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. He 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/

169. CALORIES IN VERSUS CALORIES OUT

This contribution is by Judy Barnes Baker and I am most grateful to her for permission to re-post here. The original can be seen at

http://carbwars.blogspot.co.uk/2013/03/calories-in-versus-calories-out.html

 

Ask anyone and they’ll tell you the solution for obesity. Eat less; move more. Our collective weight problem would go away if all the overweight people just quit eating more calories than they burn. Couldn’t be simpler.
There are 4,086 calories in a pound of fat. Divide that by the 7 days in a week and you get 584 calories. So if you eat 584 calories less per day you will lose a pound a week. If you continue to eat 584 fewer calories every day for a year you will lose 52 pounds. In 10 years, you will lose 520 pounds. In 20 years you will lose 1,040 pounds. Doesn’t sound so logical anymore, does it?
Consider this: A person who is 50 pounds overweight is wearing 204,300 calories of fat. That is enough calories to live on for 6 months. So why does a fat person get hungry?
Our bodies have a set point based on hormones that determines how much we weigh. The hormones tell you when to eat and when to stop with hunger signals. To change the set point you must change the hormones. Insulin is the master hormone. It is released in response to eating carbohydrates and it signals the body to store fat.
When you eat fewer calories and/or burn more with exercise, your metabolism, sensing that you are going through a famine, slows down to conserve energy. You will become more sedentary, your body temperature will drop, your energy level will go down, and your weight loss will slow down or stop.
By limiting carbohydrates, you can reduce your ability to store calories as fat. In spite of what you may hear from the critics of low-carb, I can assure you that the second law of thermodynamics is fully accounted for in the equation. All the energy goes somewhere, just not to your belly or your backside. We might be able to predict how much gasoline a finely-tuned car would use to travel a certain distance, but the human body is not a closed system like an engine. And the car won’t help you reach your destination by adjusting its rate of fuel consumption to make sure you get there.
How much fat you accumulate is not determined by how many calories you eat versus how many you burn, but by how the nutrients in those calories affect the hormonal regulation of metabolism. If a food stimulates the release of insulin, it is more likely to be stored as fat. If it doesn’t, it is more likely to be used as energy. The metabolism of an obese person is obviously biased toward saving calories as fat rather than spending them as energy, but that can be modified by dietary choices.
Most people believe in the calories-in-versus-calories-out hypothesis because they think they have witnessed it with their own eyes. Shows likeThe Biggest Loser perpetuate the myth. You may have read about a study of the contestants on the show conducted by Darcy Johannsen et al, who reported that by the end of the 30th week, the participant’s had slowed their metabolisms by 504 calories more per day than would be expected by their weight loss. That means that by losing weight the eat-less-move-more way, these big losers now have to eliminate the equivalent of one meal a day compared to what they ate before the intervention just to stay at their original weight. www.weightymatters.ca/2011/02/biggest-loser-destroys-participants.html.
A more recent (2012) study from Johannsen’s team titled, Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass, investigated whether exercise during weight loss would prevent a drop in metabolism as long as the subjects lost fat but retained non-fat mass.http://jcem.endojournals.org/content/early/2012/04/24/jc.2012-1444.short This is the conclusion from the study: “Despite relative preservation of FFM (fat-free mass), exercise did not prevent dramatic slowing of resting metabolism out of proportion to weight loss….”
The next time you hear someone bemoaning the fact that “diets don’t work,” you’ll know why.

“Obesity is a growth disorder just like any other growth disorder. Specifically, obesity is a disorder of excess fat accumulation. Fat accumulation is determined not by the balance of calories consumed and expended but by the effect of specific nutrients on the hormonal regulation of fat metabolism. Obesity is a condition where the body prioritizes the storage of fat rather than the utilization of fat….

The energy content of food (calories) matters, but it is less important than the metabolic effect of food on our body.”

~~Dr. Peter Attia,

http://eating_academy.com/nutrition/do-calories-matter

Here is a previous post on the subject:http://carbwars.blogspot.com/2008/01/biggest-loser.html
Post Scripts:

  1. A Reuter’s story (March 7, 2013) reported that a survey from the Centers for Disease Control and Prevention (CDC) showed that US calorie consumption has gone down for the last 10 years but obesity has risen. The co-author of the study said, “It’s hard to reconcile what these data show, and what is happening with the prevalence of obesity,” but that didn’t keep him from trying. He never considers that his basic beliefs about what causes obesity might be flawed. The findings appeared in the American Journal of Clinical Nutrition. Here is the article:http://reut.rs/WvGhcO
    2.The Journal of the American Medical Association (June 2012) reported about a clinical trial from the Boston Children’s Hospital conducted by Dr. David Ludwig. Ludwig et al put obese subjects on a starvation diet until they had lost 10 to 15% of their weight in order to replicate those who are pre-obese for testing. They fed the subjects one of three different diets; one diet was low-fat/high carb; one was low-glycemic; and one was low-carb/high fat and protein. All three diets contained the same number of calories.
    The results: the low-carb group burned 300 calories more per day than the low-fat group and 150 more than the low-glycemic group. Gary Taubes had this to say about the study: “If we think of Dr. Ludwig’s subjects as pre-obese, then the study tells us that the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed. The fewer carbohydrates we eat, the more easily we remain lean. The more carbohydrates, the more difficult. In other words, carbohydrates are fattening, and obesity is a fat-storage defect. What matters, then, is the quantity and quality of carbohydrates we consume and their effect on insulin….More research is necessary to shore up this finding, but, at the moment it would appear that not all calories are created equal….” www.livestrong.com/article/559435-know-thy-enemy-carbs/#ixzz2NieQ9q2y

Image above from Wikopedia.  (C) 2012, Judy Barnes Baker, www.carbwars.blogspot.com

168. Beware Jamie Oliver’s Food Revolution!

Jamie has been very busy with his Food Revolution Day which is part of his campaign to persuade governments to take action to combat obesity. While this is obviously a laudable objective, the harsh reality is that the strategies he is advocating are doomed to failure. So before you agree to lend your support to this initiative, it is important to examine what exactly Jamie is promoting. I have no quarrel with his encouragement of cooking skills and the use of whole foods. However digging a bit deeper it is evident that when it comes to the dietary guidelines, he is endorsing precisely those that are still being advocated by governments and the mainstream health professionals, which have not worked. There is no question that these have prompted the vilification of fat and contributed to increased consumption of carbohydrates which is probably the prime cause of the increase in the incidence in obesity.

On one of Jamie’s websites there is an article entitled “Understanding good and bad fats” (1). Here is an extract:

“In the Western world, fat consumption is far too high. The World Health Organisation (WHO) has estimated that by 2015, 1.6 billion adults will be overweight – that’s almost a quarter of the world’s population! Although we all need a small amount of fat in our diet, we need to be careful about the amount of fat we’re consuming, as there are many associated health problems such as weight gain, and higher risk of diabetes, cancer and heart disease.”

