may help to control blood glucose levels, eventually medication will probably be needed. There are various combinations of drugs that can be used, culminating with insulin that has to be applied by injection.

To return to the house flooding analogy, what this means is that you will just have to put up with the effects of the excess water as long as you remain in that house. However there is now overwhelming evidence from a variety of sources that T2D can be cured or at worst alleviated in exactly the same way as in a flooded house: you simply stop most of the sugar from entering the body. The specific form of sugar in the blood which is causing the trouble is glucose. This originates from the diet. First of all, there is the ordinary table sugar which is broken down to glucose and fructose.  Although fructose does not accumulate in the blood, there is growing evidence that it also causes harm inside the body. Secondly, there are the foods such as potatoes, flour, bread, rice and pasta that contain starch, which is broken down into glucose. The answer is blindingly obvious, reduce the consumption of those foods which contribute to the glucose in the body. If we go back to official source of information we find that the dietary advice is that:

“The important thing in managing diabetes through your diet is to eat regularly and include starchy carbohydrates, such as pasta….”

This is absolutely unbelievable because it means that more glucose will enter the body when action should be taken to reduce it. This is like telling the flooded householder that it is a good idea to let the bath overflow fairly regularly!

The Diabetes UK website states that:

“Carbohydrate is a nutrient that is an important source of energy in the diet. All carbohydrates are broken down into glucose which is essential fuel for the body, especially the brain.”

It goes on to advise that we should limit our intake of saturated fat and choose the ‘low fat’ versions where possible (2).

This really is rubbish! The body is perfectly capable of using fat as a source of energy, although it may take a few days to adapt. Carbohydrates are not required. There is overwhelming evidence that people can lead a perfectly healthy life with a minimal amount of carbohydrates in their diet. The brain can utilise ketones (which are derived from fat) as a source of energy.

Low fat foods are disastrous for diabetics because the fat is often replaced by sugar which makes the disease even worse.

To cap it all, recent research has indicated that the standard treatments are ineffective. In a study using information from databases in Saskatchewan on 12,272 patients with T2D, it was found that the all-cause mortality rate increased with exposure to insulin (3). Table 1 shows that those with the highest exposure had almost 3 times the death rate of those who were not treated with insulin. A similar trend was found for death due to cardiovascular diseases.

Table 1. Relationship between insulin exposure and mortality

Insulin exposure Hazard ratio
None (reference) 1.00
Low 1.75
Moderate 2.18
High 2.79

 

Information obtained from almost 50,000 patients with T2D on the UK General Practice Research Database between November 1986 and November 2008 was used to relate all-cause mortality to the type of treatment (4). It was found that those who successfully reduced their blood sugars using insulin-based therapy had an all-cause mortality which was 49% higher than those who were not treated in this way and had higher blood sugars. These treatments equate to the mop and buckets attempts to deal with the flooded house.

 

There is ample research to demonstrate that T2D can be cured by simply reducing the consumption of those foods which release the glucose into the blood (5). This is confirmed by hundreds of personal case histories from individuals who have transformed their lives by this approach. What is particularly impressive is that many of these have been able to cease all medication, which is proof of the success that has been achieved. One good example is that of a medical doctor in Canada, Dr. Jay Wortman. Here is how he describes his experience:

“The first thing that happened was that my blood sugar normalized. This was almost instant and was followed by a dramatic and steady loss of weight. I started dropping about a pound a day. My other symptoms swiftly vanished, too. I started seeing clearly, the excessive urination and thirst disappeared, my energy level went up and I began to feel immensely better.” (6).

Still not convinced, then have a look at what Dr. Jason Fung in Toronto has achieved. He actually persuades his patients to subject themselves to a period of fasting. It is somewhat surprising that this is not as traumatic as one would expect. While the first day or 2 may be difficult, Dr. Fung has found that within a short time the ability to utilize fat is activated quite quickly, so that the body can draw on the stores of fat to meet the requirements for energy. Although it may take some time for substantial weight loss to manifest itself, there is a rapid reduction in the fat content of the liver, which demonstrates that the procedure starts to have a beneficial effect very quickly.

