223. The Practicalities of Changing your Diet

The objective

The fundamental objective is to reduce the amount of carbohydrates being consumed and largely replace them with the healthy fats. You should make the changes gradually so that your body can activate its fat burning capabilities. The approach should be try out a variety of different strategies, so that you can identify those that are feasible and acceptable to you and to the other members of your household.

Focus on sugar initially

The starting point really has to focus on sugar and as much as possible should be eliminated. If sugar is used in tea or coffee if you cut it out altogether your taste buds will soon adjust if you persist. If possible, it is best not to use sweeteners, especially saccharin and aspartame. Some information on sugar-free baking is available here (1). The big problem is that sugar is present in so many processed foods. Sugar-sweetened soft drinks are full of sugar and certainly should not be consumed very day. Ideally find an alternative. Although fruit juices are perceived as healthy they do contain sugar and so should only be consumed in small quantities. Unfortunately sugar is included as an ingredient in a very wide range of foods. It you look at the ingredients, glucose, sucrose, fructose, maltose, dextrose, molasses and fruit syrup are all used to indicate a form of sugar. Probably the most insidious products which are promoted as “low fat” or “diet” and therefore portrayed as “healthy” to consumers. The reality is that these are invariably formulated by removing the fat and replacing it with sugar and/or sweeteners. Choosing these means you suffer a double whammy because the nutritious fat has been lost and replaced by sugar, which is damaging to health. Although it is to be expected that sugar will be present in biscuits, cakes and confectionery, it will also be found in savoury products such as soups, pasta sauce, bread, crisps, sauces, pizzas and baby foods. Many breakfast cereals, including some mueslis are major sources of sugar.

Just eat real food

Ideally if you are genuinely interested in modifying your habitual diet the best way by far is to limit processed foods as much as possible and prepare your own food at home using your own ingredients. So the emphasis in this section will be on what to buy and how to prepare a variety of meals that will be healthy and tasty.

Careful with starchy foods

In addition to the sugars, it will be necessary to limit those foods which are rich in carbohydrates. Essentially these are bread, potatoes, rice and pasta which contain starch which is broken down during digestion to release glucose that is absorbed into the blood. If these foods are refined then the glucose will be released quickly causing a rapid rise in the blood concentration. Hence insulin has to be produced to cope with it. The refining also means that fibre and vitamins are probably removed. Therefore it is best to choose whole grain varieties if possible when these foods are being used. Health problems may be encountered with wheat and wheat products. Some people are gluten intolerant for example. So it may be preferable to choose other cereals such as oats and rye, which tend to release the glucose quite slowly.

If it accepted that processed foods are kept to a minimum this means that there will have to be preparation in the home. The key to success is to ensure that there is a supply of ingredients available so that the resulting dishes have a composition which is low in carbohydrates and has all the appropriate fats.

This a challenge which demands a fundamental change in mind set. So much of what has been drilled into us has been wrong. It is essential to appreciate that the SFAs which in past have been condemned are actually important nutrients and therefore should become a regular part of the diet. On the other hand, the PUFAs which have been promoted as healthy because they “lower cholesterol” should be avoided because that rationale is no longer valid. Furthermore as the PUFAs are primarily omega-6s, increasing consumption simply pushes up the omega-6: omega-3 ratio to values that not consistent with good health. On the contrary, we need to reduce the omega-6s and increase the omega-3s in order to reduce the ratio. This is believed to be one of the critical factors which was responsible for the dramatic reduction in deaths due to heart disease and all causes in the Lyon Heart Study. Similarly as explained above the “low fat” versions cannot be remotely considered as healthy.

The Real Meal Revolution in South Africa

With respect to the carbohydrates, a very useful guide has been devised by Professor Tim Noakes and his colleagues in South Africa, which classifies foods as green, orange or red, as determined by the content of carbohydrates (2). Here are some examples:

GREEN which are very low in carbohydrate content and so there is no limit on the amount that may be consumed. Eggs, fresh meat, high quality sausages, cottage cheese, cream, butter, olive oil, coconut oil, duck fat, pumpkin seeds, pecan seeds, all green leafy vegetables, avocados, cauliflower, mushrooms, onions and tomatoes.

ORANGE which contain a medium amount of carbohydrates (between 6 and 25%) and should not be consumed in excessive amounts. Apples, bananas, blackberries, gooseberries, grapes, oranges, peaches, raspberries, strawberries, cashew nuts and butternut squash.

RED which contain lots of carbohydrates and should only be eaten occasionally. Flour, bread, cakes, biscuits, couscous, rice, pasta, thickening agents, all processed foods, fruit juice, potatoes, legumes, beetroot, peas, parsnips and of course sugar in any shape or form as well as any foods which has sugar as an ingredient.

