By Jerome Burne
There is a feature of mine in the Daily Mail today which deals with recent research showing the rapid benefit a high fat low carb diet can have on a dangerous disorder known as NAFLD (non-alcoholic fatty liver disease). You’ve probably heard about fatty liver disease in connection with drinking too much. This version looks like being the result of eating too much carbohydrate.
It’s a radical claim but part of the growing evidence that the low fat diet has been a disaster. Conventional wisdom has it that NAFLD is due to being diabetic and/or overweight and that the way to treat it is to follow a low fat diet. However as GP Dr David Unwin, who did the research, points out people with NAFLD have inevitably been following a low fat diet for years without it having a noticeable effect on the fat content of their liver.
At the moment NAFLD is one of those Cinderella disorders – there’s no drug treatment and the dietary advice is useless so it just languishes, even though an estimated 20% of the population has it and it can be an early warning of liver failure, heart disease and diabetes.
Diet drops fat in liver by nearly 50%
Dr Unwin made the carbs connection when he noticed that the fatty livers of diabetic patients normalised when he put them on a low carb high fat diet. Unwin has been treating diabetes by cutting carbohydrates and recording the details of the benefits for several years. For this latest study he put 69 patients on the diet for 13 months and the fat content of their liver dropped by an average of 47 per cent. Read the article for more details here.
The study, published in the journal Diabesity in Practice, comes at a time when the blowback against the low carb diet is hotting up. Last month a dietitian in Australia was expelled from her professional association for refusing to tell patients to stop following a high fat diet, even though it was making them better.
At the moment top South African sports nutritionists Professor Tim Noakes is being investigated for recommending in a tweet that a baby follow a low carb diet. A week ago the British Dietetic Association warned about the dangers of a low carb diet, recommended by TV doctor Rangan Chatterjee in his ground-breaking BBC three-part series ‘Doctor in the House.
Celebrity scientist abandons real science
What is striking about all these attacks on the low carb approach is how personal they are and how rarely they engage with the evidence. Here is Cape Town academic Jaques Rousseau, quoted in the LA Times commenting on Professor Noakes. He describes him as a ‘celebrity scientist’, accuses him of ‘sloppy thinking’ and of abandoning the domain of rigorous scientific methodology… and hard evidence for hyperbole and andecdotes.’
Contrast that with the approach Noakes himself took to his hearing in front of the Health Profession Council of South Africa. The LA Times reports that he and his legal team ‘have presented 4000 pages of research to the hearing’. An odd thing to do if you are ‘abandoning rigorous scientific methodology’.
Noakes’ comment on the whole event is equally reasoned and without accusations or slurs: ‘I finally get the chance to present the evidence. I am not invited to present the evidence to the South African community.’
During the hearing before the Council, which is still going on, Este Vorster, described as a ‘nutrition expert’ claimed that Noakes had acted ‘unprofessionally’ and ‘was not qualified to give advice’. During cross examination by Noakes’ lawyer however, ‘she admitted she was not a dietitian and hadn’t studied the low carb high fat diet’.
Dietician ordered to stop giving low carb advice
There also seemed little consideration of the evidence for the benefits of low carb by the administrators at Southern New South Wales health district in Australia when they issued a warning to pro-low carb dietitian Jennifer Eliot about a month ago.
They told her that ‘nutritional advice to clients must not include a low carbohydrate diet’. Her response was to ask: ‘Can you imagine having to tell a client with diabetes, who has lowered his blood glucose levels, lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !? As a result she was sacked.
The response of the British Dietetic Association to Dr Chatterjee’s program, in which we saw him transform the lives and health of patients who had been overweight and sick for years, and who had doubtless tried the low fat diet on a number of occasions, by encouraging them to eat fresh food and keep their carb intake low, appears equally blinkered.
“This advice is potentially dangerous with possible adverse side effects,” said Dr Duane Mellor PhD and registered dietitian. ‘Not only is there limited evidence around carbohydrate elimination and time-restricted eating for those with diabetes, but cutting out food groups and fasting could lead to nutrition problems including nutrient deficiencies and adversely affect their blood sugar control, particularly in individuals taking certain medications or insulin.
Evidence for low carb benefits ignored
What is striking about those who have looked at the evidence for a low carb diet and been convinced by it is how careful and through they are. Many of the original converts were swayed by Garry Taubes painstakingly detailed book ‘The Diet Delusion’ published over a decade ago. More recently Nina Teicholz’s Big Fat Surprise is also packed with references and detailed accounts of how flawed the evidence for the low fat diet is.
The low fat establishment is not only unscientific in its dismissal of academics who take a rival view but they also are happy to turn a blind eye to the reports of diabetic patients themselves who have been trying out the low carb diet because of the thousands of reports that it works.
Dr Mellors’ claim that it could ‘adversely affect blood sugar control of those taking medications’ is remarkably misleading. It can certainly reduce the need for medication, in which case any competent clinician will reduce the dose correspondingly.
Dr Mellor might benefit from a visit to a new website entitled ‘Take control of Type 2 Diabetes with the Low Carb Program’ which has been ‘developed with the help of 20,000 people with T2D and based on the latest research.’ Of course it could be dismissed as “anecdotal’ but it’s not science but dogma to ignore the research of doctors such as David Unwin, researchers such as Nina Teicholz and tens of thousands of patients,
Drug looks poorer option than diet change
The issue of what exactly counts as evidence and whether the system we have at the moment is doing a good job is bought into sharp focus by a study involving the diabetes drug Liraglutide that came out at much the same time as Dr Unwin’s report on his 69 patients on a low carb diet.
Researchers at Birmingham University had run a placebo controlled trial of Liraglutide, giving it to 14 patients for three months and found that four out of ten lost their liver fat and had other benefits such as weight loss. The drug has to be injected daily, can cause nausea and diabetes and costs 1400 pounds a year.
So which has better evidence in its favour? The diet trial wasn’t placebo controlled but it ran for longer involved many more subjects, benefited a larger proportion of patients and had none of the side effects.
But I suspect that the drug is well on its way to getting a licence while the response of the likes of Dr Mellor and Jaques Rousseau would be to say that the low carb trial would have to be redone with a placebo and didn’t count as good evidence. Playing by those rules doesn’t seem to be in patients’ interests.