It continues:

“A diet rich in saturated fat can cause the cholesterol level in the blood to rise, which in turn can lead to thinning of the arteries, potentially causing a blockage and increasing the risk of a heart attack. We should all aim to keep the levels of saturated fat in our diet low.”

“The best source of omega 6 is seeds and their oils (hemp, pumpkin, sunflower, sesame and corn). These fatty acids are also found in a wide variety of nuts, grains and vegetables – so an easy way of getting some into your diet is using vegetable oils for cooking. Omega 6 fatty acids are also helpful in the clotting of blood, skin health, and to help lower cholesterol.

“A healthy diet is all about balance. Bear in mind the proportion of fatty foods you should be having at each meal according to the eatwell plate (see Understanding the eatwell plate), and try to make sure your meal includes foods from all of the different food groups. Fat is a small, but essential, part of the diet. Try to make good choices about the types of fat you eat and this should help to keep your cholesterol low, and your arteries healthy.”

Unfortunately this is the same old rubbish that has got us into trouble in the first place! It really is about time that Jamie and his advisers got themselves up to date. They have slavishly followed the government guidelines to such an extent that they support the notoriously discredited Eatwell plate.

Are they not aware of the fact that the “cholesterol theory” just does not stand up to rigorous examination? There is actually an increase in total mortality with low cholesterol values: the highest life expectancy is found in those with raised cholesterol levels, especially women. It is now becoming very clear that the support for cholesterol as a risk factor for heart disease is primarily limited to the pharmaceutical industry so that it can justify the case for the use of statins.

 

 

To be fair, Jamie is taking a strong line on sugar which is absolutely correct. However if progress is to be made then people have to be advised on a suitable replacement for the sugar which is removed from the existing diet. With the conventional approach the answer is the complex carbohydrates but these also cause the blood glucose to increase, which is the real problem. This is because insulin has to be produced by the pancreas to cope with the sugar. If the body is continually subjected to high sugar/carbohydrate then there will be insulin resistance, which is damage to the organs leading to a range of chronic diseases. Eventually the pancreas cannot cope and the result is Type 2 Diabetes.

The ideal replacement is fat but here again Jamie gets it wrong. Olive oil a monounsaturated fat is absolutely fine but Omega-6s/vegetable oils are a big NO NO. Current diets in the UK and in many other countries are far too high in Omega-6 content and there is not enough Omega-3. At these levels the excess Omega-6s contribute to the development of inflammation which can trigger the processes leading to heart disease and cancer. It is rather ironic that we should be consuming MORE saturated fat. The arguments to lower it have all been discredited. In fact the consumption has fallen in the last 40 years and where did it get us? So butter, cheese, full fat milk and the fat in meat, especially from grass-fed animals is all good news.

 

If Jamie is genuinely interested in tackling obesity (and I have no reason to believe otherwise) then he really must take a good hard look at the nutritional advice he is promoting. The relevant information is not hard to find. There are plenty of books and blogs available.

I would suggest that his starting point might be to go to the Diet Doctor website (2). Here he will see that Sweden is the one country where the increasing trend in obesity has been halted and that it is now starting to come down. Guess what? Butter consumption is now higher than it ever as before and there has actually been a shortage.

He should also make himself familiar with what is happening in South Africa. Go to the Biz News website and look at some of the articles by Marika Sboros (3).

Here is very good scientific paper which sets out the case in support of diets which are LOW in carbohydrates and HIGH in fat (4).

Finally he should read the books by Gary Taubes (5), Nina Teicholz (6), Zoe Harcombe (7) and Tim Noakes et al (8).

 

 

 

REFERENCES

  1. http://www.jamieshomecookingskills.com/pdfs/fact-sheets/Understanding%20good%20and%20bad%20fats.pdf
  2. http://www.dietdoctor.com/obesity-is-exploding-in-europe-except-in-this-country
  3. http://www.biznews.com/category/lchf-health-summit/
  4. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  5. Gary Taubes (2007) “The Diet Delusion” Vermillion: London
  6. Nina Teicholz. (2014)“The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet” Simon & Shuster: New York
  7. Zoe Harcombe (2010) “The Obesity Epidemic” Columbus
  8. T Noakes, S-A Creed, J Proudfoot & D Grier (2014) “The Real Meal Revolution: Changing the World, One Meal at a Time” Quivertree Publications

167. HUGE OPPORTUNITY FOR THE NEW GOVERNMENT TO DEVISE A RADICAL HEALTH POLICY (PART 2)

In part 1, I described how there is a real scope for reducing the expenditure on drugs and many medical procedures which make little contribution to improving health and very often do more harm than good. In this blog the emphasis will be to focus on the potential for curing and preventing diseases by making simple changes to the habitual diet.

This is best illustrated by considering diabetes. During 2013-2014 there were 45.1 million items prescribed for diabetes, with a net ingredient cost of £803.1million (1). This represents an increase of 66.5% in the number of items and 56.3% in the net ingredient cost since 2005-2006. In England it is estimated that 6% of the population has diabetes and the total cost is currently about £10billion, which is 10% of the NHS budget (2). It is expected that by 2025 there will be 5 million people with diabetes in England (3). Those with diabetes have a reduced life expectancy and an increased risk of retinopathy, stroke, kidney failure, heart disease and amputation of limbs.

A man diagnosed with diabetes at age 40 will lose almost 12 years of life and 19 Quality Adjusted Life Years (QALYs) compared with a person without diabetes. A woman of the same age will lose about 14 years of life and 22 QALYs (4).

Type 2 diabetes (T2D) is responsible for the increased incidence referred to above. There is ample evidence that it can be controlled, possibly even cured completely by making changes to the diet. The condition is directly due to the increased level of glucose in the blood. As a result the pancreas has to produce insulin to keep prevent excess glucose in the body. Excess insulin damages many of the organs, which can eventually lead to a range of diseases. If there is excessive glucose over a prolonged period the pancreas is unable to cope and the glucose becomes rampant, causing all sorts of damage. The solution is obvious. Reduce the amount of glucose which enters the body by altering the diet. Sugar is one of the main culprits, so it should be avoided like the plague. In addition starch is broken down to produce glucose. This means that foods such as refined flour, rice or pasta should be limited because the starch is released quickly giving rise to big increases in the blood glucose.

We now have convincing evidence that a diet which is LOW in CARBOHYDRATES and also HIGH in FAT can effectively cure T2D in many cases (5) and that it should always be used as the first approach to treatment. This has been confirmed by numerous individual case studies from individuals. Dr Jason Fung in Toronto has been treating patients successfully by advising them how to change their diet (6). Dr Sarah Hallberg is another physician who has achieved similar results (7).