The full lists can be obtained from the website (2). It is important to understand that the changes should be introduced gradually. This information may be used as a guide and to help getting tunes in to the new concepts. It should not be interpreted too literally. While all of the items on the red list are high in carbohydrates, some are excellent sources of other important nutrients including minerals, vitamins and antioxidants. Beetroot has been shown to reduce blood pressure, improve stamina and lower the risks of cancer (3). Green peas lower the risks of developing T2D despite the relatively high content of carbohydrates and are a good source of omega-3s (4). Parsnips are a good source of many minerals and vitamins and therefore may be used instead of potatoes (5).

Nevertheless the green list should be regarded as the starting point and used as the basis for purchasing supplies. It is well worth consulting the full list because there may be items there which have not normally been used in your household. There are a number of foods which are now recognized as especially nutritious (6). These include:

Tomatoes

These are an excellent source of phytonutrients and a range of vitamins and minerals. Tomatoes contain lycopene which is a very effective antioxidant, which reduces the risk of strokes and various cancers, especially cancer of the prostate in men.

 

Avocados

Avocados are rich sources of monounsaturated fat and help the body absorb fat-soluble nutrients from other foods. They also provide close to 20 essential health-boosting nutrients, including potassium, vitamin E, B vitamins, and folic acid. They are also effective in reducing inflammation and in protecting the liver.

Berries

Berries have high concentrations of phytochemicals which boost the immunity, prevent cancer, reduce the risk of heart disease, and prevent seasonal allergies. They contain much lower levels of sugar than many fruits. Blueberries are rich in antioxidants and can prevent premature aging.

Cucumbers

They are rich in vitamin B5 (pantothenic acid), fisetin, vitamin C, vitamin K, potassium, magnesium, manganese, silica, and fiber, and can help the body eliminate toxins. They contain lignans which can help to reduce the risk of many cancers including those of the breast, uterus, ovary and prostate. The presence of certain phytonutrients strongly inhibit cancer cell development.

All types of greens

Most green vegetables are extremely nutritious. Examples include watercress, chard, spinach, lettuce, kale, dandelion leaves and beet greens.

Sprouting

Using the seeds to grow sprouts will provide concentrated nutrients which are even more beneficial than the mature vegetables. Examples include include alfalfa, mung bean, wheatgrass, peas, broccoli, and lentils. The sprouts from sunflower and watercress are particularly nutritious. They are rich in oxygen and can help protect against abnormal cell growth, viruses and certain pathogenic bacteria. It is easy to grow sprouts in the kitchen.

Preparation and cooking

It is important to have a good breakfast. Many of the cereal products found in the supermarkets are high in sugar and if consumed at breakfast will cause a build-up of glucose in the blood. The insulin will then direct the glucose to the liver where it is converted into fat and stored. So it is not in the least surprising that the person soon feels hungry again and may well have a mid-morning snack. When this process is continually repeated the inevitable result is eventually obesity. Porridge made from oats is an excellent food for breakfast because the glucose is released slowly. Nuts, seeds, berries, cream and perhaps a little honey can be added to the porridge. Eggs are also ideal for breakfast and can be boiled, fried, scrambled or used to make an omelette. The advantage of the fat is that it is utilised effectively to meet the requirements of the body so that satiation is achieved. This means the person can keep going until lunch time or longer.

In the summer months there is plenty of scope for preparing salads using plenty of greens which can be supplemented with sprouted seedlings. Boiled eggs, cold meats and cheeses can be used as well. Any number of vegetables including carrots, celery, kale and peppers can be used for dips.

Soups are a great way to consume vegetables. Onions, mushrooms, butternut squash, cauliflower, courgettes, and tomatoes are all ideal ingredients for soups. Various herbs and spices can be used to improve the flavours. Very often best results are obtained by liquidising the soup and adding cream.

For cooking, coconut oil is probably the best one to use. It is very stable and does not decompose when subject to heat unlike the “vegetable oils”. As the coconut oil is quite expensive, butter can be used with it to stretch it out.

Stir fries are quick and easy to do. They can be used all the year round. Coconut oil is ideal and the ingredients can be whatever is readily available such as broccoli spears, kale, spring onions, Chinese leaves, shredded cabbage and bean sprouts. Pieces of chicken, prawns or slices of beef can be added.

Meats can be cooked by roasting and frying as well as in stews and casseroles. Seal the meat first by frying briefly in a pan.

Avoid thickeners to prepare gravies and use the juices from the meat instead. Garlic, black pepper, chillies, sea salt as well as herbs and spices can be added to improve the flavor.

For casseroles, a slow cooker is a worthwhile investment. For a lamb stew, marinade with rosemary overnight and then seal before placing in the cooker. Add some vegetable stock. Once the lamb has cooked add in butternut squash and shallots, bring to the boil and simmer. The same procedure with other cheap cuts of beef or pork. If chicken is used then the time of cooking should be reduced.

Instead of potatoes, use sweet potatoes, which contain less carbohydrates. They can also be used with the skin to make wedges instead of regular chips. Swedes, parsnips and carrots can be roasted or mashed. Aubergines and celeriac are possible alternatives to potatoes.

