197. The Exploits of Dr Rangan Chatterjee

Rangan Chatterjee is a GP who works in the Oldham area of Greater Manchester. He is featured in a rather unique series of TV programmes on the BBC entitled “Doctor in the House”. Dr Chatterjee lives with a family for a period so that he can get to know and understand individual members in order to gain insight the root causes of any illnesses they have. His approach has stemmed from the fact that in his early days as a GP he soon realised that he was only helping about 20% of his patients. The problem was that his training had not prepared him for the majority of issues raised by his patients which include headaches, joint pain, gut problems, indigestion, weight gain, stress, diabetes and skin complaints. As a consequence, he undertook an extensive programme of additional training to obtain the expertise needed to deal with the wide range of conditions he encountered.

In the first TV programme one of the people Dr Chatterjee met was Sandip, the step-dad who was aged 49 years and had been suffering from T2D for about 10 years (1). It was evident that the condition was potentially very serious because the HbA1c was about 9, there was nerve damage in his fingers which could result in amputation and he was on 3 different drugs. He and the rest of the family were persuaded to make drastic changes to their diet. All the foods and drinks that contained sugar and carbohydrates were dumped. The focus was on plenty of fresh foods, especially vegetables. Despite a certain amount of difficulty the family eventually managed to adjust to the challenge. Because of his T2D, Sandip agreed to starve completely for one day a week on a regular basis as it has been established that this can help to overcome the T2D.

Sandip was encouraged to take up exercise and was shown how he could apply High Interval Intensity Training (HIIT) techniques to his walks. This involves setting targets which enable him to achieve continuous improvement in his fitness.

The impact of all the measures was extremely successful. The HbA1c came down to about 7 and he was able to stop taking 2 of the 3 drugs he had been prescribed. Although not ideal, it was clear that he had made incredible progress and that further improvement would be expected.

In the second programme Dr Chatterjee met Ray, who worked in the NHS as an IT manager and also owned his a fitness centre so he led a busy stressful life (2). He had been suffering from severe back pain for many years and was taking incredible amounts of painkillers and other drugs to deal with his condition. To cut a long story short, Dr Chatterjee was able to find the right kind of support. He was shown exercises that were beneficial and as a consequence he achieved a complete recovery. Drugs were no longer required and Ray reckoned that he was a “new” man.

These results are extremely encouraging and demonstrate the huge potential for dealing with the many forms of ill-health that are so common today.

On the other hand, they also highlight the serious inadequacies of the modern health care system. Those who featured in the programmes are the lucky ones. Without the help and support from Dr Chatterjee they would still be struggling to cope with their poor health which in all probability would continue to deteriorate. The reality is that there are millions of people who will not benefit in the same way because the treatments provided are not working.

There are a number of reasons to explain why this is happening.

  • It is evident from the experience of Dr Chatterjee that the training of doctors is far too limited. Hence they simply do not have the expertise or the awareness of most of the conditions they encounter.
  • The usual time allowed for a consultation with a GP is about 10 minutes, which is simply not long enough to get to know enough about the patient and their lifestyle to understand the fundamental causes of their ill-health.
  • The almost universal mantra on the part of patients and medical professionals that the answer is some form of medication. It is notable that in both the cases mentioned above once the root cause had been identified and addressed that the need for medication was drastically reduced or eliminated completely.

The insight gained from these programmes only serves to reinforce the conclusion that our healthcare services are not fit for purpose. Despite the continued increase in expenditure all the indications are that public health standards are getting worse. The incidence of diabetes has doubled in the past 15 years and all the prognostications are it will continue to increase. Obesity, kidney disease and Alzheimer’s Disease (AD) also have similar trends. The same pattern is evident in most other countries.

If things continue along the same lines it is predicted that the NHS faces a funding shortfall of £30 billion by 2020/21.

There is only one possible conclusion: the strategy is fundamentally flawed. It is absolute madness to carry on in the same old way, throwing money into the system and expecting a different result. The brutal truth is that the existing approach is not sustainable in the long run because there is a limit on how much can be spent. Eventually events will dictate that there has to be a complete overhaul.

The lesson from “Doctor in the House” is that there are ways and means of successfully overcoming many common chronic conditions. Clearly it is not feasible to provide the resources deployed in making these TV programmes to everyone with similar health problems. However the knowledge and insight gained from this type of exercise is extremely valuable. This must be used to develop completely new strategies for the mainstream health professionals.

I have no illusions about the major difficulties which will be encountered in any attempt to make radical changes. It would be a terrific start if only there was a more widespread recognition that maintaining the status quo cannot be the right option. There is huge potential for a totally new approach which provides individuals with appropriate accurate information and enables them to take on a much greater degree of personal responsibility. Self-empowerment will go a long towards increased efficiency in the utilization of resources.

Above all, Dr Chatterjee deserves to be congratulated for his own personal initiatives to extend his expertise and the amazing success he has achieved.


  1. http://www.bbc.co.uk/iplayer/episode/b06q6y95/doctor-in-the-house-episode-1
  2. http://www.bbc.co.uk/iplayer/episode/b06qqwlx/doctor-in-the-house-episode-2





196. Letter from George Osborne to Jeremy Hunt

My dear Jeremy,

As you know it is imperative that we eliminate the financial deficit and that one key element of our strategy it to ensure that that we use public money as efficiently as possible. Since the election the Treasury has been conducting evaluations of the various government departments and agencies to determine how effectively they fulfil their role. As part of that we have been considering if they offer value for money.

I am sorry to have to tell you that the Department of Health (DoH)/NHS has come out of this extremely badly. In fact it was bottom of this particular league table by a big margin. Despite the enormous expenditure which never seems to be enough it is evident that the standard of public health is lower than it has been for years and continues to deteriorate. If things continue along the same lines it is predicted that the NHS faces a funding shortfall of £30 billion by 2020/21.

We have also discovered that many of the treatments and procedures are ineffective and inappropriate. In fact some of them do more harm than good. Diabetes was one area we examined in depth and, quite frankly, the results were absolutely appalling. I am sure you are aware that the costs of treatment are about £10Bn per annum of which about £1Bn is for drugs. On top of this we have the costs to the national economy because workers have to take time off because of illness. Despite this, all the prognostications from your people are that the number affected will continue to increase. Surely it must be obvious to you that your existing policies are not working and that it is imperative that a totally different strategy is needed? It has emerged that the definition of diabetes which underpins your Diabetes Prevention Programme is:

“a chronic condition where the body does not produce enough insulin to regulate blood glucose levels” (1).

While this is a reasonably accurate definition of Type 1 Diabetes (T1D) it is certainly totally inaccurate and misleading as far as Type 2 Diabetes (T2D) is concerned. Since T2D accounts for about 90% of all cases of diabetes the definition/cause is absolutely crucial. The fundamental cause of T2D is excessive sugars in the blood. Therefore the pancreas has to produce extra insulin to ensure that the blood sugars are kept under control. However this then causes insulin resistance (IR) which is responsible for widespread damage inside the body. One effect of the IR is to increase the requirement for insulin which places even more strain on the pancreas. Eventually the pancreas is unable to cope and it cannot produce enough insulin. Consequently the blood sugar can no longer be kept under control. This is full-blown T2D. The excess sugar causes even further damage which may result in blindness and amputation of limbs.

Is there no-one in the DoH who understands that the fundamental problem is too much insulin?

There is only one way to cope with T2D and that it is to stop the build-up of sugars in the body. So the habitual diet must be altered. This means that the intake of sugar and those foods which contain starch (which breaks down to glucose) must be restricted. We know from the studies of Professor Robert Lustig that sugar is especially dangerous. It is present in many soft drinks and in lots of “healthy” low fat foods. It seems to us that sugar consumption must be reduced. Ideally it should eliminated from diet, especially for those who cannot tolerate it. But that is not sufficient and many people will also have to reduce their consumption of the carbohydrate-containing foods such as bread, flour, rice and pasta. Therefore I find it unbelievable that NHS choice website has the following advice for those with T2D:

“The important thing in managing diabetes through your diet is to eat regularly and include starchy carbohydrates, such as pasta” (2). This is linked another section which has the following advice:

Starchy foods are our main source of carbohydrate, and play an important role in a healthy diet.

Starchy foods such as potatoes, bread, cereals, rice and pasta should make up about a third of the food you eat, as shown by the eatwell plate” (3).

Surely you appreciate that this is only making things a lot worse? There is a sound body of research which demonstrates conclusively that people with T2D can cope with the disease and improve their health significantly by consuming a diet which is low in carbohydrates and high in healthy fats (LCHF) (4). Furthermore there are numerous case studies from individuals who have been extremely successful in overcoming T2D using this approach. Here are some examples (5, 6, 7). The last reference is to the outstanding work of Dr David Unwin, a GP in Southport who has had wonderful results. I am especially impressed by the fact that he has been able to save over £20,000 per years by prescribing less drugs. I do hope you watched the excellent TV programme “Doctor in the House” in which Dr Rangan Chatterjee spent some time with a family advising the members how they can improve their health (8). This showed precisely how the NHS is failing but also provides valuable insight which I am sure you will find helpful in devising completely new strategies.