Because  those with T2D have an increased risk of many other diseases/conditions, a reduction in the incidence of T2D would result in a big improvement in the standard of public health. Furthermore there is now good evidence that a diet which is high in sugar/carbohydrates is a critical factor in the development of diseases which include cardiovascular disease, Alzheimer’s Disease and various cancers.

Sweden is probably the first country to make adjustments to the national diet in line these concepts. Butter consumption has increased to such an extent that shortages have been reported (8) and the incidence of obesity is starting to decline (9). There is also evidence that the incidence of T2D is falling and I hope to access the data in the near future.

The fundamental problem is that here in the UK and in most other countries the official dietary recommendations are almost entirely in direct conflict with the concepts outlined here.

According to the current official advice on Healthy Eating in the UK:

  • ‘’We all need some fat in our diet, but eating too much makes us more likely to become overweight. What’s more too much of a particular kind of fat – saturated fat – can raise our cholesterol, which increases the risk of heart disease’’
  • ‘’Eating too much fat can make us more likely to put on weight, because foods which are high in energy (calories). Being overweight raises our risk of serious health problems such as heart disease, type 2 diabetes and high blood pressure’’
  • ‘’Starchy foods such as potatoes, bread, cereals, rice, pasta should make up about one third of the food you eat’’.

As a consequence, the messages that you should reduce the consumption of fat, especially the saturated fat (SFA) and increase that of carbohydrates/starchy foods were heavily promoted. This was reinforced by the food industry which developed a range of products which could be marketed as “low fat”. All of this helped to alter the national diet so that the consumption of the carbohydrates increased at the expense of fat. Two of the main reasons were the low fat foods, in which the fat was frequently replaced by sugar and the explosive growth in the market for soft drinks, which can have a high content of sugar. These changes in consumption patterns have been accompanied by increases in the incidence of obesity, T2D, Alzheimer’s Disease and kidney disease. There are very sound scientific reasons for concluding that the dietary changes are largely responsible for this deterioration in public health standards.

It follows from this that there will have to be major changes in the official advice on Healthy Eating. This will not be easy because there are very powerful interests which will defend the existing established recommendations. The new ministerial team responsible for health must recognise that that that they should not rely entirely on the existing agencies such as NICE and the Scientific Advisory Committee on Nutrition (SACN). In recent years there have been a number of excellent evaluations of nutritional science that challenge the current conventional wisdom. These include “The Diet Delusion” by Gary Taubes (10) “The Big Fat Surprise” by Nina Teicholz (11) and “The Obesity Crisis” by Zoe Harcombe (12). In the past year “The Real Meal Revolution” by Professor Tim Noakes and colleagues in South Africa has had a massive impact and been on the best seller list for about 6 months (13). There is absolutely no questions that these publications are striking a chord with many individuals. Essentially they all agree that a healthy diet is low in sugar and starchy foods but also relatively high in the SFAs. There are literally thousands of individual case histories which demonstrate that changing to such diets are associated with improved health and weight loss. Even our Prime Minister has decided that he will be “cutting the carbs” (14).

We can be reasonably confident that the “establishment” does not take kindly to these concepts. In South Africa Tim Noakes has been subjected to rather hysterical criticism from those who still support the status quo. The reality is that this is not based on an objective view of the science. Many of the criticisms are absolutely extreme and cannot be supported by reliable scientific evidence. In truth, these critics are somewhat pathetic and lack the integrity to admit that in the past they got things badly wrong.

We really need ministers with the ability, confidence and determination to consider all the evidence objectively and decide the way forward. It is imperative to appreciate that existing policies are failing badly. We cannot continue indefinitely with the same strategy. Einstein’s definition of insanity was to continue doing the same thing and expecting a different result!

Do we have the politician with the necessary attributes to face up to these challenges? There really is the potential to start out on a path which will lead to significant improvements in health without the need for continuous growth in expenditure.

REFERENCES

  1. http://www.hscic.gov.uk/catalogue/PUB14681/pres-diab-eng-200506-201314-rep.pdf
  2. http://www.diabetes.org.uk/Documents/About%20Us/Statistics/Diabetes-key-stats-guidelines-April2014.pdf
  3. http://www.diabetes.org.uk/Documents/Reports/State-of-the-Nation-2012.pdf
  4. http://jama.jamanetwork.com/article.aspx?articleid=197439
  5. http://www.sciencedirect.com/science/article/pii/S0899900714003323
  6. https://www.youtube.com/watch?v=mAwgdX5VxGc
  7. https://www.youtube.com/watch?v=da1vvigy5tQ
  8. http://www.dietdoctor.com/butter-shortage-in-sweden
  9. http://www.dietdoctor.com/obesity-is-exploding-in-europe-except-in-this-country
  10. Gary Taubes (2007) “The Diet Delusion” Vermillion: London
  11. Nina Teicholz. (2014)“The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet” Simon & Shuster: New York
  12. Zoe Harcombe (2010) “The Obesity Epidemic” Columbus
  13. T Noakes, S-A Creed, J Proudfoot & D Grier (2014) “The Real Meal Revolution: Changing the World, One Meal at a Time” Quivertree Publications
  14. http://www.independent.co.uk/news/people/david-cameron-on-his-patriotic-struggle-to-quit-bread-9976617.html

 

 

 

 

 

166. HUGE OPPORTUNITY FOR THE NEW GOVERNMENT TO DEVISE A RADICAL HEALTH POLICY (PART 1)

Now that the Conservatives have enough MPs to form a government, they should seize the initiative to tackle some fundamental issues about public health. At the outset it is crucial to question much of the current thinking.

It is essential to appreciate that the present strategies are just not working. The incidence of Type 2 diabetes (T2D) has doubled in the past 15 years and is expected to continue increasing. The picture for obesity is somewhat similar. Although life expectancy has increased, more and more people suffer from conditions such as Alzheimer’s Disease which means that the costs of care are escalating.

Lack of resources is not the fundamental problem with the NHS. If we keep throwing money at the system, we will finish up like the USA, which spends more than twice the amount on health care per capita as other developed nations, but ranks 49th in life expectancy worldwide.

The prime objective of any national health policy ought to be to ensure that that the standards of public health are as high as possible. Unfortunately the politicians have allowed themselves to be influenced by vested interests which have succeeded in manipulating policy formulation so that they (the vested interests) actually benefit in a big way.