Conclusion

Adjusting your diet need not be difficult. The starting point should be to understand the basic principles and then make changes gradually. There is tremendous scope to make meals that are tasty and enjoyable. Be prepared to experiment and discover what works best for you and the other members of your household. Positive results should be evident within a very short time, which will provide the stimulation and encouragement to make further progress.

References

  1. http://www.bbcgoodfood.com/howto/guide/sugar-free-baking
  2. http://realmealrevolution.com/
  3. http://articles.mercola.com/sites/articles/archive/2014/01/25/beets-health-benefits.aspx
  4. http://www.whfoods.com/genpage.php?tname=foodspice&dbid=55
  5. http://www.livestrong.com/article/485728-the-health-benefits-of-parsnip/
  6. http://articles.mercola.com/sites/articles/archive/2014/10/20/summer-superfoods.aspx

222. More about the History of the “Cholesterol” Issue.

It is becoming increasingly obvious to anyone who examines the scientific literature with an open mind that the justification for cholesterol-lowering simply does not exist. So I have been digging into the background to try to find out how it all originated. Although the work of Ancel Keys stimuated interest in cholesterol, it was a trial which commenced in 1958, which started the ball rolling with massive programmes. These have continued to the present day.

The Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT)

This LRC-CPT was a major NHLBI study, which cost about $150 million (1). Men with high TC values were recruited. One group was given a cholesterol-lowering drug, cholestyramine, and the other acted as control.

At the end of the trial it was found that 1.6% of those in the treatment group had suffered a fatal heart attack compared with 2.0% of those in the controls. For all-cause mortality (ACM), the results were almost identical: 3.6% in the cholestyramine group and 3.7% in the controls. So in absolute terms this was not exactly a profound difference. Nevertheless this did not prevent Dr. Basil Rifkind, the trials director, from proclaiming that:

“The cholestyramine group had a 19% reduction in risk …. of the primary endpoint of definite CHD, death or definite nonfatal myocardial infarction” (2).

In Time magazine he claimed the study:

“strongly indicates that the more you lower cholesterol and fat in your diet, the more you reduce your risk of heart disease” (3).

Rather conveniently, there was no mention of the ACM data, which would have totally destroyed the credibility of the study.

This information was announced to the media and presented as a great success, which justified the use of cholesterol-lowering as an important strategy in controlling the high incidence of CHD that was such an issue in the USA the time.

These differences were statistically non-significant, which meant that it could have been due to chance and was not necessarily a genuine difference. Anthony Colpo in his book on cholesterol has described how the data was manipulated in order to claim that the results had achieved “statistical significance” (4). In particular:

  • The original protocol specified that because it was essential to be sure that any observed beneficial effect of cholesterol-lowering was beneficial, stringent standards were specified for assessing the differences between the treated and control groups. These were not achieved.
  • The results for fatal heart attacks and non-fatal attacks on their own did not reach statistical significance.
  • When the 2 sets of results were combined, the difference was significant but this was only achieved at the less demanding level.

At a later follow-up, it was reported that after 13 years, the ACM in the drug treated group was 7.5% and in the control group 8.2% (5). It was also noted that the incidences of benign colorectal tumours (50 vs 34), cancer of the buccal cavity and pharynx (eight vs two), gallbladder disease (68 vs 53), and gallbladder surgery (58 vs 40) were increased in the cholestyramine group although these differences were not statistically significant. Another important result was that those in the treated group had a raised incidence of deaths due to violence and suicide. Hence there is a possibility that this could be a specific effect of low cholesterol per se.

The critics

Dr. Mary Enig pointed out that:

“An interesting feature of the study was the fact that a good part of the trial’s one-hundred-and-fifty-million-dollar budget was devoted to group sessions in which trained dieticians taught both groups of study participants how to choose “heart-friendly” foods—margarine, egg replacements, processed cheese, baked goods made with vegetable shortenings, in short the vast array of manufactured foods awaiting consumer acceptance. As both groups received dietary indoctrination, study results could support no claims about the relation of diet to heart disease” (6).

She also revealed that at a workshop to discuss these results there was widespread criticism of the manner in which the information had been tabulated and manipulated.

Another critic, Colin Rose commented in his blog:

Note also that the LRC-CPPT recruited only men with primary hypercholesterolemia, a rare disorder of lipid metabolism that affects at most one in five hundred of the population and a very small fraction of the total number of people dying of heart attacks. The results, insignificant as they were, were then extrapolated to the entire population without primary hypercholesterolemia.”(7).

Even though both groups had the same diet, it was still claimed that the results provided support for the Diet-Heart Theory and were used to promote the dietary guidelines which recommended low fat and low SFA. As Nina Teicholz commented:

“It’s important to understand that this trial did not test diet. Both groups in the study were advised to eat the same low-fat fare. Therefore, diet was not a variable tested in the trial; only the drug cholestyramine was tested in this design. The reason for not testing different diets, the investigators explained to critics, was that the NHBLI could not, in good conscience, deprive any high-risk man of a cholesterol-lowering diet—even though one of the trial’s original goals was to test whether such a diet would protect against heart disease in the first place. It was a Kafkaesque circle of reasoning. Keys’ hypothesis had evidently managed to sail over the normal hurdles of scientific proof such that the mere act of testing the diet was now considered unethical” (8).