In the light of what we have learned I have decided that sugar has to be controlled in the same way as alcohol and tobacco. It may take a little time to set up the necessary arrangements to do so. Ideally there should be total ban but I am realistic enough to understand that this would drive the trade underground. However I am convinced that a system of licensing is feasible. In the meantime I propose to introduce legislation which will prohibit the use of added sugar in all foods which are marketed to children. The implementation will be phased in over the next two years. In the meantime I expect you to cease the existing policies forthwith and develop new ones based on research and practice which are demonstrably successful.

Moving on to other areas we examined. It is obvious that the use of drugs is far too excessive and costly. I strongly suspect that Dr Unwin’s experience is just the tip of the iceberg and that many of the drugs currently in use have minimal benefit and once the adverse side-effects are factored in probably do more harm than good. In addition to savings in the treatment of diabetes, I find the case for statins lacks conviction. You probably saw the recent paper in BMJ Open which showed that the benefits of statins are just a few extra days of life (9). In view of the nasty side effects, I doubt if anyone would wish to be treated with them. Personally I know several members of my own family who have suffered from severe aches and pains before decided to stop the treatment. Consequently I have decided that we can no longer justify this expenditure.

This takes me to NICE, which relies heavily on people who are closely involved with the pharmaceutical industry. I am also aware of the many recent studies which have shown conclusively that we cannot rely on the drug companies to be responsible for the testing of their own products (10). Furthermore the vast majority of new drugs are not an improvement on those already available (11). We must cut down drastically on the use of drugs and where possible use those which are tried and tested rather than new ones which are usually horrendously over-priced. Accordingly I have decide to abolish NICE at the earliest opportunity. In its place I will establish a new organisation which will be totally independent. This body will be responsible for all testing and will be funded by a levy on the sales of drugs. It is my intention to re-invent our health services so that there is considerably less emphasis on the use of drugs and much more on identifying the fundamental causes. Essentially this will mean that the focus will have to be on lifestyle.

Which brings me to my final issue because nutrition will be fundamental to this new strategy. I have to tell you that I am appalled at the recommendations on Healthy Eating which the DoH has been promulgating. I realise that this is based on the advice of the Scientific Advisory Committee on Nutrition (SACN). I find that its performance has been abysmal. It took seven years to complete its report on carbohydrates yet the recommendations were fatally flawed as Zoe Harcombe has so effectively exposed (12). It is all far too complacent and cozy. In fact I am now convinced that this committee system is fundamentally flawed. It is much too easy for one forceful individual to get his/her ideas accepted and then the final report is regarded as gospel. In any case I find that these committees tend to be dominated by specialist scientists who lack the expertise in policy aspects. I have therefore decided that SACN and all other similar advisory committees will be disbanded immediately. In future we will scour the world for individuals with a proven track record who are genuinely independent of commercial interests. We will ask them to provide a report which will then be open to scrutiny and if necessary challenged. I believe this will provide us with the high quality advice which is essential if we are to get policies which are robust and effective.

I appreciate that my decisions will upset some of our “friends” in the food and pharmaceutical industries. As far as food is concerned, people will always have to eat so there will still be plenty of business. It is up to the food companies to make the necessary adaptations. This is nothing new because the food industry is in a constant state of flux. However I do envisage that the market for drugs will definitely be a fraction of what it is at the moment. But to be perfectly honest it is a pretty awful business as Peter Gøtzsche has explained in his excellent book (13).

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 …” (14)

I am resigned to the fact that we will just have to take a hit. On the other hand I have not the slightest doubt that this will be more than compensated by the fact that we will have a highly productive workforce and that we will be spending much less on the costs of health care. In addition the new policies which I am introducing will create a whole plethora of opportunities for new businesses, which will facilitate the improvement of personal health. The fundamental weakness with the existing set up is that the profitability of too many businesses is dependent on people remaining ill.

But there is a lot more to it than that. By making these innovative changes in policy we will be stimulating the development of new skills and starting new companies which have the potential for business in many other countries as they come to understand that our current health policies are no longer sustainable. I have total confidence that is the way we must go and I trust that I will have your enthusiastic support.

In the long run, I am convinced that it is essential to take initiatives like this in order to demonstrate that the Conservative Party is actively promoting the interest of the man in the street and even more important is seen to do so. As a consequence we will be able to gain positive support from millions of people who will not only vote for us but would be prepared to make small donations. This would mean that we would no longer have to rely on large contributions from a small number of individuals, which realistically cannot continue. It is becoming increasingly difficult to justify. In any case I am simply fed up to the back teeth with the necessity of having to lunch with those awful types who are stupid enough to spend up to £50,000 every year for the privilege (15).


With best wishes



  1. https://www.nao.org.uk/wp-content/uploads/2015/10/The-management-of-adult-diabetes-services-in-the-NHS-progress-review.pdf
  2. http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Living-with.aspx
  3. http://www.nhs.uk/Livewell/Goodfood/Pages/starchy-foods.aspx
  4. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  5. http://www.drbriffa.com/2012/10/02/diabetic-transforms-his-health-with-a-low-carb-diet-and-his-doctor-urges-him-to-eat-more-carbs/
  6. http://vernerwheelock.com/?p=422
  7. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
  8. http://www.bbc.co.uk/iplayer/episode/b06q6y95/doctor-in-the-house-episode-1
  9. http://bmjopen.bmj.com/content/5/9/e007118.full
  10. http://healthland.time.com/2012/09/24/a-doctors-dilemma-when-crucial-new-drug-data-is-hidden/
  11. D W Light, J Lexchin & J J Darrow (2013) Journal of Law, Medicine and Ethics 14 (3) pp 590-610
  12. http://www.zoeharcombe.com/2015/07/sacn-report-carbohydrates-health/
  13. Peter Gøtzsche (2013). “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” Radcliffe Publishing London
  14. https://www.guernicamag.com/interviews/healthscare/
  15. https://www.conservatives.com/donate/Donor_Clubs

195. Diabetes Review by Public Accounts Committee. Call for Action

The UK House of Commons Public Accounts Committee (PAC) is currently reviewing the effectiveness of the treatment of diabetes by the Department of Health (DoH) and the NHS. My previous blog has explained the background (1). I have now had a chance to look at the transcript of the session when officials from the DoH/NHS presented evidence to the Committee. It is very obvious that there is general acceptance of the current strategy. It is clearly recognised that the number of people affected is increasing but the emphasis of the proceedings was on how to improve the effectiveness of the existing programmes. This is probably because as shown below the PAC’s remit is to consider how public money is spent, while government policy would be examined by the Health Committee.

Nevertheless there are several members who clearly wish to know why things are getting worse and why there is so little progress. However it was also evident that they were completely unaware of why the current strategy is going nowhere and is really part of the problem not part of the solution. They seemed to have no idea that there are numerous initiatives all over the world which demonstrate conclusively that Type 2 Diabetes (T2D) can be overcome by a diet which is low in carbohydrates and high in fat (LCHF).

Furthermore it could well be argued that this approach is not inconsistent with current policy as there are some individuals who are using the LCHF strategy within the NHS. One of the most notable is Dr David Unwin in Southport (2).

The purpose of this blog is to encourage anyone who wishes to see genuine progress with T2D and other diseases by  adopting an LCHF diet to make contact with the committee secretariat, chair and individuals. I believe it is important they are properly informed of the enormous benefits of an LCHF diet and of the growing pressure for a fundamental change in mainstream attitudes towards the dietary guidelines (which would require a change in policy) and in the treatment of T2D.

My previous blog summarises the main points but as far as the PAC is concerned it should be worth highlighting the financial aspects. Interestingly there are some relevant points made in the submission from Novo Nordisk (3). These include:

  • Since the previous PAC report on the management of diabetes in 2012 an additional 900,000 people in England have been diagnosed with diabetes which makes a total of 3.2 million people with diabetes in England. It is estimated that an additional 9.6 million people in England are at high risk of getting T2D.
  • The NHS faces a predicted funding shortfall of £30 billion by 2020/21. Presently diabetes costs the NHS nearly £10 billion a year in direct costs. Which is about 10% of the NHS budget. In addition, the annual social care costs associated with supporting people with diabetes are estimated to be a further £1.4 billion. This figure is expected to rise to £2.5 billion by 2030..
  • The costs to the economy, due to people with diabetes not working because of poor health, having a lower level of productivity or as a result of death, are estimated at nearly £9 billion per annum. It follows that these costs will continue to increase in line with the number diagnosed which is estimated at 5% every year.
  • The National Diabetes Inpatient Audit states that about 1 in 6 hospital beds in England are occupied by a person with diabetes. The estimated cost of avoidable admissions in diabetes is £686 million per year.
  • Patients admitted to hospital with diabetes also stay on average 1.1 days longer than a person admitted for a similar compliant without the condition, leading to bed blocking and capacity issues for the NHS.