There is absolutely no doubt that enormous sums of money are being spent on drugs which are totally ineffective and many do more harm than good. An excellent example of this is “polypharmacy”, which is the prescription of multiple drugs, especially for elderly people. The new Minister for Health would do well to ask for hard evidence that the policy is effective. No doubt he/she would be surprised to learn that a study conducted in Israel evaluated the impact of reducing the medication in elderly patients in nursing homes (1). At the outset the average number of medications was just over 7. It was found that out of 190 it was possible to stop some drug usage in 119 of them so that the average usage was reduced by 2.8. The results showed that the mortality rate in the control group whose medication remained the same was 45% but in the study group whose medication was reduced the mortality rate was only 21%. Furthermore 30% of those in the control group had to be referred to hospital whereas only 11.8% of those in the study had to be referred. These figures are absolutely staggering and have been confirmed repeatedly by other workers. Above all, the results demonstrate conclusively the damage to the individual patients that is caused by the excessive use of drugs. There really can be no other explanation.

In his excellent book “Doctoring Data”, Dr Malcolm Kendrick is critical of the Quality Outcome Framework (QoF) because it provides guidelines on “risk factors” which have to be measured and used as a basis for prescribing drugs as a preventative treatment (2). In his experience this has resulted in patients with an average number of medications of 10. This is much higher than in those patients involved in the research described above. The only way to prove that a specific combination will be effective is to conduct thorough trials which are designed to find out the benefits and assess the adverse side-effects. This has certainly never been done and is pretty well impossible to do because of the number of possible combinations is infinite. Even for a limited number of trials, the expense would be enormous and realistically will never be made available. However before we get to that point there is simply no reasonable justification for such a programme. The reality is that many of the drugs which are widely used can hardly be justified in their own right let alone in combination with others. Despite all the hype the benefits of statin use are minimal. When the latest NICE recommendations were being announced, the spokesman Mark Baker accepted that 77 people with previous heart problems would have to be treated for 3 years in order that one would benefit. And what exactly is the benefit…an extra 6 months of life (thanks again to Malcom Kendrick, 3). Then there are the adverse side-effects such as the aches and pains which seem to affect most of those I know who have been on statins. Some unfortunates suffer cognitive impairment. It is now becoming apparent that statins can substantially increase the risks of developing Type 2 Diabetes. For men without any heart issues and for all women there is no convincing evidence that there will be any reduction in mortality but of course these people will still experience the same incidence of adverse effects.

The more I discover about drugs and the way they are being used the less convinced I am of their value. No doubt there are some drugs which are effective but there is absolutely no doubt many drugs have no benefit whatsoever. The NNT (Number Needed to Treat) website (4) is an excellent source of reliable information on the effectiveness of various drugs. Consideration of those dealing with heart conditions shows that for about half of them the evaluation was that “none would helped”. When there is a benefit it is limited to relatively few people….a particularly good one would be for 10% of those treated to be helped. In my experience, most people would expect that there would be some benefit as a result of a drug treatment. If the chances of success were as little as 10% which has to be set off against any harmful effects, how many would agree to the treatment if this information was spelled out before any decision on medication was taken?

But there is not only excessive use of drugs.

In 2010, Dr Atul Gawande was named by Time magazine as one of the world’s influential thinkers.

In one of his Reith lectures last year he described a comparison he made between the medical facilities in 2 Texas communities (5). One was McAllen and the other was El Paso County. Both of these counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006, Medicare expenditures which is the best approximation of the costs of health care in El Paso was $7,504 per enrollee—half as much as in McAllen (6). There was no evidence to indicate that the treatments and technologies available at McAllen were any better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. In fact Mc Allen actually has fewer specialists than the national average.

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

 

All of this shows unequivocally that enormous sums of money are being wasted in health treatments that are useless and in many cases do more harm than good.

If the new Minister is to do the job properly then he/she must make it a priority to ensure that all expenditure on treatment and diagnostic procedures is justified on the grounds that it makes a significant contribution to improvements in health and that any adverse effects are definitely outweighed by the benefits.

I find it particularly galling that soon after the results of the UK General Election were announced  the former Minister of Health, Jeremy Hunt, was still talking about putting more money into the NHS.

It is blindingly obvious that a new approach is essential. The new Minister will have to exert control right from the beginning otherwise the existing apparatus of advisers and agencies will ensure that things carry on as before. There are many individuals the Minister could invite who are independent of vested interests and have the authority and expertise to provide the necessary input.

I have already mentioned Dr Atul Gawande and Dr Malcolm Kendrick who would be ideal. Other suggestions could be:

  • Dr Peter Gøtzsche, Professor of Clinical Research and Design Analysis at the University of Copenhagen
  • Dr Tim Noakes, emeritus professor of Sports Science at the University of Cape Town
  • Dr Richard Smith, Former editor-in-chief of the BMJ (British Medical Journal).

While there are very powerful interests that will fight tooth and nail to maintain the status quo, the political rewards for the person who can devise and implement a cost-effective strategy that results in significant improvements in health are immense. Can David Cameron find anyone with the capability of achieving these objectives to take on the Health portfolio?

REFERENCES

  1. D Garfinkel et al (2007) Israel Medical Association Journal 9 (6) pp430-434
  2. M Kendrick (2014) “Doctoring Data: how to sort out medical advice from medical nonsense”. Columbus
  3. http://drmalcolmkendrick.org/2014/12/01/what-is-t/
  4. http://www.thennt.com/home-nnt/
  5. http://downloads.bbc.co.uk/radio4/open-book/2014_reith_lecture3_edinburgh.pdf
  6. http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum?currentPage=all

165. More Doubts about Crestor (Rosavustatin)!

A recent article in the BMJ highlighted concerns about the statin Crestor which in 2014 was the most prescribed brand name drug in the US, with 22.3 million prescriptions at a cost of $5.8bn. World-wide sales for 2013 were $8.2bn (1). The report is by Sidney Wolfe, who founded Public Citizen based in Washington DC and for many years was its director until he retired recently. The statin was approved for use as a cholesterol lowering drug in 2003, despite opposition from Public Citizen at the time.

In particular it was concerned because rhabdomolysis because Rosuvastatin is the only statin in which rhabdomyolysis was detected in randomized controlled clinical trials before the drug was approved. The objection pointed out that with cerivastatin which was eventually banned because of rhabdomyolysis, no cases had occurred in the clinical trials before its approval. Furthermore a recent study of 641?703 patients in the UK prescribed different statins, those taking rosuvastatin had a significantly higher risk of an abnormally raised creatine phosphokinase activity (which is a measure of muscle inflammation) than patients on large daily doses of other statins (simvastatin, pravastatin, or atorvastatin).

There was also serious concern seen during preapproval trials was renal problems. At the time, rosuvastatin was the only statin to have been associated with proteinuria and hematuria. According to FDA documents “in the subgroup of patients with dipstick [protein and blood] positive urine, the percentage of patients with an increase of serum creatinine of 30% over baseline was 14%, 16%, 24%, 33%, and 41% for 5 mg, 10 mg, 20 mg, 40 mg and 80 mg of rosuvastatin, respectively. . . These data suggest that some patients with greater levels of proteinuria and hematuria may progress to clinically relevant renal disease.”