Consensus Conference: The Lowering Blood Cholesterol to Prevent Heart Disease

This conference was held in December 1984 and followed on from the publication of the LRCPPT results. The driving force behind it was Dr. Rifkind.

It was concluded that:

“Elevated blood cholesterol level is a major cause of coronary artery disease. It has been established beyond a reasonable doubt that lowering definitely elevated blood cholesterol levels (specifically blood levels of low-density lipoprotein cholesterol) will reduce the risk of heart attacks due to coronary heart disease. This has been demonstrated most conclusively in men with elevated blood cholesterol levels, but much evidence justifies the conclusion that similar protection will be afforded in women with elevated levels. After careful review of genetic, experimental, epidemiologic, and clinical trial evidence, we recommend treatment of individuals with blood cholesterol levels above the 75th percentile (upper 25 percent of values). Further, we are persuaded that the blood cholesterol level of most Americans is undesirably high, in large part because of our high dietary intake of calories, saturated fat, and cholesterol. In countries with diets lower in these constituents, blood cholesterol levels are lower, and coronary heart disease is less common. There is no doubt that appropriate changes in our diet will reduce blood cholesterol levels. Epidemiologic data and over a dozen clinical trials allow us to predict with reasonable assurance that such a measure will afford significant protection against coronary heart disease” (9).

It is absolutely unbelievable how such a conclusion could have been reached in view of the flimsy nature of the results, which in any case were limited to a very narrow sector of the population. The assumption that results data men could extrapolated to include women simply flies in the face of basic biology.

Clearly the objective was to spell out a clear message that blood cholesterol was an important risk factor for heart disease and that there should be a big push to reduce the TC levels, with changes in diet being strongly recommended. As this was a “consensus”, it really is time to get down to business and take steps to overcome what was regarded a major public health issue in the USA the time.

Was there really a consensus?

However, if we dig beneath all the hype, everything in the garden was not quite so rosy. There were a number of individuals who had serious reservations. One of the leading researchers on cholesterol,

Dr. Edward ‘Pete’ Ahrens, a veteran cholesterol researcher at Rockefeller University was highly critical of the LRC-CPPT study that was crucial to the report stated quite bluntly:

“Since this was basically a drug study, we can conclude nothing about diet; such extrapolation is unwarranted, unscientific and wishful thinking” (10).

In an article in The Lancet he spelled out his concerns:

“I would have been content with the consensus statement if it had confined itself to what we do know and what we do not. It promises benefits without giving the evidence to back up that promise. By failing to emphasise what we do not know, the statement sweeps these weaknesses in our evidence under the-rug, as if they were trivial. I have disagreed with that position” (11).

In Science magazine, Gina Kolata noted that Thomas Chalmers of Mount Sinai Medical School and Paul Meier of the University of Chicago both considered that the consensus report was misleading because the impact of the evidence had been exaggerated (12).

Conclusion

There seems little doubt that the entire edifice of cholesterol-lowering has been constructed on a foundation of sand.

References

 

  1. https://www.ncbi.nlm.nih.gov/pubmed/6382999
  2. http://content.time.com/time/subscriber/article/0,33009,921647,00.html
  3. A Colpo (2006) “The Great Cholesterol Con: Why everything you have been told about cholesterol, diet and heart disease is wrong” Lulu
  4. http://archinte.jamanetwork.com/article.aspx?articleid=616413
  5. http://www.westonaprice.org/know-your-fats/the-oiling-of-america/
  6. https://medicalmyths.wordpress.com/drugs/the-lipid-research-clinics-coronary-primary-prevention-trial-lrc-cppt/
  7. N Teicholz (2014) “The Big Fat Surprise: Why butter, meat and cheese belong to a healthy diet” Simon & Shuster New York
  8. https://consensus.nih.gov/1984/1984cholesterol047html.htm
  9. http://content.time.com/time/subscriber/article/0,33009,921647,00.html
  10. http://www.sciencedirect.com/science/article/pii/S0140673685923827/part/first-page-pdf
  11. http://science.sciencemag.org/content/227/4682/40.long

220. Big Boost for Campaign to Reduce Consumption of Carbohydrates

The National Obesity Forum (NOF) and Public Health Collaboration (PHC) has just issued a joint press release which is a direct challenge to the UK Government/NHS advice on healthy eating (1). Introducing the report Professor David Haslam, who is chairman of the National Obesity Forum, said:

“As a clinician, treating patients all day every day, I quickly realised that guidelines from on high, suggesting high-carbohydrate, low-fat diets were the universal panacea, were deeply flawed.