These are all points well worth re-iterating.

Finally, the PAC should consider inviting Dr David Unwin to present a paper which describes his success in treating T2D with the LCHF. Many of his patients have improved their health very significantly as a result. Because this has enabled them to reduce their dependency on drugs, the practice has saved at least 20,000 for each of the past 3 years. Presumably he is operating within the framework of current policy especially as Dr David Haslam, Chair of NICE has said that NICE guidance is not meant to be prescriptive and should not replace a doctor’s clinical judgment (5).

Call for action

If you wish to see progress, please feel free to use any of the information here or in any other blogs, especially the previous one (1). No doubt many of you have lots of your own ideas and stories that will be appropriate.

All the relevant contacts are shown below. Click on the names to obtain emails and other details. Although I do not know of any plans by the Health Committee to tackle T2D, I suggest a direct approach to PAC members but copy to Health Committee members.

Public Accounts Committee

The PAC is appointed by the House of Commons to examine:

“the accounts showing the appropriation of the sums granted to Parliament to meet the public expenditure, and of such other accounts laid before Parliament as the Committee may think fit”

The Committee looks at how rather than why public money has been spent and does not examine the merits of Government policy. That role is performed by the relevant Departmental Select Committee.

Member Party
Meg Hillier (Chair) Labour (Co-op)
Mr Richard Bacon Conservative
Harriett Baldwin Conservative
Deidre Brock Scottish National Party
Chris Evans Labour (Co-op)
Caroline Flint Labour
Kevin Foster Conservative
Mr Stewart Jackson Conservative
Nigel Mills Conservative
David Mowat Conservative
Stephen Phillips Conservative
Bridget Phillipson Labour
John Pugh Liberal Democrat
Karin Smyth Labour
Mrs Anne-Marie Trevelyan Conservative

Committee contact details:

Committee of Public Accounts House of Commons London SW1P 3JA

Telephone: 020 7219 4099 Fax: 020 7219 2782

Email: pubaccom@parliament.uk

Health Committee

The Health Committee is appointed by the House of Commons to examine the policy, administration and expenditure of the Department of Health and its associated bodies

Member Party
Dr Sarah Wollaston (Chair) Conservative
Mr Ben Bradshaw Labour
Julie Cooper Labour
Dr James Davies Conservative
Andrea Jenkyns Conservative
Andrew Percy Conservative
Emma Reynolds Labour
Paula Sherriff Labour
Maggie Throup Conservative
Helen Whately Conservative
Dr Philippa Whitford Scottish National Party

Committee contact details:

Health Committee House of Commons London SW1A 0AA

Telephone: 020 7219 6182




  1. http://vernerwheelock.com/?p=897
  2. http://vernerwheelock.com/?p=842
  3. http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/public-accounts-committee/diabetes-followup/written/24521.html
  4. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
  5. http://www.gponline.com/gps-patients-choose-when-ignore-nice-advice-says-haslam/article/1368070

194. Review of Diabetes by House of Commons Public Accounts Committee

I have just discovered the House of Commons Public Accounts Committee(PAC) is undertaking a review of how the UK Department of Health/NHS is coping with diabetes. This is a follow-up to a previous review by the PAC which was not very complimentary about the quality of services at that time. Since then there has apparently been little progress as shown by a report from the National Audit Office entitled “The management of adult diabetes services in the NHS: progress review” (1). Unfortunately this illustrates the fundamental problem with the current official strategy because it starts off with the statement that:

Diabetes is a chronic condition where the body does not produce enough insulin to regulate blood glucose levels.”

While this is a reasonable definition of Type 1 Diabetes (T1D) it is certainly totally inaccurate and misleading as far as Type 2 Diabetes (T2D) is concerned. Since T2D accounts for about 90% of all cases of diabetes the definition/cause is absolutely crucial. As this is the same definition which is used by NICE/NHS it is foundation of the existing policy. I find it unbelievable that this seems to be accepted without question. For those who are not familiar with current knowledge, I will explain. The underlying cause of T2D is excessive sugar (mainly glucose and fructose) in the blood. In order to control this, the pancreas has to produce extra insulin to keep the blood glucose under control and prevent it from building up in the body. One of the ways in which it does this is to direct the glucose to the liver where it is converted into fat, which is then stored resulting in weight gain and eventually obesity.

However the persistently high levels of insulin cause insulin resistance (IR) in many different organs in the body. This is somewhat similar to antibiotic resistance and so the main consequence is that even more insulin has to be produced in order to fulfil its role. It must be emphasised that IR per se represents a form of damage, which may ultimately result in serious chronic disease such as heart disease, cancer and impairment of the brain, which may progress to Alzheimer’s Disease. But there is even worse to come because eventually the pancreas simply cannot cope and at this point is unable to produce sufficient insulin to limit the blood glucose. The excess glucose then causes even further damage. For example, it sticks to proteins which it makes impossible for them to function properly. This is full-blown T2D. By this time the person is suffering a double whammy from both the IR and the hyperglycaemia (high blood sugar).

The current policies are doomed to failure because they are focussed on rather pathetic attempts to deal with the symptoms and have totally failed to identify the basic cause. In fact it is not rocket science. Sugar in the diet is broken down to glucose and fructose, while the starch which breaks down to glucose is present in foods such as bread, flour, rice and potatoes. There is absolutely no question that the only effective way to deal with T2D is to alter the diet by reducing the amount of sugar and other carbohydrate-containing foods. Sugar should be the primary target because as Professor Robert Lustig explains the 50:50 combination of glucose and fructose is particularly dangerous (2). There can be little doubt that the consumption of sugar-sweetened soft drinks coupled with the growth of “Healthy low fat“ foods are the major reasons why T2D has increased so much in recent years. Very often these low fat foods are formulated by removing the fat and replacing it with sugar.

On top of all this we have the NHS, as illustrated by its NHS Choices website (3), advocating a high intake of carbohydrate-containing foods as part of a healthy diet. This advice is also being recommended specifically for those with T2D by Diabetes UK (4). This is absolutely crazy because it is simply adding fuel to the fire and making the condition worse. Instead of stemming the flow of sugars into the body it is actually increasing them. There is a wealth of high quality research which demonstrated that diets which are low in carbohydrates and high in fat can be used for the successful treatment and control of T2D.

Here is one very comprehensive review which was published recently (5). In addition there are literally hundreds of individuals who have successfully coped with the disease using this approach and many of them have been able to stop all treatment with drugs (6). Incidentally, this strategy is also very effective with T1D because when the carbohydrates are restricted, less insulin is needed and the frequency of “hypos” is reduced significantly.

There is not the slightest doubt that the current policy is a complete and utter disaster which is not only failing to address the fundamental issue but is actually contributing to the problem. It is not in the least surprising that more and more people are finding this out for themselves. As a consequence, there is widespread pressure building up from the grassroots as shown by these responses (7, 8, 9).

If the PAC is to do its job properly then it must address the issues which I have highlighted here. Unfortunately so far it appears to have accepted the basic premise of the current official policy without question. There are many examples where the approach advocated here is being put into practice. In Sweden, the importance of increasing the fat in the diet has been accepted as part of official policy, this is one of the few countries where the increase in obesity has been halted and I understand that there are also indications the T2D is being brought under control (10). In South Africa, there is rapidly growing interest as shown by the large number of restaurants which specialise in providing meals which are low in carbohydrates and high in fat. Further details are given in this reference (11).

Here in the UK, Dr David Unwin, a GP in Southport has had great success (12). Perhaps the PAC would be especially interested in the fact that he has been able to save about £27,000 per annum on the costs of drugs in his practice. Patients with T2D or who wish to lose weight are encouraged to switch to a diet along the lines suggested here. Ultimately there will have to be an admission that the current policy has failed completely. To continue along the present lines will eventually bankrupt the NHS not to mention the fact that millions will continue to suffer and die prematurely.



  1. https://www.nao.org.uk/wp-content/uploads/2015/10/The-management-of-adult-diabetes-services-in-the-NHS-progress-review.pdf
  2. http://www.youtube.com/watch?v=dBnniua6-oM
  3. http://www.nhs.uk/livewell/loseweight/pages/the-truth-about-carbs.aspx
  4. https://www.diabetes.org.uk/About_us/What-we-say/Food-nutrition-lifestyle/Consumption-of-carbohydrate-in-people-with-diabetes/
  5. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  6. http://vernerwheelock.com/?p=229
  7. http://healthinsightuk.org/2015/09/29/time-for-diabetes-uk-to-unplug-ears-and-respond-to-chorus-of-disapproval-demanding-u-turn/ …
  8. https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033 … …
  9. http://www.bmj.com/content/351/bmj.h4023/rapid-responses …     
  10. http://www.dietdoctor.com/obesity-is-exploding-in-europe-except-in-this-country
  11. http://www.thenoakesfoundation.org/news/blog/profs-words-the-real-food-revolution-gains-momentum
  12. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf


193. Diabetes: Academy of Nutrition and Dietetics Must Do Better!

I have just been reading a paper on the Eatright website which is from the USA Academy of Nutrition Dietetics (AND). This states that the causes of Type 2 Diabetes (T2D) are:

“complex and still not fully known. Sometimes diabetes is triggered by genetics, illness, being overweight or simply getting older. Although food doesn’t cause diabetes, it is part of the strategy for managing the disease” (1).

