Dr Jay Wortman is an MD based in Canada. At the age of 50 years it suddenly woke up to the fact that he had all the typical signs and symptoms of Type 2 Diabetes (T2D). He tested his blood glucose and found that it was far too high. At this point he decided the only way forward was to eliminate as much sugar and starchy foods as possible from his diet in order to lower his blood glucose even though this was not a recognized from of treatment for T2D. He describes the response in his own words:
“The first thing that happened was that my blood sugar normalized. This was almost instant and was followed by a dramatic and steady loss of weight. I started dropping about a pound a day. My other symptoms swiftly vanished, too. I started seeing clearly, the excessive urination and thirst disappeared, my energy level went up and I began to feel immensely better.” (1)
At the time Dr Wortman was working with the Aborigines. He was extremely conscious of the high rates of T2D in the Canadian Aboriginal population which were between 3 to 5 times higher than in the population as a whole. Obesity and metabolic syndrome were also major problems with the result that the Aboriginal communities were being devastated and the costs for treatment and care were huge. In addition to the usual costs in the community for drugs and personal care, people had to be transported from remote communities for treatment of complications such as kidney failure and amputations. Despite the fact that money was being spent on education and prevention the incidence of the disease continued to rise and there seemed to be no way that the trend could be reversed.
In the light of his own experience, Dr Wortman began to consider the diet of the Aboriginal population and discovered that the traditional diet which consisted of foods such as salmon, halibut and shellfish in coastal areas while Inland, it would include moose, deer and elk. There would also be berries and other seasonal wild plants. In reality there was little carbohydrate, in contrast to the contemporary diet which includes lots of carbohydrates such as bannock bread, consumed in large quantities as well as soft drinks and juices.
As a consequence he decided to see if he could set up a research project to study the role of dietary carbohydrates in the development of T2D and to clarify the impact of reducing their intake. He made contact with Dr Eric Westman, professor of medicine at Duke University in North Carolina who had just published a paper which showed how a number of young men had lost weight by consuming an Atkins diet over a 6-month period. What was especially significant was that the cholesterol levels had actually fallen. At the time the conventional view was that the high fat content in the Atkins diet would push up the cholesterol levels. Dr Westman helped formulate a proposal to conduct a dietary trial with Aborigines living in a coastal community which was submitted to the Canadian Institute of Health. The proposal was rejected and was the first hint to Dr Wortman of the deeply ingrained institutional opposition to low-carb diets. He soon became aware that the dietary changes which had been so successful for him personally were viewed with intense fear and suspicion by those who are supposed to be the authorities in the field. He was openly attacked by dietitians when he suggested that a low-carb diet could be an effective way of losing weight and treating T2D. As he put it himself he was
“…surprised to find that a debate that should be dispassionate and grounded in evidence would often become so emotional and irrational.”
Further evidence of the validity of the low-carb approach was shown by a case study of James Wilson, who was suffering from T2D.He had been on insulin for 17 years, but had been unable to get his blood sugars down to the normal range. He was also on medication for hypertension, was overweight and had high cholesterol. By simply cutting out sugars and starch within 2 weeks he had achieved normal levels for his blood glucose and had been able to stop the insulin treatment. He had also lost about 7 kg.
Two weeks later, he had lost another 5 kg and had discontinued his medication for blood pressure. After 18 weeks he had lost a total 23 kg, all the readings were normal and he required no medication. Interestingly he had not increased his physical activity.
It just so happened that Dr Wortman shared a flight with Dr Carolyn Bennett, who at the time was the Minister of Public Health and was working to develop what was to become the Public Health Agency of Canada. He was able to share information on the importance of the low-carb approach with her and clearly she took this on board. Subsequently she agreed to host a symposium which Dr Wortman had organized in February 2003. The purpose was to debate the issues around diabetes in the Aboriginal population, traditional diet and low-carb diet.
Those who agreed to participate were Dr Westman, Dr Steve Phinney, who had done work on the relationship between a high-fat low-carb diet on stamina in athletes and Dr Mary Vernon, who had been treating T2D patients successfully with a low-carb diet for years at her family medicine clinic in Kansas. Much to Dr Wortman’s delight, he persuaded Dr Walter Willett, the distinguished nutrition researcher at Harvard to attend. Dr Willett has recently argued that the USDA Food Pyramid had got it wrong because the advice on fats and oils was misguided and that the recommendations on refined carbohydrates should be much lower.
The object of the symposium was to address the following questions:
- Does the extent of the epidemic of diabetes in Aboriginal populations constitute a public health emergency?
- Is there enough evidence that traditional diets and low-carb diets are similar to support further research in this area?
- Is there enough evidence to warrant immediate program activity in this area?
To all of these the answer was a resounding “Yes”.
As a consequence, Dr Wortman eventually managed to obtain the funds to support a trial in which volunteers from the Aboriginal community were encouraging to revert to their traditional diet. The results were a great success and it was found that most lost weight, overcame T2D and generally improved their health. Unfortunately I have not been able to find the detailed results so if anyone can point me to them I would be grateful. A TV programme was made which featured a number of individuals who improved their health significantly when they changed their diet, but this does not appear to be easily accessible. However Dr Wortman describes his results in this interview on You Tube (2).
Dr Wortman, Dr Phinney and Dr Westman will all be speaking at the Low Carb Summit which is being held in Cape Town next February (3). We have come a long way since Dr Wortman first discovered how to deal with his T2D. It is uncanny that Professor Tim Noakes encountered similar rather irrational opposition to that experienced by Dr Wortman when he started to promote low carb diets in South Africa (4). Judging by what is happening in the social media coupled with the coverage in the media there is certainly a growing acceptance of the effectiveness of low-carb diets as a means of avoiding a range of common chronic diseases and achieving good health. The big problem is that national nutrition policies are still dominated by concepts which have absolutely no credibility but are still defended by the reactionaries. By providing a forum which brings together most of the advocates of the low-carb strategy, this event could well be the stimulus which will start to see changes in official national policies.