“Current efforts have failed – the proof being that obesity levels are higher than they have ever been, and show no chance of reducing despite the best efforts of government and scientists.”

Professor Haslam is certainly not alone. There is a growing number of medical and health professionals who know from their own experience that the current guidelines are not working despite the fact that many people have altered their diets so that they comply with the Government recommendations. The hard reality is that we have a major public health crisis on our hand because of the unprecedented levels of obesity. Type 2 Diabetes (T2D) is even worse with the incidence having more than doubled in the past 15 years and all the indications are that it will continue to increase for the foreseeable future. The real scandal is that the official advice is to reduce the consumption of fat and INCREASE that of carbohydrates. There is overwhelming evidence that this makes the condition worse. Hence those affected suffer from poor health and some may eventually have to have limbs amputated.

The other side of the equation is that the carbohydrates should be replaced by healthy fats which include the saturated fats (SFAs), which are present in milk and meat but include coconut oil. This is in direct conflict with the official advice which insists that the SFAs must be reduced. The report draws attention to a recent study which found that:

“Compared with subjects on low-fat diets, subjects on low-carbohydrate diets experienced significantly greater weight loss, greater triglycerides reduction and greater increase in HDL-cholesterol after 6 months to 2 years of intervention.”

The report also emphasised that the low calorie approach to weight loss has not been effective, while there are studies which demonstrate conclusively that diets which are low in carbohydrates and high in fat (LCHF) do work successfully. These may have about 65% of calories as fat while the carbohydrate content is only 10%.

The report highlight the work of Dr David Unwin who has used this approach successfully with many of his patients who have T2D, fatty liver disease and wish to lose weight. On top of all this he has reduced the costs of drugs prescribed at his practice by about £45,000 per annum.

Added to this are the personal case histories of numerous individuals all over the world who have successfully treated their own T2D and lost weight. Very often this is in direct conflict with the advice from doctors and dietitians. Last year the American Diabetes Association (ADA) was bombarded on Facebook with messages from individuals who were highly of the ADA’s advice to increase the intake of carbohydrates (2).

It is therefore utterly amazing that there are still many who refuse to accept the obvious and defend the status quo with vigour. For example, Dr Alison Tedstone, who is the chief nutritionist at PHE, said:

 “In the face of all the evidence, calling for people to eat more fat, cut out carbs and ignore calories is irresponsible. Unlike this opinion piece, our independent experts review all the available evidence – often thousands of scientific papers – run full-scale consultations and go to great lengths to ensure no bias.” (3).

Prof Simon Capewell, from the Faculty of Public Health, said:

“We fully support Public Health England’s new guidance on a healthy diet. Their advice reflects evidence-based science that we can all trust. It was not influenced by industry.

“By contrast, the report from the National Obesity Forum is not peer reviewed. Furthermore, it does not it indicate who wrote it or how is was funded. That is worrying.”

These attitudes reflect a “head in the sand” approach. The blunt truth is that the current policies are not only failing but are a major contributor to our current problems. These people simply cannot contemplate that they have been wrong and are incapable of facing up to reality.

This issue has all the characteristics of the Hillsborough incident in Sheffield where almost 100 spectators died at a football match because of the incompetence of the local police force. Although this was clearly shown in an Inquiry conducted by Lord Justice Taylor within months, it took the relatives 29 years before this was recognised by the Government. Documents released subsequently revealed the Prime Minister, Margaret Thatcher, had vetoed effective action by the Home Secretary on the grounds that the police had to be defended. It took concerted action by the relatives to the matter finally resolved.

With respect to nutrition, substitute the medical and health professionals who support the current strategy for the South Yorkshire Police Force. For the victims of the tragedy, substitute all those who suffer from T2D for a start. This means millions of individuals who are being given the WRONG advice which causes their health to deteriorate even further.

There is a clear responsibility on the part of the politicians to act but to date their performance has been absolutely pathetic. They appear to have neither the brains and/or balls to tackle the advisers. We are not dealing with complicated science here. In fact it is really quite straight forward as I have shown in a blog which draws a parallel between T2D and a house which has been flooded with water because of a burst pipe (4). The first step must be to stop the excess water entering the house. With T2D, it is exactly the same. Turn of the supply of glucose entering the body by reducing the consumption of sugar and carbohydrates, which break down to release glucose. Standard treatment of T2D is like telling a householder that the water cannot be stopped: here are some buckets and mops. You must do the best you can with these and face up to the fact that as long as you live in that house you will have to cope with the water coming in all the time!