An editorial in The Lancet in October 2003 also expressed reservations and commented that:

“Physicians must tell their patients the truth about rosuvastatin—that compared with its competitors, rosuvastatin has an inferior [clinical] evidence base supporting its safe use. AstraZeneca has pushed its marketing machine too hard and too fast. It is time for McKillop to desist from this unprincipled campaign.”

In 2010 it was approved to reduce the cardiovascular risk. This was based on the results of the JUPITER Trial. However in a review of several key aspects, Michel de Lorgeril and colleagues concluded that the results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors (2). Sidney Wolfe points out that the JUPITER study, was restricted to patients with both low density lipoprotein (LDL) cholesterol <130 mg/dL (3.4 mmol/L) and C reactive protein ? 2 mg/L (19 nmol/L) which is quite a limited population and therefore does not provide a justification for general usage.

It is also crucial to recognise that the JUPITER Trial was stopped early. Invariably those trials which are stopped early consistently overestimate treatment effects. In a major study the results of 91 trials which were stopped early were compared with 424 trials which were completed in accordance with the original plan. It was found that those which stopped early systematically overestimate treatment effects. Large differences in treatment effect size between truncated and non-truncated trials (ratio of relative risks <0.75) occurred with truncated trials having fewer than 500 events. In 39 of the 63 questions (62%), the pooled effects of the non-truncated RCTs failed to demonstrate significant benefit (3).

In some trials, it has been found that the benefits observed with an early stop have not been confirmed in a full-length trial. If clinicians act on the results of shortened trials it is likely that they will be misled when trying to balance benefits, harms, inconvenience, and costs of a specific health care intervention.

The JUPITER trial also found that those treated with rosavustatin had an increased incidence of T2D, which is consistent with an increase in the glycated haemoglobin (HbA1c) and reduced insulin sensitivity. Both of these factors are associated with increased incidence of heart disease, obesity and various cancers. Hence it may well be that any benefit attributed to a decrease in the risks of heart disease by the effect of the statin are counterbalanced by deleterious effects linked to increase in blood sugar and reduced insulin sensitivity. According to NICE, 77 people who have heart disease have to be taking statins for 3 years in order that one person will benefit. Hence it follows that those who experience the increased risk of developing T2D are probably not the same individuals who benefit from the reduced risk of heart disease.

In addition, rosavustatin is associated with relatively high incidence of rhabdomolysis (muscle pain and damage) renal failure.

On top of all this, the behaviour of the company AstraZeneca in promoting the statin does not exactly inspire confidence. In late 2004 there was an advertisement in the Washington Post which stated that:

The scientists at the FDA who are responsible for the approval and ongoing review of CRESTOR have, as recently as last Friday, publicly confirmed that CRESTOR is safe and effective; and that the concerns that have been raised have no medical or scientific basis,” claiming this was information provided by the FDA website, which was not correct. As a consequence the FDA wrote to the company demanding that it immediately stop the advertising because it contained false and misleading information about Crestor’s risks. The letter also stated that:

“The ‘patient safety’ print ad makes false or misleading safety claims that minimize the risks associated with Crestor, thereby suggesting that Crestor is safer than has been demonstrated by substantial evidence or substantial clinical experience.”

The agency wrote to the company again the following year about “misleading superiority claims” for Crestor in other promotional materials.

This is just one more example of a drug being granted approval despite doubts about the adverse side-effects which may be associated with it. Subsequently there have been very many reports of statin users with muscle pain. Even so NICE continues to play down this damage to health. Then in February Sir Rory Collins of Oxford University which analyses data on statins for the pharmaceutical companies admitted to a Sunday newspaper that:

“his team had assessed the effects of statins on heart disease and cancer but not other side effects such as muscle pain”.

You just could not make it up!!

This information should be given to every individual before they agree to go on statins but I suspect it rarely happens.

REFERENCES

  1. http://www.bmj.com/content/350/bmj.h1388
  2. http://vernerwheelock.com/?p=670
  3. http://jama.jamanetwork.com/article.aspx?articleid=185591

164.NHS is not short of money!

When will the politicians face up to the fact that pouring more and more resources into the NHS will not solve our current health issues? The fundamental problem is that standards of public health are deteriorating while costs escalate. This is illustrated by the increased incidence of diabetes which has doubled in the past 15 years. All the indications are that this increase will continue. A report published in 2012 estimated the direct cost of patient care was £9.8 billion and the indirect cost related to increased death and illness, loss of work and the need for informal care was £13.9 billion (1). The vast majority of these cases are Type 2, which is the result of excess glucose in the blood. It is a particularly nasty disease. A 40-year old may expect to reduce life expectancy of at least 12 years AND will suffer many years of disability. Those with diabetes may be as much as 4 times more likely to develop heart disease, cancer and Alzheimer’s Disease as those without it.

The blunt truth is that current strategies are not working and there seems to be a general acceptance that things will continue to get worse. The NHS Choices website tells us that with respect to type 2 diabetes:

There is no cure for diabetes. However, treatment aims to keep your blood glucose levels as normal as possible, which will control your symptoms and minimise the risk of health problems developing later on.” (2).

Furthermore it continues:

“….. as type 2 diabetes is a progressive condition, you may eventually need to take medication to keep your blood glucose at normal levels. You may need to take tablets initially, but move on to injected therapies, such as insulin, at a later stage.”

This is a policy of absolute despair which is utterly and completely wrong! It is the excess insulin which has to be produced by the pancreas to cope with the high levels of glucose in the blood which damages the organs inside the body. This results in chronic conditions such as heart disease and Alzheimer’s Disease. So it is absolute madness to treat the patients with insulin, which only adds fuel to the fire.

There is no debate that the glucose in the blood comes from the diet. Therefore if we can reduce the amount of glucose originating from the food consumed, there will be less glucose available to be absorbed into the blood. So the solution is obvious. Change the diet by lowering the amount of sugar and other carbohydrate-containing foods such as bread, potatoes, rice and pasta which are the sources of the blood glucose. But unbelievably the NHS advice on healthy eating is to consume:

“A diet based on starchy foods such as potatoes, bread, rice and pasta”(3).

On top of this the growing demand for “low fat” foods over the past 40 years has made things even worse. Many of these have been formulated by removing fat from traditional products and replacing it with sugar.