To say that food does not cause T2D is unbelievable. Does the author not live in the real world? Anyone who troubles to do some research on the topic which is relatively easy with access to the internet will quickly discover that it is the composition of the food which is the primary cause of T2D.

Here is what actually happens:

  • If you consume a diet which has a high content of sugar and other foods which contain carbohydrates, the body will have to cope with excessive levels of glucose in the blood.
  • This is done by the pancreas which responds by producing insulin which enables the extra glucose to be utilised by the liver and other organs.
  • However the high concentrations of insulin in the blood cause insulin resistance to develop in the organs including the liver and the pancreas.
  • This means that the demand for insulin is increased even further.
  • Ultimately this results in catastrophic failure of the pancreas so that the ability to secrete insulin is impaired.
  • As a consequence, it is no longer possible to keep the blood glucose under control. Effectively this is full-blown T2D because it is at this point that the blood glucose starts to increase and if the appropriate tests are conducted the disease will be diagnosed.
  • This only happens if a person persists with a diet which is high in sugar and carbohydrates over a long period.
  • During this time the insulin resistance which damages the internal organs gradually increases.
  • This insulin resistance can result in various diseases/conditions including weight gain, hypertension and cardiovascular disease.
  • The effect of the raised blood glucose levels is to make things even worse.

There is absolutely no question that the high intake of sugar/carbohydrates is what causes T2D. There is comprehensive research to demonstrate that carbohydrate restriction is an effective treatment (2). Furthermore there are numerous case studies which provide very compelling evidence of the effectiveness of this approach. Many can be found on the Diet Doctor’s website (3).

The key issue is that there are very powerful vested interests which do not want this information to become widely available. This includes food companies which produce foods that have a high content of sugar and or carbohydrates. It is self-evident that if consumers understand which foods are direct cause of T2D then sales will be adversely affected.

The AND is the world’s largest organization of food and nutrition professionals. According to the website it is committed to:

“improving the nation’s health and advancing the profession of dietetics through research, education and advocacy” (4).

However it is dependent on sponsorship from some of the major multinational food companies for part of its income. Currently the main sponsors are the US National Dairy Council, Abbott Nutrition, the Coca-Cola Company Beverage Institute for Health & Wellness, PepsiCo and Unilever. Although Coca Cola has announced that it will cease to act as a sponsor from the end of 2015.

In 2013, Michele Simon, a public interest lawyer, produced a report which was highly critical of the AND with the provocative title:

“Are America’s Nutrition Professionals in the Pocket of Big Food?”(5).

This described in detail the close working relationship between the organisation and many of the big agro-food corporations. Representatives are actively involved in CPD programmes and play a major role in the annual conference. Specific findings included:

  • Companies on AND’s list of approved continuing education providers include Coca-Cola, Kraft Foods, Nestlé, and PepsiCo.
  • Among the messages taught in Coca-Cola-sponsored continuing education courses are: sugar is not harmful to children; aspartame is completely safe, including for children over one year; and the Institute of Medicine is too restrictive in its school nutrition standards.
  • The AND Foundation sells “nutrition symposia” sponsorships for $50,000 at the annual meeting. In 2012, Nestlé presented a session on “Optimal Hydration.”
  • Roughly 23 percent of annual meeting speakers had industry ties, although most of these conflicts were not disclosed in the program session description.
  • In an independent survey, 80 percent of registered dietitians said sponsorship implies Academy endorsement of that company and its products.

It is unbelievable that the message:

“sugar is not harmful to children

is being presented as part of a training programme. No doubt the assertion that:

“food does not cause T2D”

is an attempt to provide some kind of justification but it is utterly pathetic.

The President of AND at the time responded the report in a letter which included the following sentence:

“Let me make it clear that the Academy does not tailor our messages or programs in any way due to influence by corporate sponsors and this report does not provide evidence to the contrary” (6).

However none of the above statements were challenged. The fact remains that there is clearly a close working relationship between some of the leading multi-nationals in the food/drink industry and the organization. It is inconceivable that these companies would continue with the relationship if it was not proving to be beneficial.

There is no doubt that if there is a concerted effort to reduce the consumption of sugar and other foods which contain carbohydrates that this will have a detrimental impact on the sales of specific products of some of the AND sponsors. The suspicion is the companies which are likely to be affected will attempt to throw doubts about the validity of the evidence. This is an established strategy which was used to great effect by the tobacco industry. All the indications are that the article on diabetes is very much part of these tactics. If so, this is regrettable because it shows complete disregard for the health of consumers.

This is not an isolated case and is certainly not restricted to the USA. Companies clearly believe that it is to their benefit to work closely with societies and charitable organizations. Food scientists, nutritionists and dietitians are in a position to influence the food purchasing patterns of a wide range of businesses as well as individual consumers. Unfortunately conflicts of interest are all too common with the result that endorsements of products are not always the independent assessments they appear to be.


  1. http://www.eatright.org/resource/health/diseases-and-conditions/diabetes/diabetes-an-overview
  2. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  3. http://www.dietdoctor.com/diabetes/success-stories
  4. http://www.eatrightpro.org/resources/about-us/academy-vision-and-mission
  5. http://www.eatdrinkpolitics.com/wp-content/uploads/AND_Corporate_Sponsorship_Report.pdf
  6. http://www.foodpolitics.com/2013/01/an-open-letter-to-registered-dietetians-and-rds-in-training-response-to-yesterdays-comments/ /

192. Assessing Diets which have Low Carbohydrates

A paper which has just been published concluded that:

“Recent studies suggest that low carbohydrate diets appear to be safe and effective over the short term, but show no statistical differences from control diets with higher carbohydrate content and cannot be recommended as the default treatment for people with type 2 diabetes.” (1)

This is in direct conflict with a comprehensive review published earlier this year which concluded:

“The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science.”(2)

In addition there are literally hundreds, if not thousands, of individuals who have successfully coped with type 2 diabetes (T2D) by switching to a diet low in carbohydrates (LC). Many of these people have been able to eliminate medication completely. Similarly those with type 1 diabetes (T1D) have been able to reduce their medication and so avoid the extreme variation in blood glucose levels which can cause hypoglycaemia (3, 4, 5).

I find the totality of evidence which supports the case for diets which are low in carbohydrate convincing. Not only are they superior to drug therapy for T2D but they are also very useful for those who have T1D. Furthermore those who switch to these diets usually also benefit by reducing the level of blood triglycerides and increasing the HDL cholesterol, thereby improving risk factors for heart disease. Many experience weight loss, although this does not always occur.

So why is the latest paper so far out of line? In the introduction it is stated that the carbohydrate debate:

“seems to be based on strong personal opinion and those working in the area tend to cherry-pick the evidence to support their particular view”

It continues:

“The evidence available is contradictory at best, and leaves both health professionals and people with diabetes alike wondering if low carbohydrate diets do live up to the hype surrounding them, and whether they should be recommended as a suitable treatment”.

There is no question that this scepticism is not justified. It simply dismisses much solid research not to mention all those individuals who have posted details of their success in coping with their disease by choosing an LC diet. There have to be genuine doubts about the objectivity of the author.

As for the study itself, this is a compilation based on 8 different studies which have been conducted in recent years. We can gain some insight into the investigation by considering the individual investigations separately.