References

  1. https://phcuk.org/wp-content/uploads/2016/05/Healthy-Eating-Guidelines-Weight-Loss-Advice-For-The-United-Kingdom-Public-Health-Collaboration.pdf
  2. http://vernerwheelock.com/201-let-those-with-diabetes-speak-for-themselves/
  3. http://www.theguardian.com/society/2016/may/22/official-advice-to-eat-low-fat-diet-is-wrong-says-health-charity
  4. http://vernerwheelock.com/170-a-flood-of-sugar/

219. The Life and Work of Dr. Richard Bernstein

Richard Bernstein developed T1D in 1946 when he was 12 years old. For the next 20 years he endured a poor quality of life (1). He was placed on a diet which was low in SFAs and contained about 45% of calories as carbohydrates. As a consequence he had to have very high doses of insulin. During his twenties and thirties, his general health was deteriorating. He suffered from severe mid-chest burning all the time, “burning shoulders” and progressive deformities of his feet which had impaired sensations.

By his early thirties he had trained as an engineer and was married with small children but his health continued to get worse. His wife who was a physician pointed out that he spent most of his time ei9ther experiencing or recovering from hypoglycaemia. This was usually accompanied by fatigue and headaches. The fundamental cause was the due to the high doses of insulin which were necessitated by the amount of carbohydrates he was consuming. In order to obtain information on how his blood glucose levels were fluctuating he purchased an instrument which enabled him to make these measurements using a drop of blood.

By doing this 5 times every day he discovered that his blood glucose varied from under 40 mg/dl to 400 mg/dl which is huge when compared with approximately 80 mg/dl which is considered to be normal. Applying his engineering expertise, he decided to reduce his intake of carbohydrates so that the insulin dose could be lowered and have two injection per day instead of one. So while he succeeded in reducing the fluctuations in blood glucose, his health remained poor. In an attempt to learn what further steps he could take Dr Bernstein researched the scientific literature and discovered that in animals, the complications of diabetes could be prevented or even reversed by avoiding the swings in blood glucose levels and maintaining them at normal levels.

In the light of this information he monitored his blood glucose carefully, up to 8 times a day. Crucially, he started to make small, experimental changes in his diet and in his insulin regimen to determine the effect on the blood glucose. The insight gained enabled him to fine tune his insulin treatment and his diet so that he could achieve normal values all the time. Very quickly his health improved significantly. His fatigue disappeared, he gained weight and he was able to develop muscle quite easily. His insulin dose was just one third what it had been previously. Subsequently this was reduced to one sixth with the development of human insulin. The painful lumps under the skin caused by the insulin injections which were slow to heal disappeared. Above all he had the satisfaction of solving a difficult problem and of getting his condition under control.

This was 1973 and he felt obliged to try to share his information with others who suffered from similar problems and would benefit from his experience. He believed that all physicians would be delighted to learn how easy it is to prevent and possible reverse the serious complications of the disease. He thought they would keen to make the information available to their patients. Unfortunately he was far too optimistic. A paper he prepared which described his investigations and the results he had personally experienced was rejected. The New England Journal of Medicine stated that:

Studies are not unanimous in demonstrating a need for ‘fine control’ “.

The Journal of the America Medical Association dismissed the article by posing the following question:

“How many patients would use the electric device for measurement of glucose, insulin, urine, etc?”

At it happens once the equipment reached the market place in 1980, it has developed into a multi-billion $ business.

Despite persistent efforts to persuade the specialists in diabetes to adopt his approach, Dr. Bernstein only managed to find three physicians who were willing to try these new methods. However with the support of Charles Suther of the company which produced the glucose monitoring equipment he was able to get two studies sponsored by universities in the New York area. Both of these were successful in reversing the early complications in patients with diabetes. As a result two international symposia were organised and this helped to generate interest in self-monitoring of blood glucose although ironically not particularly in the USA. However by 1980 it was decide to launch the products on the open market.

Meanwhile Dr. Bernstein had decided that if he was to make any genuine progress he would have to become a physician. So in 1977 he gave up his career as an engineer and entered medical school. Then at the age of 49 years in 1983 he graduated and established his own medical practice.

Since then he has helped an enormous number of people who suffer from both T1D and T2D. His book (1) which is now in the 4th edition is highly regarded and has proved to extremely valuable to many individuals. There are numerous testimonials from those he has dealt with directly as well as from those who have simply relied on his book for guidance.

Here is one from an MD who suffered from T1D:

“I was always extremely conscientious about testing and exercising and eating and doctor visits, to the point where my friends thought I was neurotic. I was consistently following the conventional guidelines recommended to diabetics, and I thought I was a rather model patient.”……..

“Nine years ago, I met Dick Bernstein. Dr. Bernstein not only gave me the most complete, comprehensive, logical, reasonable, and informative teaching on diabetes that I have ever encountered, but his uniquely expert and comprehensive physical examination and testing illuminated for me the most accurate picture of my overall health and the subtle tolls that the previous management of my diabetes had permitted. Then with a personalised, comprehensive, tightly controlled but reasonable diet, exercise, and blood sugar-monitoring plan, he put me in control of my diabetes for the first time.” (1)

It is important to re-iterate that this was from a doctor who had T1D himself and presumably would have taken a special interest in the treatment and would have been familiar with the recognised ways of treating the disease. It demonstrates just how much mainstream medicine has to learn about current knowledge in order to provide their patients with what is best for them.