The reality is that type 2 diabetes can be cured. This was conclusively demonstrated at the recent Low Carb Summit held in Cape Town. Numerous specialists from the USA, Canada, Australia, South Africa and the UK presented cast-iron evidence of successful treatment of type 2 diabetes with the simple strategy of helping their patients to reduce the amount of sugar/carbohydrates and to increase their intake of the healthy fats. Many of these were able to stop medication completely and as an additional benefit, actually lost excess weight without any difficulty.

One of the speakers was Dr Jay Wortman from Canada who suddenly woke up to the fact that he had all the symptoms of diabetes. He decided the only way forward was to eliminate as much sugar and starchy foods as possible from his diet in order to lower his blood glucose. He noticed an immediate improvement and within a few months his blood glucose was back to a normal level. What is more he lost weight at the rate of about one pound per day. He included plenty of vegetables as well as meat and dairy products in his diet. There are thousands of others with a similar story to tell. It is absolutely criminal that this information is not being presented to all those diagnosed with type 2 diabetes.

The message for UK politicians comes through loud and clear. We need a complete re-think about the current healthy eating policy. The advice to reduce fat and increase carbohydrates has been an absolute disaster and has been a major factor contributing to the incidence of type 2 diabetes. A radically different approach to dietary advice could improve the health of those who are affected and help to reduce the costs that are incurred in providing care and treatment.

But it is also essential to consider all the other costs associated with the NHS. Throwing money at the problem is not the answer. We have to be extremely hard-nosed about assessing the costs and benefits of any specific treatment or procedure.

In his recent Reith lectures on the BBC Dr Atul Gawande compared 2 similar communities of about 700,000 people in Texas in which the standards of public health were identical but the expenditure in one was double that of the other. The US as a whole spends more than twice the amount on health care per capita as other developed nations, but ranks 49th in life expectancy worldwide. UK politicians please note this is where we will finish up unless there is a fundamental re-think about how our health budget is spent.

The NHS spends far too much money on drugs and procedures that are ineffective. Many of them do more harm than good as shown by example here of treating diabetics with insulin. Does it really make sense to prescribe statins when 77 men have to be treated for 3 years for one to benefit? This only applies to those who have actually suffered from heart disease. For those who do not have heart disease and for all women the proven benefits are even less. This is before the adverse side-effects, which can be traumatic, are factored into the equation.

Unfortunately the politicians have fallen hook, line and sinker for the mantra pumped out by the drug companies which are extremely effective in promoting medicines which fail to live up to expectations. Before making any further commitments about putting more money into the NHS, I recommend that all politicians, civil servants and health administrators read the book entitled “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare”(4). This is written by Peter Gøtzsche who is professor of Clinical Research Design and Analysis at the University of Copenhagen. This book exposes in detail how thousands of individuals are killed every year by prescription drugs, which are promoted and sold even though there is reliable evidence of the dangers they pose. Many of these companies flout the laws and have paid billions of dollars in fines and compensation. Because the profits are so enormous, these are simply regarded as the costs of doing business. He quotes a former vice-president of Pfizer who has concluded that:

“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 case he presents is extremely compelling. It follows from this that much of the money spent on drugs is not only ineffective but also a contributor to the ill-health. There is tremendous scope for saving large sums of the current health expenditure by reducing the amount spent on drugs of dubious value.

Current policies are going nowhere. The case for a totally different approach is absolutely convincing. Do we have any politician with the ability and drive to take things forward? This issue will have to be tackled eventually so why not sooner rather than later?

REFERENCES

  1. http://www.diabetes.org.uk/about_us/news_landing_page/nhs-spending-on-diabetes-to-reach-169-billion-by-2035/
  2. http://www.nhs.uk/conditions/Diabetes-type2/Pages/Introduction.aspx
  3. http://www.nhs.uk/Livewell/Goodfood/Pages/Healthyeating.aspx
  4. Peter Gøtzsche (2013). “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” Radcliffe Publishing London

163.Low Carb Helps Aussie Cricketers to Improve Performance

Peter Brukner is the medical adviser to the Australian cricket team. A few years ago he became concerned about his general health. He had learned that Tim Noakes had switched to a diet which was low in carbohydrates and high in fat (LCHF) so he decided to investigate. He read “The Diet Delusion” by Gary Taubes (1), which he describes as the “the most amazing book I have ever read”. As a result he decided to try the LCHF diet himself. He has described his progress on hid blog (2).

At the time Peter was 60 years old and weighed 90.4kg with a BMI of 28 and a family history of Type 2 Diabetes (T2D). His blood tests indicated that he has degree of insulin resistance (IR). After 2 months his weight had dropped to 82.5kg and his well-being had improved enormously. He had more energy, felt less sleepy in the afternoons and was sleeping better at night.

He had no problems with the diet which consisted of eggs and bacon for breakfast; cold meats, salads and cheese for lunch; fish or meat for dinner with lots of vegetables, followed by berries and cream for dessert. For drinks he had water, coffee, beef broth and most nights a couple of glasses of red wine. Snacks have mainly been almonds. There was no problem with hunger pangs and occasionally missed lunch without any difficulty (3).

After 3 months his weight was below 80kg and because he looked too skinny he eased off a bit and his weight settled down at 81-82kg. After 8 months, his blood tests showed that his triglycerides had fallen from 2.1 to 1.3 which is all good news. There was an increase in the total blood cholesterol (TC) which did not bother him. Much more important was the test which confirmed that that he did not have a “fatty liver” (4).

This improvement in his health made quite an impact on some of the players who wanted to discover more about what he had done to achieve this. In a talk, Peter describes some case studies of elite athletes which he has kept anonymous (5).

  • The first one had a long history of weight problems who had a history 27 muscle injuries which meant that he had missed about half of all the test matches, in which he could have played. As a result of his change in diet he “felt fantastic” and had enjoyed the best 8 months of his career
  • The second one was overweight. Because of injury he had not played for some time and so his fitness levels had deteriorated. When he changed to a LCHF diet he lost 7 kg. As a result he was able to train harder and longer so that his improved very significantly. There was also a substantial reduction in the skinfold thickness demonstrating that he has lost body fat. He is now back playing and performing very well
  • The third one was on the verge of the Australian cricket team but had to stop playing cricket 3 years ago because of chronic knee pain. He tried all sorts of specialists without any great success and then he developed pain in his other knee. He was diagnosed with sero negative arthritis and prescribed some very powerful drugs, which he had to treat himself by injection. As a result he was able to resume training. At this point he decided to try the LCHF Within weeks on an LCHF diet which he followed religiously. But after 3 weeks the pain had disappeared completely and he forgot to do the injection. Almost one year later he was still off his medication. His ability to train has improved significantly and he is feeling very happy with life.