  1. In this study the investigators recognised the value of an LC diet and so the purpose of their research was to focus on compliance (6). In the event they found that:Hence the results can have no bearing on the effect of an LC diet.
  2. “Participants in the two groups appeared to consume similar diets, despite the prescription of markedly different intake. Thus, the interventions were not effective in facilitating dietary adherence.”
  3. In this study the object was to compare an LC Mediterranean diet with a traditional Mediterranean diet and with one which complied with the recommendations of the American Diabetic Association (7). It was found that only the LC Mediterranean diet improved the HDL cholesterol and was superior to the other 2 in improving the glycaemic control as determined by the reduction in HbA1c. This diet also achieved the greatest reduction in blood triglycerides. In any case this LC diet had 35% E as carbohydrates, which is much higher than that normally used.
  4. The object of the third study was to compare a diet which was high in protein (30% E Protein, 40% E Carbohydrate) with one which was high in carbohydrates (15% E Protein, 55% E Carbohydrate) (8). It was found that there were decreases over time in weight, serum triacylglycerol and total cholesterol, and increases in HDL-cholesterol. So it was concluded that the high protein diet was no better than then the high carbohydrates. As both of these diets had relative high contents of carbohydrate this study makes no contribution to our understanding of the role of LC diets.
  5. In this study, a comparison was made between a diet which was low in carbohydrates (20% E) and one which was low in fat (55-60% E carbohydrates (9). After 6 months, weight loss was similar but those on the LC diet were able to achieve significant reductions in the doses of insulin required. Although compliance deteriorated subsequently the authors concluded that an LC diet with 20% E from carbohydrates is an effective means of improving glycaemic control in those who have T2D.
  6. In this study 14 obese patients with T2D were placed on a diet which was low in carbohydrates and high in fat (LCHF) and monitored for body weight, insulin sensitivity, HbA1c, lipids and blood pressure (10). Glycaemic control was significantly improved with resulting reductions in medication. Systolic blood pressure was reduced and the HDL cholesterol increased. The diet was well tolerated and the results fully support the LC approach as an effective means for treating those who have T2D.
  7. In this study, a comparison was made between participants with T2D who were on either an LC diet or a low fat diet plus the weight loss drug orlistat over a period of 48 weeks (11). It was found that the LC diet resulted in improved glycaemic control and a greater reduction in medication than the low fat diet.
  8. In this Japanese study, a comparison was made between a conventional calorie-restricted diet and an LC diet which had no calorie restriction for patients with T2D (12). It was found that patients in the LC group had a significant reduction in their HbA1c levels. The patients in the former group also experienced improvements in their triglyceride levels, without experiencing any major adverse effects or a decline in the quality of life. It was concluded that an LC diet is effective in lowering the HbA1c and triglyceride levels in patients with T2D who are unable to adhere to a calorie-restricted diet.
  9. In this study conducted in Australia, the effects of a diet very low in carbohydrates which was high in unsaturated fat and low in saturated fat was compared with one which was low in fat and high in unrefined carbohydrates (13). The subjects were obese patients with T2D. Although both diets were effective in reducing body weight, blood pressure and fasting blood glucose, the LC diet achieved greater reductions in HbA1c, glucose variability and in medication. The LC diet also raised the HDL cholesterol. The authors concluded:“…the LC diet induced greater improvements in glycemic control, blood glucose profiles, and reductions in diabetes medication requirements compared with the HC diet. The LC diet also promoted a more favorable CVD risk profile by elevating HDL-C and reducing TG levels, with comparable reductions in LDL-C compared with the HC diet. These effects were most evident in participants with greater metabolic derangements, suggesting that an LC diet with high–unsaturated/low–saturated fat content can improve primary clinical diabetes management targets beyond conventional lifestyle management strategies and weight loss.”In a further paper on this research project, the authors commented as follows:This is one of the groups to have included glucose variability in the values monitored. These results emphasise that one of the important factors is the reduction in the use of drugs, which has been substantial in this case.
  10. In the current study, although no apparent diet differences in HbA1c were evident, greater reductions in diabetes medications occurred with the LC diet. Compared with the HC diet, the LC diet achieved comparable HbA1c reductions with a significantly greater reduction in diabetes medication requirements, suggesting the achievement of better glycemic control. Because of the progressive nature of T2D, a reduced reliance on pharmacotherapy to achieve glycemic control presents important advantages for long-term diabetes management. These advantages include potential reductions in treatment costs and a reduced likelihood of drug-related side effects including hypoglycemia risk and weight gain with implications for long-term weight-loss maintenance.” (14)


Getting back to the original papers cited in this report has proved to be an enlightening experience. I cannot find any evidence to support the conclusion of the author that there are no statistical differences between diets wish are LC and HC with respect to the treatment of T2D. This is simply a misrepresentation of the information.

In Study no. 5 there was a significant improvement in glycaemic control as determined by a reduction in HbA1c. Similar results were obtained in Study no. 6 which also recorded a big drop in the use of medication by the LC group. Further confirmation that the LC improves glycaemic control was provided by the Japanese study (no. 7). In this one, the triglycerides declined from 141.7 to 83.5 mg/Dl while in the control the reduction was from 155.2 to 148.4 which is a huge difference as this is one of the critical risk factors for heart disease. In the Australian work (Study no.8) there were statistically significant improvements in HDL cholesterol and in triglycerides for those with an LC diet.

It turns out that discounting those studies which are not applicable because the amount of carbohydrate in the diet was too high or because of non-compliance, these results confirm the fact that a diet which is LC does benefit a person with T2D. This is precisely what would be expected since T2D is caused by excessive glucose in the blood, which means the pancreas has to increase insulin production. The excess insulin causes insulin resistance in many organs including the pancreas. Ultimately the pancreas is damaged and is no longer able to produce enough insulin to cope with the glucose in the blood. This is full blown T2D. The most effective way to deal with the disease is to eliminate the cause, which means altering the diet to reduce the amount of glucose entering the blood. In other words, just eat less sugar and other foods which contain carbohydrates.

This paper badly misrepresents and distorts the research which has been considered. It is certainly not an objective evaluation. It is somewhat ironic that the author alleges that those who advocate LC diets as a form of treatment for T2D of “cherry-picking” without any evidence to justify her charge, does exactly that herself! She has conveniently ignored any evidence which supports the case for using the LC approach in an attempt to cast doubt on the validity of such diets. In particular there is a failure to recognise the value of LC diets in reducing the amount of medication needed.

It is extremely unfortunate that this paper has been published. It is seriously misleading. I strongly recommend that it should be retracted.

Anyone interested in those studies which contribute to our understanding of the benefits of a diet which is LC (and high in fats) will find many of them here (15)


  1. P Dyson (2015) http://link.springer.com/article/10.1007/s13300-015-0136-9/fulltext.html#copyrightInformation
  2. R D Feinman (2015) http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  3. http://lowcarbdiabetic.co.uk/My%20Friends%20Stories.htm
  4. http://www.bmj.com/content/351/bmj.h4023/rapid-responses
  5. https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033?comment_id=10153144986604033&ref=notif&notif_t=like&hc_location=ufi
  6. N Iqbal et al(2012) http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.460/abstract
  7. A Elhayany et al (2010) http://onlinelibrary.wiley.com/doi/10.1111/j.1463-1326.2009.01151.x/abstract
  8. R N Larsen et al (2011) http://link.springer.com/article/10.1007%2Fs00125-010-2027-y
  9. H Guldbrand et al (2012) http://link.springer.com/article/10.1007%2Fs00125-012-2567-4
  10. J D Krebs et al (2013) http://www.tandfonline.com/doi/full/10.1080/07315724.2013.767630
  11. S B Mayer et al (2014) http://onlinelibrary.wiley.com/doi/10.1111/dom.12191/abstract
  12. Y Yamada et al (2014) https://www.jstage.jst.go.jp/article/internalmedicine/53/1/53_53.0861/_pdf
  13. J Tay et al (2014) http://care.diabetesjournals.org/content/37/11/2909.full
  14. J Tay et al (2015) http://ajcn.nutrition.org/content/102/4/780.full.pdf
  15. http://authoritynutrition.com/23-studies-on-low-carb-and-low-fat-diets/

191. Get the Fat Burners Working to Improve Performance in Sport

It is well established that it takes several weeks of adaptation to get the fat-burning systems functioning effectively. But there is rather more to this than simply reducing the carbohydrates and replacing them with fat. As Steve Phinney has emphasised, the mineral balance has to be considered (1). This means that if the diet is low in fruit and vegetables, steps need to be taken to ensure that adequate amounts of sodium and potassium are provided. When meat is baked, roasted or grilled, potassium will be lost unless the juice is included in the meals that are being served to the participants. Steve advocates a protein intake of about 15% Calories. If there is an inadequate supply of protein, there is likely to be a progressive loss of functional lean tissue resulting in a loss of physical performance. By contrast if there excessive consumption of protein, say about 25% Calories, there may be suppression of ketogenesis. This can manifest itself as headaches and lassitude and has been reported in those who casually undertake a “low carbohydrate, high protein”(LCHF) diet.

In an investigation in Italy the effect of adjusting to a ketogenic diet was studied in a group of highly trained gymnasts (2). At the outset, the main objective was to find out if this approach could be used to achieve weight loss without the disadvantages which are associated with the conventional methods of reducing the energy intake, dehydration and the use of saunas.

Those who agreed to take part were elite male artistic gymnasts who competed in the Italian premier league for the CorpoLibero Gymnastics Team ASD, Padova, Italy. Two of them were members of the Italian national team. They all trained for about 30 hours per week and this training regime was maintained throughout the study, during which time they were asked to exclude virtually carbohydrates from their diet. They were provided with a detailed menu containing permitted and non-permitted foods. The gymnasts were tested for performance and anthropometric measurements made at the beginning and after 30 days on the ketogenic diet. The entire process was repeated after 3 months when the gymnasts were consuming their usual diet.