Here are three testimonials from reviews of his book on Amazon UK (2):

  • “A really useful book for type 1 or type 2 diabetics. This is different to the recommendations by the NHS in terms of dietary advice, but this has really helped me to control my blood sugar levels. There’s a lot of information in the book and it is well worth buying.” 

 

  • “Back in 2008 I was diagnosed with Type 2 Diabetes in England. I had no idea what it involved or how I was ever going to get out of hospital whilst the nurses kept offering me sugar in my tea and carbs on every menu. I didn’t know, that is, until I read this book. I researched like crazy from my hospital bed and ordered the book which my wife brought to my bedside. I immediately put into practice what Dr. Bernstein says and I always quote to people that “Dr. Bernstein saved my life”. I went from 5 needles a day to absolutely NO diabetic medication whatsoever and perfect HbA1c tests every time. You can read my story and how I reversed Diabetes in 6 months just go to www.ReverseDiabetesNow.co.uk” 

 

  • “I brought this book (older edition) for my mum (type 2 diabetes) when her doctor told her that her blood sugars were still too high and he was recommending she start insulin injections. Three years on and she still hasn’t started them and for that fact alone I can’t rate this book highly enough.”

 

Presumably these respondents will not have had the opportunity to consult personally with Dr Bernstein and must have been totally dependent on what is in the book. Clearly they have gleaned much useful information from it and have been able to bring about significant improvements in their own health.

In September 2015 the American Diabetic Association (ADA) asked on Facebook (3):

“What was your most recent blood glucose reading?”

It must have been shocked at the responses. A number described how they had followed the ADA recommendations which had made their condition worse. By contrast, there were many who had managed to get their diabetes under control by relying on the information from Dr. Bernstein.

He is now over 80 years old which is a great age for a person with T1D and still actively practising. He is still doing his monthly Teleseminar and Webcast (4). The next one is on Wednesday 25th May.

 

References

  1. R K Bernstein (2011) “ Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars” Little Brown New York ISBN 978-0316-18269-0
  2. http://www.amazon.co.uk/product-reviews/0316182699/ref=cm_cr_pr_btm_link_2?ie=UTF8&showViewpoints=1&sortBy=bySubmissionDateDescending&reviewerType=all_reviews&formatType=all_formats&pageNumber=2
  3. https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033?comment_id=10153144986604033&ref=notif&notif_t=like&hc_location=ufi
  4. http://www.diabetes-book.com/free-teleseminar-registration/

 

218.Should I take Statins?

I have lost count of the number of people who have been recommended to use statins but subsequently decided to stop taking them. There are two reasons normally used to justify these regimes, namely:

  • You are at high risk of having a heart disease, which may well be fatal.
  • You have survived a heart attack, so you need to take statins so that you reduce the risks of having another one.

Most people have a high degree of trust in the medical and health professions so that the advice/recommendation is usually accepted as credible.

However more and more doubts about the effectiveness and safety of these drugs has emerged in recent years, which places many patients in a difficult position. In this blog, I will attempt to provide an objective narrative on what is known about these drugs.

All-cause mortality (ACM)

It is unfortunate that most of the information on the benefits of statins is focussed on the heart disease. In my opinion, the only reliable information is limited to deaths. Anything which is based on symptoms must be disregarded because it is based on subjective judgements and therefore is not reliable. It is also essential to have comprehensive details on all causes of death. If the treatment does actually reduce the incidence of deaths due to heart disease but there is a corresponding increase in deaths due to some other cause such as cancer, then that is very small comfort. So it is essential to have the information on ACM to assess the value of statins or any other drug for that matter.

Those with known heart disease

An excellent source of data is the NNT website (1). Based on an evaluation of the relevant scientific publications, for those who already suffer from heart disease, the benefits of statin therapy in terms of the Number Needed to Treat (NNT) are as follows:

 

  • 96% saw no benefit
  • 1.2% were helped by being saved from death
  • 2.6% were helped by preventing a repeat heart attack
  • 0.8% were helped by preventing a stroke
  • 1 in 83 were helped (life saved).
  • 1 in 39 were helped (preventing non-fatal heart attack).
  • 1 in 125 were helped (preventing stroke).

Similarly the harms caused by statins are:

  • 1% were harmed by developing diabetes**
  • 10% were harmed by muscle damage
  • 1 in 100 were harmed (develop diabetes).
  • 1 in 10 were harmed (muscle damage) (2).

 

These numbers may come as a shock to many who tend to accept that when they take a drug that they personally will be affected. I am sure many will be surprised to learn that 82 out of 83 people will not experience any benefit. On the other hand, all are exposed to the risks of adverse side-effects (ADRs), with at least 10% having to cope with muscle damage.

 

Those without prior heart disease

When statins are used as a preventative measure, the effect on death rate is zero, while there were marginal benefits with respect to preventing heart attacks and stroke:

  • 98% saw no benefit
  • 0% were helped by being saved from death
  • 0.96% were helped by preventing a heart attack
  • 0.65% were helped by preventing a stroke
  • None were helped (life saved).
  • 1 in 104 were helped (preventing heart attack).
  • 1 in 154 were helped (preventing stroke).