Although Peter did not identify individuals, it is probably no secret that one of them is Shane Watson, who has been happy to go public (6). In a You Tube video, he describes how he had serious problems in maintaining his weight on a diet which complied with the conventional guidelines in which the emphasis is on lowering the fat and consuming plenty of carbohydrate-containing foods such as rice and pasta. He explains how he had a “fat phobia” and was very worried about his cholesterol and concerned that if he ate excessive fat his arteries would get clogged up. Having observed the success of Peter Brukner with LCHF, he also studied the Gary Taubes book and decided to follow suit. He is absolutely convinced that when he switched to LCHF his general health improved. In particular he discovered that he did not eat as much and that hunger was no longer a problem. His life has changed for the better, his endurance has improved and he has limitless energy. As an all-rounder this must make a great difference to his ability to perform on the field. His father suffered from T2D and has also benefitted because by adopting an LCHF diet he has been able to control his blood sugar. His mother has lost weight by using the same approach.

Word has spread amongst the cricketing community. David Warner, Mitchell Johnson and Usman Khawaja have all switched to LCHF with very positive results (7). The Indian cricketer Rahul Dravid is another convert who lost 7kg and feels very much better as a result of his dietary change.

Professional sport is a tough business which can place tremendous strains on the body and although this is anecdotal evidence it fits in very well with all the other information which has accumulated. However these people are driven by results and there their experience cannot be readily dismissed. The facts that injuries have been reduced and that training is improved obviously makes a huge contribution to the performance on the field where it matters.

There are also examples from other sports and I hope to cover these in separate post.

REFERENCES

  1. Gary Taubes (2007) “The Diet Delusion” Vermillion: London
  2. http://www.peterbrukner.com/
  3. http://www.peterbrukner.com/two-months-of-low-carb/
  4. http://www.peterbrukner.com/my-lchf-diet-after-8-months/
  5. https://www.youtube.com/watch?v=JMuD4Z-Oxys
  6. https://www.youtube.com/watch?v=LeyufWjByG8
  7. http://www.reddit.com/r/keto/comments/1rb34q/we_just_went_mainstream_in_australia/

162. Another Desperate Attempt to Defend the Conventional Dietary Guidelines.

In the light of the excellent paper by Zoe Harcombe and her team which demonstrated conclusively that there was no reliable evidence on which to base the official dietary guidelines when first devised in the USA and in the UK, the BBC has featured this issue in a radio programme (1). This includes interviews with Zoe herself and Aseem Malhotra who explained why the advice to reduce total fat and especially saturated fat (SFA) is fundamentally flawed and has been a crucial factor responsible for the current high levels of obesity and Type 2 Diabetes (T2D). These were followed by what I can only describe as an extraordinary interview with Simon Capewell, who is Professor of Clinical Epidemiology at the University of Liverpool. He also has roles in which he advises the British Heart Foundation, the European Society of Cardiology, Heart of Mersey, National Institute of Clinical Excellence, Public Health England and the World Health Organisation. In his opinion the research by Zoe Harcombe is flawed because it failed to consider the totality of evidence. He goes on to say that there have been “over 1000 papers” since then which support the current guidelines. He cites the work of his own research team which claims it has established that there is a fall in the intake of SFA which is correct. Then he goes on to say there has also been a fall of 20% in the levels of blood cholesterol (TC) from which he concludes that this proves the advice has been responsible for the fall in the death rates from heart disease. To his credit the interviewer points out that this is all based on epidemiology, which cannot demonstrate “cause and effect”. The interviewer quite rightly suggests that there may have been other factors which have contributed to the decline in deaths from heart disease, such as the reduction in smoking and the improvements in treatment. It is true that the mortality due to heart disease has fallen and improvements in treatment and care have had a major impact. According to British Heart Foundation statistics, the percentage of women aged 55-59 years old dying after a heart attack almost halved between 1968 and 1998 while that for men aged 60-64 fell by a third (2). This report comments that measuring morbidity is much more problematic than monitoring mortality so we cannot be sure that there has actually been a genuine decrease in the chances of suffering from heart disease and if so the magnitude of the change.

Anyone who considers that lowering TC is beneficial must be deluded. Just watch this You Tube video (3).

Simon Capewell goes on to imply that Ancel Keys was correct when he concluded that there was a direct correlation between the amount of fat/SFA in the diet of different populations, the level of cholesterol in the blood (TC) and the death rate due to heart disease. In fact he even states that Keys has been vindicated by subsequent studies. This position is absolutely remarkable. The fact is that the work of Keys was full of inconsistencies, was based on data from 6 different countries and made the fatal mistake of assuming that an association is evidence of cause and effect. The work of Keys has been totally discredited by Zoe Harcombe (4), Malcolm Kendrick (5) and most recently by Nina Teicholz (6). The reality is that when information is obtained from many different countries there is no relationship. It just so happened that Keys conveniently omitted:

  • Countries where people eat a lot of fat but have little heart disease, such as Holland and Norway
  • Countries where fat consumption is low but the rate of heart disease is high, such as Chile.

I would strongly recommend that if you really wish to understand what went on then have a look at these references. It is absolutely disgraceful and it simply beggars belief that anyone should even attempt to justify this rubbish!

Simon Capewell states that the dietary guidelines were “prophetic and solid” and “that history has demonstrated how very sound they were”. This is unbelievable! How on earth can anyone reach this conclusion, when we look at the current state of public health in the UK, the USA and most of the rest of the world????

Obesity is an obvious issue of concern but a more accurate indication of public health is shown by the incidence of T2D, which in the UK had doubled in the last 15 years. Those with T2D have a reduced life expectancy and an increased risk of retinopathy, stroke, kidney failure, heart disease, cancer, Alzheimer’s Disease and amputation of limbs.

A man diagnosed with diabetes at age 40 will lose almost 12 years of life and 19 Quality Adjusted Life Years (QALYs) compared with a person without diabetes. A woman of the same age will lose about 14 years of life and 22 QALYs (7).

T2D is caused by excess glucose in the blood. This stimulates the pancreas to produce insulin. The continuous production of high amounts of insulin cause damage to the various body organs which can result in many different chronic diseases. The solution is obvious…..lower the blood glucose by reducing the consumption of sugar and the other foods that contain carbohydrates, which are broken down to produce glucose. These foods, primarily potatoes, bread, rice and pasta must be replaced by other foods, especially those animal products such as meat, dairy and eggs, all of which contain fat. This is direct contrast to the current guidelines which Simon Capewell praises so highly.

The evidence has been very neatly summarised in a recent paper (8). There is absolutely no doubt that this approach works very effectively. At least one of the authors, Dr Jay Wortman, has been able to cure his T2D by altering his own personal diet along these lines. There are literally hundreds of individuals who have achieved exactly the same result (9). The presentations at the recent Low Carb Summit in Cape Town showed just how persuasive our knowledge is at present. Several practising clinicians showed how successful the Low Carb High Fat (LCHF) diet with their own patient records (10).