The results showed that the mean body weight was reduced from 69.6kg to 68.0kg. However the body fat declined from 7.6 to 5.0%, which meant that the lean body mass increased from 92.4 to 95%. Although a comprehensive series of performance tests was conducted there was no evidence of deterioration as a result of making the adjustment to a ketogenic diet. When the procedures were repeated with the usual diet, no differences could be detected. It was concluded that the results demonstrate that the ketogenic approach can be used successfully to help athletes lose weight and is certainly preferable to the use of many of the alternatives, which may actually cause harm to the individuals. Because sufficient time was allowed for the adjustment to become fully effective, this explains why other attempts to adopt this approach have failed.

The object of this study was specifically focused on the issue of removing excess weight prior to a competition event. Nevertheless there remains the possibility the ketogenic diet could be beneficial to competitors in short events if adopted as a long term strategy. There is evidence to suggest that continual variation in body weight (weight cycling or “yo-yo dieting”) is detrimental to health. A study in the USA found that those who regularly lost weight and then re-gained it had 3 times the all-cause mortality of those who were non-obese but whose weight remained stable (3). The Italian study also noted that those who were keto-adapted had lower levels of insulin, which would mean that the scope for damage to the internal organs was reduced. In addition if the ketogenic approach was permanently applied, any concern about having to meet specific weight criteria would probably be eliminated. This could facilitate the preparation for a competition.

The Los Angeles (LA) Lakers is a top basketball team in the US. Because of concern that the poor diet of their players was having an adverse effect on the team performance. It was decided to employ Dr Cate Shanahan to review and to advise on the nutrition of the team members (4). To begin with, one of the top players, Dwight Howard was recovering from back surgery but it had not healed properly. He suffered from persistent tingling in his fingers and toes. He was in continuous pain and his performance was poor. It then emerged that he was eating the equivalent of 24 Hershey bars in sweets and soda every day. It was no surprise that tests showed that his blood sugars were at dangerous levels. Howard responded very positively to Cate’s advice and cut out all sugar, processed foods and the unhealthy fats and oils. Within weeks of starting the programme, Howard said his blood-glucose levels declined 80 percent. After increasing his consumption of healthy fats and decreasing processed carbs, all the indicators of heart health were moving in the right direction. After some initial lethargy during the detox phase, Howard said his endurance improved and his energy levels became more consistent. His body-fat percentage, which had been around 5-6% throughout his entire career, dropped to 3 percent.

Many of the other players have found that by following the dietary advice the soreness in the joints has been reduced and that muscle recovery has improved. Kobe Bryant was out of action for 8 months while he recovered suffering from Achilles’ tendon surgery and is convinced that this was helped by the change in diet. The programme is referred to as PRO Nutrition, which stands for Performance, Recovery and Orthogenesis — the latter being the theory that evolution is strongly influenced by environmental factors, such as diet. Cate Shanahan would like all the players to have at least 50% of their calories from fat, and no more than 25% each from protein and carbohydrates.

Since then Dwight Howard has moved on to Houston where these ideas are also being picked up.

Bode Miller is an American skier who has competed in 5 Winter Olympics. Prior to Sochi in 2014 he missed 2 seasons, because of a micro fracture in his knee. He decided he needed to lose weight so that he would lighten the load on his joints in order to improve his ability to manipulate himself out of precarious positions when he is about to crash. By reducing his carbohydrate intake he lost about 8kg and at the Olympics he managed a podium place with a bronze medal, which is highly commendable for a 36-year old (5).

Jonas Colting is an exceptional Swedish endurance athlete. On several occasions he has been the Triathlon Champion in Sweden as well as winning many other triathlons, long distance running and swimming events (6).

He eats lots of eggs, red meat, salmon, avocados, leafy greens, nuts and seeds. Although he is sparing with dairy he has plenty of butter and drinks full fat milk. His favourite fruits are pomegranate, blueberries, mango, citrus and bananas. He also likes potatoes, carrots, red beets and turnips. He does have some carbohydrates and enjoys the occasional bowl of pasta. He is convinced that the carbohydrate-loading that many athletes utilise is ill-advised and even if they are coping at present will ultimately cause serious health problems in the future.

There is a particularly interested case study in the Phinney/Volek book from David Dreyfuss who was trained as an engineer and scientist. He kept active throughout his life by activities such as running, including marathons, biking, hiking and swimming. Like so many others he has tried to follow the conventional dietary guidelines but despite this he gained weight and in his fifties, he reached 100kg and had hypertension, raised triglycerides and raised blood glucose. At this point he discovered “Good Calories Bad Calories”/”The Diet Delusion” by Gary Taubes (7). This led him to adopt an LCHF diet and he lost his excess weight and the other indicators reverted to “normal” although he still finds it necessary to take medication to control the hypertension. He discovered that when he ran a marathon that he no longer encountered the “wall”, which is what would be expected if the concepts of fat-burning are correct. He is absolutely categorical that after competing in an event he has much less pains and aches and that his recovery is much quicker than it ever was in the past. Despite his age, his performance is equal to or better than he was fuelled by carbohydrates.


Despite the warnings that there may be dangers associated with an LCHF diet, the fact that it is proving to be effective and usually also improves performance is pretty convincing evidence that it is perfectly safe for all. When this is combined with all the information about the benefits with respect to reducing the risks of a wide range of diseases, there can be little doubt it should be the basis for all healthy eating strategies.


  1. S D Phinney (2004) http://www.nutritionandmetabolism.com/content/1/1/2
  2. A Paoli (2012) Journal of the International Society of Sports Nutrition 9, pp34
  3. Vanessa A Diaz (2005) Journal of Community Health 30 (3) pp 153-165
  4. http://www.cbssports.com/nba/writer/ken-berger/24370416
  5. http://www.examiner.com/article/after-losing-20-pounds-on-low-carb-diet-skiier-bode-miller-soars-at-olympics
  6. http://www.marksdailyapple.com/jonas-colting/#axzz3W9dy2QA5
  7. Gary Taubes (2007) “The Diet Delusion” Vermillion: London



190. Low Carb Diets Improve Sports Performance

For many years the accepted wisdom for those participating in any sports that required endurance was that carbohydrate-loading was essential in order to meet the demands for an energy supply. This view was reinforced by the results of investigations designed to compare the effectiveness of fat and carbohydrate as energy sources which apparently demonstrated the superiority of the carbohydrates. However the recognition that ketogenic diets (those which are low in carbohydrates and high in fat (LCHF)) are effective in overcoming Insulin Resistance (IR) has stimulated a re-think about the roles of fat and carbohydrates in sports performance. Two of the leading researchers in this field are Jeff Volek and Stephen Phinney who have summarised their conclusions in

“The Art and Science of Low Carbohydrate Performance” (1).

Their starting point is that the body can store over 40,000 Kcals as fat whereas with carbohydrates the total is about 2,000 Kcals. This means that there a limit to what can be achieved when the carbohydrates are the main energy source. Eventually the body runs out of fuel, even if this can be delayed for a while by consuming sugary drinks, a phenomenon referred to by marathon runners as “hitting the wall”. Despite this a very high proportion of the research done over the past 40 years has been about enhancing glycogen levels while there has been little effort devoted to finding out how to decrease the body’s dependence on carbohydrates during physical activity. Nevertheless the different fatty acids can be broken down to ketones, which can be utilised efficiently by all the organs in the body, including the brain, as a source of energy.

The factors which control the “fat-burning” capability of the body are rather more complicated than for carbohydrate utilisation. Firstly, a diet which has a high carbohydrate content, will stimulate the production of insulin, which in turn will act to inhibit the fat-burners. Secondly, it takes at least several weeks for the fat-burning to become fully activated. Hence the LCHF diet must be maintained continuously for this to happen. Incidentally this explains why early experiments reported that fat was less effective than carbohydrates as a source of energy. The investigators had not appreciated that the fat-burning capability takes time to develop and become fully operational. To make matters even more difficult there is considerable variation between individuals in their ability to burn fat.

As long ago as 1983 Steve Phinney conducted a study with lean highly trained cyclists who had been used to consuming a diet which was high in carbohydrates. At the outset, they did an endurance test to exhaustion. Then they spent 4 weeks adjusting to an LCHF diet described as keto-adaptation. When they did the endurance test, the results were just as good as those done originally. However this was achieved by almost complete reliance on fat rather than on carbohydrates.

Athletes who are not keto-adapted reach a point at which the availability of the carbohydrate starts to fall off which results in a deterioration in both mental and physical performance. This is unlikely to occur when the athlete is utilising the fat as a source of energy. This means, for example, in a marathon, the runner would not experience the “wall”. Hence it would be expected to be especially beneficial for those whose active participation is for more than about 2 hours. In addition even for events of shorter duration, training sessions would be facilitated. All-round improvements in general health and a reduction in proneness to injury all combine to have a positive impact on performance when the finest margins can make a huge difference to the final result.