Nevertheless the ADRs were same as shown above:

  • 1% were harmed by developing diabetes**
  • 10% were harmed by muscle damage
  • 1 in 100 were harmed (develop diabetes).
  • 1 in 10 were harmed (muscle damage) (3).

In addition, there is evidence that even more severe ADRs may also occur even if the chances of this happening are relatively small. The experiences of Dr Duane Graveline, an astronaut, are very worrying. There are lots of very disturbing case histories of those who had extremely bad experiences when treated with statins (4).

Benefits v risks

It should be clear that the advantages of taking statins are extremely limited and I strongly suspect are very much smaller than most people have been led to believe, especially for those who do not have heart disease. Even for those few whose lives are “saved” this only means that death has been postponed. Dr Malcolm Kendrick has shown that this life extension is a quite simply a matter of days and if you are extremely fortunate you might survive for an extra month, which is not exactly a big deal (5).

If not statins, then what?

The idea for this blog was triggered by my recent visit to the French city of Lyon, which is where the Lyon Heart Study was conducted. In this investigation, volunteers who had already had a heart condition were divided into 2 groups and each one allocated to different diets. Full details are given in a blog I did a few years ago (6).

Table 1. Death rates in the control and experimental groups

  Control Experimental  
Cause of   death Number Rate Number Rate Relative   Rate
Cardiac 19 1.37 6 0.41 0.35
All 24 1.74 14 0.95 0.44

 

Note: The rates are given per 100 patients per year of follow-up; they were calculated from a follow-up of 1383 and 1467 person-years for mortality in the control and experimental groups, respectively.

The diets of the 2 groups are shown in Table 2. In any investigation of this type it is difficult to identify which particular changes in diet have contributed to the very significant improvements in the prospects of the experimental group which have been observed. The increase in omega-9s was largely due to increased consumption of olive oil. There was also a reduction in the intake of omega-6s and an increase in that of the omega-3s. The net effect of this was to reduce the omega-6:omega-3 ratio from 18.3 to 4.3. In the light of our existing knowledge the authors considered that this was the critical factor.

Table 2. Nutrients in the control and experimental groups

  Control Experimental
Total calories 2088 1947
Total fat,% E 33.6 30.4
SFA, %E 11.7  8.0
PUFA, %E 6.1 4.6
Omega-9, %E 10.8 12.9
Omega-6, %E 5.3 3.6
Omega-3, %E 0.29 0.84
Alcohol, %E 5.98 5.83
Protein, g 16.6 16.2
Fibre, g 15.5 18.6

 

Conclusion

A reduction of over 50% in the death rates from all causes is absolutely outstanding. This dwarfs anything that can be achieved by statins or any other type of medication. Any benefit from statins is minute compared to this result. Once the potential damaging side effects are factored into the equation it simply does not make sense to use these drugs. It is also crucial to appreciate that the Lyon Heart Study is not necessarily the last word on what is the ideal diet. There may well be scope for further improvements by reducing the intake of sugar and carbohydrates generally. We still have a lot to learn about the optimum ratio of the different types of fat.

In addition to diet, there can be enormous improvements in health by taking even moderate exercise. A sedentary person can reduce ACM by a factor of 3 by taking regular exercise (7).

By focussing on statins to the exclusion of all other aspects of lifestyle that can be so much more effective, we really have got things out of proportion. So to answer the question posed by the title to this blog, I will definitely NOT be taking statins. In the light of the information presented here, I cannot understand why anyone would possibly agree to use them.

References

217. Achieving Change: the Lessons of Hillsborough

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

Results of the Hillsborough Inquest

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

The jury reached the following decisions:

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

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

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

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

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

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

 

The Taylor Inquiry

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

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

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

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

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

He also noted that:

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

Margaret Thatcher’s response

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

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

South Yorkshire Police continue to blame the fans

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

According the report of the inquest in The Guardian:

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

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

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

Implications for nutrition policy

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

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

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

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

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

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

In other words:

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

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

References

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

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

216. Faith in Medicine: Is this a Religion?

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

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

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

Doubts about modern medicine

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

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

Dangerous procedures

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

Modern medicine is a religion

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

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

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

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

Cozy relationship

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

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

Things are no better to-day

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

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

Conclusion

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

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

References

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

 

215.The Shaky Foundations of the Case for Statins

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

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

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

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

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

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

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

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

JUPITER

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

CORONA

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

GISSI-HF

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

AURORA

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

Conclusions

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

 

213. The New Eatwell Guide

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

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

 

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

 

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

 

According to Dr Alison Tedstone, chief nutritionist at PHE:

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

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

Dr Lisa Jackson said:

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

 

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

Lots of carbs

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

Insulin resistance

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

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

Conclusion

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

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

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

References

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