The chaos in nutrition
There is little doubt that nutritional science is in a real mess. Despite convincing evidence of the benefits of a diet, which is low in carbohydrates and high in healthy fats (LCHF) authorities continue to recommend diets that are high in carbohydrates and low in fat. This advice has contributed to the current high levels of obesity and Type 2 Diabetes (T2D). There is also a strong possibility that this same diet is a key factor in the development of other common chronic diseases including heart disease, cancers and Alzheimer’s Disease. The recommendations originated in the USA and were effectively adopted by the WHO so that many other nations followed suit. Enormous resources were devoted to the research on which these recommendations were based. The reality is that much of this work was very poor quality and many of the conclusions could not be justified (1). The good news is that we now have a sound understanding of the relationship between diet and health. However the bad news is that the failed policies still predominate primarily because so many of the “great and the good” in the health care professions will not accept that these policies have been so disastrous and are responsible for much poor health.
Progress at last
Looking back at how the story has evolved over the past 40-50 years, what is so striking is the contribution made by non-nutritionists to our understanding. I am particularly impressed by the results obtained by engineers. In this blog, I will highlight three, but I must emphasise that these are by no means the only ones who have helped to gain insight into the relationship between diet and body functions.
Dr Richard Bernstein
Dr Bernstein is a remarkable character. I described some of his history and work in a previous blog (2). When he was 12 years old he was diagnosed with Type 1 Diabetes (T1D). He was placed on a diet that was low in saturated fat (SFA) 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.
By his early thirties he had trained as an engineer, but his health continued to get worse. His wife who was a physician pointed out that he spent most of his time either experiencing or recovering from hypoglycaemia (low blood glucose (BG) levels). This was usually accompanied by fatigue and headaches. The fundamental cause was the high doses of insulin, which were necessitated by the amount of carbohydrates he was consuming.
He decided to monitor his own BG and discovered that the levels fluctuated 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. He also decided to have two injection per day instead of one. Further studies on the relationship between what he was eating and the BG level improved his insight so that he could fine tune his insulin treatment in order to achieve normal BG values all the time.
Much to his dismay the medical profession was not in the least bit interested in what he had discovered. Consequently, at the age of 43 years he enrolled in medical school and in 1983 graduated as an MD and set up his own practice in New York. Today, aged 83 years he is still working. His book “Dr Bernstein’s Diabetes Solution” (3) provides invaluable advice. Although primarily for those with T1D, it is also very helpful to those with T2D. I have personally recommended it to several people who followed the advice and this has resulted in huge improvements in their health.
Ivor has an exceptional blog entitled “The Fat Emperor” (4). He trained as an engineer and held various positions that involved problem-solving. In 2013, he had blood tests, which showed that he had exceptionally high levels of cholesterol (TC), ferritin and the enzyme, gamma-glutamyl transferase (GGT). He was concerned about these and so he sought advice from three different doctors, none of which he found convincing. This caused him to dig into the scientific literature. Within a few weeks he had discovered that:
- Those who complied with the TC recommendations had the highest all-cause mortality (ACM).
- As the GGT level increased the death rate increased progressively so that those with the highest levels were as much as 7 times than those with low levels. For liver cancer the factor was 19!
- Similar differences were found for ferritin.
On this basis, Ivor concluded that we had all been conned for years into worrying about cholesterol but that if the ferritin and GGT levels were high then this was a matter of concern.
Very shortly afterwards he became aware of “The Metabolic Syndrome” or MetS, which is a cluster of diseases, including T2D, heart disease and cancer. In a Eureka moment, Ivor hypothesised that GGT and ferritin were markers for MetS. Basically Mets is caused by high BG and high insulin levels in the blood. There is considerable evidence to confirm that his hypothesis is correct. Hence it follows that the way to deal with MetS is to reduce the sugar/carbohydrates in the diet and replace them with healthy fats. To get the whole story, I recommend that you watch this video of a lecture Ivor presented to the Weston Price Society meeting in Limerick (6). It seems incredible that one individual working away on his own without the resources of an institution could accurately assess the scientific state of play in a matter of weeks and produce sound conclusions. What a poor reflection on those specialists who over the years have led all of us including governments up a blind alley.
Dave has only recently become involved. He has his own website “The Cholesterol Code” (7). He is a senior software engineer and entrepreneur. He began a LCHF diet in April 2015 because he wished to reduce his risks of developing T2D. He found that as a result he controlled his BG successfully, lost about 15 kg and seemed to improve his health in every way. However when he had blood tests he learned that his TC had gone from 186 to a whopping 357mg/dL, with LDL-C cholesterol climbing from 137 to 271mg/dL.
This convinced him to conduct detailed investigations himself so he kept detailed information on his diet and nutrition. In particular, he varied the amount of fat in his food and closely monitored his TC in an attempt to work out the relationships. What he found was absolutely amazing. There was an almost perfect correlation between the LDL-cholesterol and the fat intake but it was a negative one rather than a positive one. In other words the more fat he ate, the lower the value of the LDL-C. Furthermore the response was almost immediate, because the best correlation was with the average fat intake in the 3 days prior to blood analysis.
Here is how he summarises his results:
- The more fat I eat, the lower my TC (87% inverted correlation)
- The more fat I eat, the lower my LDL-C (90% inverted correlation)
- The more fat I eat, the lower my Triglycerides (61% inverted correlation)
- The more fat I eat, the higher my HDL-C (74% correlation).
Since then he has had a number of volunteers who follow similar protocols and all get the same results.
More detail is shown on Dave’s website (7).
The magnitude of these differences are so great that they cannot easily be discounted. In all probability, they will be confirmed. The significance is obvious. If you wish to reduce your TC/LDL-C, then just eat more fat. The reduction that can be achieved in this way is so much greater than anything that can be done with statins.
The work of these individuals and others like them is absolutely phenomenal. Operating on a shoe string, they have made more progress than all those specialists with virtually unlimited resources have been able to achieve. I suspect that one of the key characteristics is that they can approach the issue without any pre-conceived ideas or baggage. On top of this they have the experience and training to tackle problems so that they can produce solutions. When faced with a problem they have to come up with answers. If a building falls down or an engine blows up, the engineer has to accept responsibility: there is no place to hide. However medics can always find excuses not to be blamed if a treatment does deliver the expected results. There are certainly lessons that can be learned about how we can do much better in the future but there are no indications that this is likely to happen.
- 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