Anyone with a tendency to excess weight will almost certainly lose adipose tissue (fat) by adjusting to an LCHF diet. At the same time, there is likely to be a build-up of muscle mass, which may translate into improvements in speed, agility and performance. This also improves power to weight ratios, which play a key role in acceleration and endurance. This can be crucial in athletes involved sports which demand high intensity and explosive bursts.

During physical activity, oxygen free radicals are produced which can cause damage to the various organs. When fat is utilised as the source of energy, there are less free radicals produced than with carbohydrates.

The advantages of a ketogenic diet were amply demonstrated by the experience of those who participated in the Schwatka expedition in 1879-80. A total of 18 people led by Lt Frederick Schwatka departed from the west coast of Hudson’s Bay in April of 1879 with 3 heavily laden dog sleds. They had a month’s supply of food (mostly walrus blubber). Apart from that they had to rely on their own ability to acquire food by hunting and fishing. They succeeded in covering over 3000 miles on foot over ice, snow and tundra. All 18 members of the original party plus their 44 dogs returned to the starting point in March of 1880. This remarkable feat of physical endurance was achieved on a diet which was virtually devoid of any carbohydrate (2).

Some people can cope with a reasonable amount of carbohydrates in their diet, which is fine. But there are many who are carbohydrate resistant (CR) which means that the presence of carbohydrates in their diet is damaging to their health, which is manifested as T2D and related diseases. It is well established that in such individuals, almost invariably good health can be restored by reducing the intake of sugar/carbohydrates and replacing them with the good fats. However it also means that the sporting performance can be improved or recovered. Professor Tim Noakes is a distinguished scientist who was the professor of Sports Science at the University of Cape Town for many years. Because he developed Type 2 Diabetes (T2D) he studied the research and discovered that it was almost certainly caused by his habitual diet that pretty well complied with the conventional dietary guidelines (Low Fat and High Carb). As a result he switched to a LCHF diet and within 8 weeks he had lost 11kg. Over the same period, many of his minor ailments disappeared, he had energy to spare and his running was back to where it had been 20 years earlier. As he says himself:

“it was astonishing” (3).

He is convinced that the LCHF approach will definitely be beneficial to all those who are CR and probably overweight. He goes on to give a number of examples. Bruce Fordyce is one of the best marathon and ultramarathon runners in the history of South Africa. During the late 1970s and early 1980s he worked with Tim who put him on a high carbohydrate diet. Bruce won repeatedly over a 10-year period but then things began to go horribly wrong. He started putting on weight and was no longer enjoying his running. When he had gained 16kg he tried the LCHF diet and within a short time at the age of 56 years he had reduced his time for 5k from 23 to 17 minutes. Another athlete who Tim helped improved his time for 56k by 3 hours, largely because he was able to double the amount of training he could do.


Clearly there is convincing evidence that the LCHF approach is beneficial for athletic performance. Some more examples will be posted in the next blog.


  1. J S Volek and S D Phinney (2012) “The Art and Science of Low Carbohydrate Performance” ISBN 13 978 0 9834907 1 5
  2. S D Phinney (2004) http://www.nutritionandmetabolism.com/content/1/1/2
  3. http://paleorunner.org/2014/05/pr80-tim-noakes-low-carb-endurance-performance.html/



189. Time Australia Recognised the Importance of Low Carb Diet

There are sound theoretical reasons why a diet which is low in carbohydrates and high in certain fats fats is consistent with good health and longevity. This is supported by numerous case histories from individuals as well as long and short term studies. A useful contribution to our understanding has been provided by a recent study conducted in Australia under the auspices of the Commonwealth Scientific and Industrial Research Organisation (CSIRO) (1). This investigation was specifically aimed at those with Type 2 diabetes (T2D) who were overweight or obese. The participants were divided into 2 matched groups. One of these was allocated to a diet containing 14% energy (<50 mg/day) of carbohydrates (Low carb, LC) and other had a diet with 53% energy as carbohydrates (High carb, HC). All participants were required to undertake vigorous exercise under supervision on 3 occasions every week. The calorie intake in both groups was similar and the study continued for a full calendar year.

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

In another paper written by members of the same research team it was noted that the total economic costs of T2D have been estimated as A$10.3 billion in Australia and US$174 billion in the USA (2). Referring to the results of the study described here, they comment:

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

In 2008-2009, the cost of treating T2D in Australia was just over A$1,507 million of which one third was spent on medication. It is suggested that by helping patients with T2D to switch to an LC diet, there would also be enormous improvements in personal health and well-being.

Although the savings in expenditure on treatment are substantial they are relatively small when compared with the benefits to the national economy of reducing the number of people who suffer from T2D.

These results from the leading research body in Australia highlight the extraordinary position taken by the Dietitians Association of Australia (DAA) (3).In a statement on its website, apparently written in July 2015, it effectively endorses that of the Diabetes Australia organization which is that:

very low carbohydrate diets are not recommended for people with diabetes. The organization states: ‘If you eat regular meals and spread your carbohydrate foods evenly throughout the day, you will help maintain your energy levels without causing large rises in your blood glucose levels’ ….. Diabetes Australia recommends people with diabetes eat moderate amounts of carbohydrate and include high-fibre foods that also have a low glycaemic index (GI)” (4).

It continues by emphasizing the importance of including carbohydrates in the diet:

“While there are specific requirements for amino acids (from proteins) in the diet, and essential fatty acids (from fats), there is talk that there is no specific requirement for carbohydrate.

This is not true. Both your brain and red blood cells require glucose and while some can be supplied by breaking down proteins in your body, there are a number of reasons why this is not beneficial and is specifically not recommended – for example, during childhood (due to growth requirements) and during pregnancy. The long-term effect of placing this demand on the body has also not been tested and there is evidence to suggest that performance in mental and physical tasks could be affected. Therefore, a diet that is very low in carbohydrate may not be physically or mentally sustainable as a diet pattern.

In addition, carbohydrate foods supply many nutrients. These include B vitamins and fibre from grains, and vitamins, minerals, dietary fibre and other plant components such as antioxidants from fruit and starchy vegetables. So without careful planning, it can be more difficult to meet nutrition needs on a low carbohydrate diet”.

The reality is that there is no specific requirement for carbohydrates by the human body. Here is a quote From Dr Walter Willett who is Chairman of the Department of Nutrition at the Harvard School of Public Health:

One thing we know is that the grains are not essential for sure in a diet, but if we replaced them all with sugar that would be even worse, so that to make a point about relativity being important, but even carbohydrate in general is not essential as a nutrient. We have essential fats, we have essential proteins, amino acids and proteins, but grains and carbohydrate in general are not essential and it would be fine if people did replace all of the grain with a wide variety of vegetables, so that is good news, a wide variety of options that can be healthy, not just a single sort of exactly one style of diet.” (emphasis added)

The energy demand can be met effectively by fat. Any glucose which is needed can be produced in the body from protein and/or fat. There are examples of populations which such as Eskimos and the Maasai tribe in Africa which live on a diet which is high in fat and are perfectly healthy.

Not only does the DAA advise against a LC diet but it has recently expelled one its members Jen Elliott because of her recommendation to lower carbohydrate diets to people with insulin resistance and type 2 diabetes (T2D) (6). 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”.

Details are given in a previous blog (7).


It is abundantly clear that the DAA has adopted a stance that is untenable. The evidence from the CSIRO which is in agreement with that of many other investigations confirms that the advice being promulgated by the DAA is actually contributing to the growing incidence of T2D in Australia. Although the change to an LC diet would be an effective therapy, the DAA is aggressively opposed to this as demonstrated by the expulsion of Jen Elliott. We now learn that Health Minister in New South Wales has seen fit not to intervene on behalf of Jen.

The DAA and other bodies which take the same approach are definite contributors to the growing incidence of T2D which is causing unnecessary suffering, increasing expenditure on treatment and damaging to the economy. It is imperative for the Federal Government to step in and clean up this almighty mess. Jen Elliott has behaved impeccably and it is appalling that she has been treated so despicably. In fact she should be applauded for highlighting what is absolutely scandalous behaviour on the part of a professional body which seems to have completely lost sight of its fundamental purpose. This issue is not going to go away. Immediate action is needed and must include the exoneration of Jen Elliott.


  1. J Tay et al (2015) http://ajcn.nutrition.org/content/102/4/780.full.pdf
  2. C Proud et al (2015) https://theconversation.com/how-the-right-diet-can-control-diabetes-and-reduce-its-massive-economic-costs-42910
  3. http://daa.asn.au/for-the-media/hot-topics-in-nutrition/low-carbohydrate-high-fat-diets-for-diabetes/#7
  4. https://www.diabetesaustralia.com.au/what-should-i-eat
  5. http://pages.sanesolution.com/dr-walter-willett-chat-with-the-worlds-most-influential-nutrition-researcher/
  6. http://www.babyboomersandbellies.com/blog/2015/08/my-case-with-daa-revisited-or-revisiting-my-case-with-daa-or-daa-revisited/
  7. http://vernerwheelock.com/?p=805


188. Report by Credit Suisse Research on Nutrition

An extremely valuable contribution to our understanding of contemporary nutrition has just been released. This is a review of research which has been conducted by a team from the Credit Suisse Bank. The primary purpose is to understand the basic concepts which should be used to devise a diet consistent with good health. In my opinion, the work is objective and extremely competent. Hence the conclusions should be regarded as reliable.