Here are 2 testimonials as described by individual patients:

    • “My name is Marg. Just 8 months ago I walked into the building for my appointment with Dr. Fung thinking this is a waste of my time. I had tried everything. My eye sight was getting really bad, I had to have surgery. I have been over weight my whole life it seems. I could not even bend over to tie my shoes. I could hardly breathe as I walked through the door, but I continued on hoping to find something to at least help with my diabetes that I have had for 25 years. I recall Dr. Fung introducing himself and telling me I was there because I needed help. I thought to myself here we go again, however, the doctor carefully explained I had options. I could have an operation or I could Fast which could help me get off Insulin. I was then introduced to Megan who helped and guided me on how to get started Fasting. I was told to try and Fast as long as I can. Megan took my measurements and could not even reach around me. I was told to come back in a week. I went home feeling excited and anxious, could I actually do this? I told my family and they were so encouraging. I thought could this be what I have been looking for my whole life? Prior to seeing Dr. Fung I was taking 60-20-60 units of Insulin and 2000 mg of Metformin a day. Within 11 days of my first appointment I was decreasing my Insulin as my readings were already dropping. By the 12th day I completely stopped taking the Insulin. It was not easy I did a complete fast for approximately 4 weeks. However just not having to take Insulin was so encouraging!! I then started the next phase of eating 2 times one day and Fasting until lunchtime the next day. Pills were next I starting cutting down by September 6th, I took my last Metformin. I have already lost 66lbs and several inches from my waist. I have dropped from a 5X to a 3X. I can honestly say I have not felt this good in years. I can pick up the newspaper and actually read it. I can also bend down and tie my own shoes” (7).
  • “Kirk: I have been overweight since 3rd grade. Having tried numerous diets and methods of losing weight, I became desperate for a solution and received approval for gastric bypass surgery. During a regular visit to Dr. Fung I mentioned this and he asked if I would be interested in taking part in a new dietary management program he was starting. I feel very blessed that this happened because I was totally put off the gastric bypass surgery after attending an information session at Toronto Western. I began the Intensive Dietary Management program in June of 2013 and with the help & encouragement of Dr.Fung, Megan and my family (especially my daughter Catherine whom we call the food police) I have achieved fantastic results.Before the program I was taking 9 pills a day, 3 types of which were to help control my diabetes and one for high blood pressure. Today I take only 2 pills a day, one of which is for diabetes control. My A1C level is now better controlled, although my insulin resistance is still an issue. I have more energy, increased mobility and look forward to continuing in the program. The monthly group sessions are enjoyable and a good source of information……Thank you, Kirk” (8).

 

  • In the past eighteen months I have seen my weight reduced from 360 lb. to 244 lbs. Yes that’s a 116 lbs. or the equivalent of a small adult. My waist size decreased substantially from a starting point of 63 inches and now is 48 inches, a reduction of 15 inches! Most amazing of all is the reduction in prescription drugs.

 

 

This is not rocket science but quite simply the application of common sense which obviously works very well for many people. T2D is a very serious disease in its own right but also increases the risks of developing various other diseases including heart disease and Alzheimer’s Disease. Individuals who suffer from it have a reduced life expectancy and deterioration in the quality of their lives. The costs of treatment are at least £10Bn per year in the UK and the incidence is expected to continue increasing.

The official approach to this particular disease is incompetent and irresponsible. The current strategy is expensive, ineffective and causes unnecessary suffering to many people and their families. It is unbelievable that there has been a total failure to tackle the problem, when there is so much evidence to demonstrate that answers are readily available.

From a much broader perspective, this particular example highlights the fundamental fault in the current policy on healthcare not only here in the UK but in many other countries. Essentially the emphasis is on fire-fighting, which means that invariably considerable damage has been done before any action is taken. It follows that if real progress is to be achieved than there has to be a very significant shift in attitude and resources towards prevention. Looking back, it is evident that the most significant advances have been made in this way. Examples include:

  • Smoking and lung cancer
  • Clean water and a range of infectious diseases
  • Ensuring adequate intakes of vitamins and minerals

The only logical way forward to achieve this objective is to cut back drastically on the resources directed to curative medicine. There will undoubtedly be massive opposition to any attempt to do so. The extremely powerful vested interests will fight tooth and nail to maintain the status quo. Nevertheless the fact remains that existing policies are not working. If the example of T2D described here is symptomatic of other diseases/treatments then it follows that in spite of all the efforts and expenditure, standards of public health are not being improved. Ultimately the issue will have to be addressed. Why not tackle it sooner rather than later?

REFERENCES

  1. http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Treatment.aspx
  2. https://www.diabetes.org.uk/About_us/What-we-say/Food-nutrition-lifestyle/Consumption-of-carbohydrate-in-people-with-diabetes/
  3. J M Gamble et al (2010) Diabetes, Obesity and Metabolism 12 (1) pp 47-53
  4. C J Currie et al (2010) Lancet 375 (9713) pp481-489
  5. http://www.sciencedirect.com/science/article/pii/S0899900714003323
  6. http://www.drjaywortman.com/blog/wordpress/about/
  7. http://intensivedietarymanagement.com/idm-patient-profile-december-2014-margaret/
  8. http://intensivedietarymanagement.com/idm-patient-profile-november-2014-kirk/