So we have now reached a point where we have the knowledge not only to halt the current inexorable rise in the incidence of chronic disease but to reverse it. Regrettably the official approach by government and the NHS in the UK is making things worse with the result that millions are suffering unnecessarily and many of these are dying prematurely. It is imperative that there is a complete re-evaluation of public health policy. We have to accept that what is being done at present is one of the main reasons why things are deteriorating.

To identify why there is so little progress, we only have to consider the views expressed by people like Simon Capewell who seem to defend the status quo come what may. Because of his role with so many key organisations, he has enormous influence. But in order to maintain his stance he has to manipulate and misinterpret the evidence.

If we are ever to make the break-through, it is essential the Simon Capewells of this world are tackled at every possible opportunity. His errors are so fundamental that you do not need to have specialised knowledge to do so and I would encourage all those who are aware of the benefits of LCHF, especially those with personal experience, to make your views known to anyone in a position to make the changes. For a start the forthcoming General Election in the UK is a timely opportunity to force the issue on the political agenda. If enough of us rally round then maybe the message will begin to get through.

REFERENCES

  1. http://www.bbc.co.uk/programmes/b054t9hn
  2. https://www.bhf.org.uk/~/media/files/research/heart-statistics/bhf-trends-in-coronary-heart-disease01.pdf
  3. https://www.youtube.com/watch?v=i8SSCNaaDcE
  4. Zoe Harcombe (2010) “The Obesity Epidemic” Columbus p 87
  5. http://drmalcolmkendrick.org/2013/03/13/the-untainted-mind/
  6. Nina Teicholz. (2014) “The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet” Simon & Shuster New York
  7. http://jama.jamanetwork.com/article.aspx?articleid=197439
  8. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  9. http://vernerwheelock.com/?p=422
  10. http://vernerwheelock.com/?p=729

 

161. More Reflections on the Cape Town Low Carb Summit: Old Mutual Shows the Way Forward

If anyone had doubts about why the current official dietary recommendations which emphasise the benefits of a diet low fat and high carbohydrates are fundamentally flawed, they should have been at the recent Low Carb Summit in Cape Town. When all the available scientific evidence is collected together it is abundantly obvious that the existing approach has been absolutely disastrous. In addition, there are an enormous number of individuals, who have improved their own personal health by switching to a diet which is high in the right type of fats and low in carbohydrates (LCHF, widely referred to as the Banting diet). All of these simply cannot be written off as anecdotal. To do so is to imply these people are all charlatans!
At the end of the conference the following statement, endorsed by all the speakers was issued:
“The mainstream dietary advice that we are currently giving to the world has simply not worked. Instead it is the opinion of the speakers at this convention that this incorrect nutritional advice is the immediate cause of the global obesity and diabetes epidemics.
This advice has failed because it completely ignores the history of why and how human nutrition has developed over the past three million years. More importantly, it refuses to acknowledge the presence of insulin resistance (carbohydrate intolerance) as the single most prevalent biological state in modern humans.
Persons with insulin resistance are at an increased risk of developing a wide range of chronic medical conditions if they ingest a high carbohydrate diet for any length of time (decades).”
Or to put it another way:
“Excessive insulin in the body causes damage to the internal organs, which in turn leads to chronic diseases/conditions including Type 2 Diabetes (T2D), obesity, high blood pressure, fatty liver, heart disease, Alzheimer’s Disease and cancer. The insulin production is stimulated by the high level of glucose in the blood, which is caused by the consumption of sugar and refined carbohydrates. Hence a diet which is low in carbohydrates and has fat as the main sources of energy will result in better health and a reduced risk of developing many diseases.”
The key message from the conference is that the time for debate is over. The emphasis now must be to focus on how the message can be disseminated to all those people who could benefit by altering the composition of their diet. Ideally national policies should be re-vamped but there is so much entrenched opposition and built-in inertia in most governmental systems that this approach is unlikely to be successful in the short term. In the real world, the starting point has to be with the grassroots. As awareness of the effectiveness of the LCHF gathers momentum, there will be opportunities for businesses to capitalise and generate further impetus.
This is already happening in South Africa and some other parts of the world. One of the most significant aspects of the Cape Town conference was the sponsorship by Old Mutual, which is an international investment and insurance company. One of the keynote speakers was Dr Peter Bond who is the company’s Chief Medical Officer. In particular, he described how the standards of public health across the globe are deteriorating because of the increasing incidence of T2D, obesity and the various related diseases. According to company estimates, 3.5 million South Africans have T2D and 50% are unaware of the condition, which is often only diagnosed when an insurance examination is done. As a consequence the application may be declined or subjected to an additional mortality or morbidity loading. Seven out of 10 women and 4 out of 10 men are overweight or obese, which is double the global rate of almost 30%. It is evident that current strategies are not working. Data collected by Old Mutual confirms that total cholesterol (TC) is NOT an effective measure of mortality risk. If currents trends are maintained, then the costs of health care will continue to rise. From the company perspective, this means that the premiums will have to be increased and therefore customers may allow their policies to lapse and it becomes much more difficult to get new business. Old Mutual sells critical illness products: so if those who purchase these policies can be persuaded to adopt lifestyle changes such as a LCHF diet, everyone benefits. The costs of pay-outs will be reduced, which results in lower premiums and increased profitability. From the individual perspective, a reduction in the chances of a serious illness equals better health and quality of life.
Although Dr Bond stated that he was not endorsing any particular diet or way of eating the company has clearly recognised the significance of the event and the impact that the Banting approach is already having in South Africa. All the indications are that the response to the Old Mutual involvement has been very positive.
The crucial factor is that the business understands there is a powerful incentive to encourage people to follow a healthy lifestyle. This may prove to be of huge significance in promoting the benefits of a Banting diet to a much wider audience. The fact that Old Mutual operates in many different parts of the world could be vital. If the initiative in South Africa is a success, then we may expect to see it repeated in many other countries. Assuming this happens, competitors are likely to follow suit. Ultimately governments will wake up to the fact that there are actually ways of halting the apparently inevitable increases in the costs of health care.
This approach is in stark contrast to many other businesses currently involved in health care where consistent poor health equates to the continued demand for drugs and use of the various tests and procedures. As one cynic has pointed out, drug companies derive little benefit if their products successfully cure patients. The ideal for them is to have patients who remain ill and therefore continue to purchase their products. However the reality is that many drugs show absolutely no benefit and are a waste of money (1).
The LCHF approach has tremendous potential to reverse the current disastrous trends in chronic disease patterns and it is imperative that all possible opportunities are exploited so the basic messages are disseminated as widely as possible and as quickly as possible.
REFERENCE
1. http://vernerwheelock.com/?p=587