There can be no disagreement that there are fundamental problems with the quality of the diet in many countries as demonstrated by the high incidence of obesity and type 2 diabetes (T2D). However there is debate about the relative importance of the different fats and carbohydrates. This blog will highlight the key points in the report:

  • Natural fat consumption is lower than “ideal” and if anything could increase safely well beyond current levels.
  • Although saturated fat (SFA) was blamed for being the main cause behind an epidemic of heart attacks this cannot be substantiated because consumption declined between 1930 and 1960. Smoking and alcohol were far more likely factors behind the heart attack epidemic.
  • SFA has not been a driver of obesity: fat does not make you fat. The most likely causes are carbohydrates and the solvent-extracted vegetable oils (canola, corn oil, soybean oil, sunflower oil, cottonseed oil). Globally consumption per capita of these oils increased by 214% between 1961 and 2011 and 169% in the U.S. Carbohydrates and vegetable oils accounted for over 90% of the increase in calorie intake in this period.
  • Total blood cholesterol (TC) and LDL cholesterol (the “bad” one)—are poor indicators of CVD risk. In women in particular, TC has zero predictive value if we look at all causes of death. Low blood cholesterol in men could be as bad as very high cholesterol. The best indicators are the size of LDL particles and the ratio of TG (triglycerides) to HDL (the “good” one). A VAP test to check your pattern A/B costs less than $100 in the USA, yet few know of its existence.
  • The intake of foods rich in SFA (butter, palm and coconut oil and lard) poses no risk to health and particularly to the heart. SFA should be regarded as a healthy source of energy and it has a positive effect on the pattern A/B.
  • Transfats have negative health effects.
  • Most research on consistently shows benefits from additional intake of omega-3 fatty acids. Additional intake of 1 gram per day of omega-3 reduces the risk of CVD death by 5-30%. It has also been shown to be beneficial in lowering the risk of mental illnesses such as Alzheimer’s Disease or dementia.
  • An analysis based on a group of 22 European countries shows that there is a positive correlation between the increase in omega-6 intake and the level of CVD deaths.
  • Two surveys of doctors, nutritionist and consumers revealed that all three groups had only superficial knowledge of the potential benefits or risks of increased fat consumption. Their views are influenced significantly more by public health bodies or by WHO and AHA rather than by the results of research. With respect to cholesterol, 40% of nutritionists and 70% of the general practitioners surveyed still believe that eating cholesterol-rich foods is bad for your heart.
  • Consumers have a positive perception of fish, nuts, chicken, eggs, yogurt and milk as sources of fat and a negative view of beef, pork, cheese, margarine and butter. They are neutral to positive on vegetable oils in general, but olive oil commands a very positive “healthy” image.
  • Health care officials and government bodies have been consistently behind developments on the research front. Research showed that transfats were quite unhealthy as early as 1993, yet a full ban of transfats in the U.S. will only happen in 2018. In Europe only Switzerland and Denmark have so far banned them. The stance of most officials and influential organizations such as WHO or AHA is now well behind research in two main areas: SFA and polyunsaturated omega-6 fats.
  • Carbohydrates are one if not the major cause behind the fast growth of metabolic syndrome cases in the U.S.—4% a year—which includes T2D and obesity.

The research team analysed the changes which changes in consumption which occurred in the USA between 1971-75 and 2009-10 during which time the percentage of obese males rose from 12.1% to 35.5%. Over this period, total fat consumption increased just 2%, SFA declined by 7% and protein increased just 7%. By contrast, carbohydrate consumption increased by 30%. The corresponding changes in specific foods is also relevant. Red meat consumption declined by 24%, butter and lard by 39% and eggs by 21%, and dairy rose by just 5%. Conversely, the consumption of vegetable oils (rich in omega-6) soared by 89%, chicken by 139% (which contains saturated fat and omega-6 in almost equal quantities), maize by 100% (rich in omega-6) and sugar by 25%.This led to the conclusion that:

“It seems clear that saturated and monounsaturated fats have very little to do with the soaring levels of obesity among the U.S. population but that carbohydrates and/or polyunsaturated fats (mostly omega-6) have a lot to account for and are also the two main factors behind the overall increase in calorie intake. Excessive consumption of carbohydrates and omega-6 have been shown to trigger insulin resistance through an inflammatory response. Note that obesity is not just an isolated “illness.” Most obese people have a higher probability of experiencing cardiovascular problems, diabetes, and other metabolic illnesses. In retrospect, it would be easy to conclude that in the U.S. the stance of many health officials and medical researchers against saturated fat—and the concomitant switch into carbohydrates and potentially omega-6—created a health disaster of major proportions.”

By focussing on the fundamental changes in the food consumption patterns, the research team has been able to obtain insight into those factors which may have been contributing to the changes. Even more significant, it is shows conclusively that the SFA could not possibly have any involvement in the development of obesity and related health problems. This approach contrasts favourably with that of many academic researchers who restrict themselves to investigations of doubtful validity while ignoring what is happening in the real world.

This is illustrated very neatly in this report with an evaluation of an epidemiological work on omega-6s. A meta-analysis reached the conclusion that replacing 5% of SFA with polyunsaturated fats lowered coronary events by 13%. But there was no breakdown of the relative proportions of omega-3s and omega-6s. Because omega-6s cause inflammation and omega-3s are anti-inflammatory, this information is essential if any sound conclusion is to be drawn. Furthermore there was no information on the content of transfats present in the SFA. In the absence of this information it was totally impossible to reach a definitive conclusion. The fact that the research team identified these weaknesses certainly inspires confidence in the quality of the investigation.

Based on the results, forecasts are made about how demands for various foods and ingredients are likely to change in the future which include:

  • Fat consumption per capita is expected to grow from the 26% of total energy intake registered globally in 2011 to close to 31% by 2030.
  • Carbohydrates will decline from 60% of global energy intake in 2011 to 55% by 2030. This substantial decline is likely to happen because of that the rising awareness of the link between excess carbohydrate consumption (and particularly sugar) and T2D, cardiovascular issues and mental illnesses.
  • SFA is likely to experience the fastest growth, rising from 9.4% in 2011 to 12.7% of daily energy intake by 2030, monounsaturated will increase from 10.2% to 12.2%. On the other hand omega-6s are expected to decline slightly from 6% to 5.4% and omega-3s to grow from 0.50% to 0.55%.
  • Meat consumption is expected to grow 23% over the next fifteen years. The perception of red meat is likely to improve with the acceptance of SFA as healthy rather than harmful.
  • The two leading processed oils: rapeseed and soybean oil should decline somewhat. Palm oil should gradually improve its image and see the benefits of a trend towards “natural” oils and should grow by 10%. There is also a good future for olive oil and coconut oil.
  • The growth in the demand for fish and nuts should be maintained.
  • Eggs should do particularly well as the more people understand that the cholesterol theory has been discredited. By 2030, it is predicted that everyone will be consuming about 5 eggs per week.
  • Demand for butter and cheese should continue to grow at a fast pace, in line with growth rates in the last 3-5 years. Milk and milk-related products should grow by 50% or 2.5% a year. Butter should continue to replace margarine and benefit from the full ban on transfats.


Publication of this report represents a significant step forward in progress towards a total re-evaluation of the current official dietary recommendations in most countries. As it clearly recognises, the guidelines developed in the USA during the 1970s have proved to be an unmitigated disaster. Awareness that changes are required is growing but there is inertia within governments to take the necessary policy initiatives. The fact that these issues are now being considered seriously by the business/financial interests will certainly help to drive things forward. While the implications in the marketplace for some products are poor there are others which will provide opportunities that can be exploited by progressive entrepreneurs. There are indications that this is already happening in Sweden where there has been a shortage of butter reported (2).

I am delighted that the conclusions here are in total agreement with several of my earlier blogs on topics including:

  • Cholesterol (3)
  • Saturated fat(4)
  • Omega-s/omega-6s(5)

A very welcome report which is further ammunition for those of us who to are keen to get these concepts widely accepted.


  1. Credit Suisse Research (2015) “Eat: The New Health Paradigm” https://doc.research-and-analytics.csfb.com/docView?language=ENG&source=ulg&format=PDF&document_id=1053247551&serialid=MFT6JQWS%2b4FvvuMDBUQ7v9g4cGa84%2fgpv8mURvaRWdQ%3d
  2. http://www.dietdoctor.com/butter-shortage-in-sweden
  3. http://vernerwheelock.com/?p=838
  4. http://vernerwheelock.com/?p=854
  5. http://vernerwheelock.com/?p=710