Low carb revolt: start of a brave new medical future?

By Jerome Burne

Last week the front page of The Times carried a story that was an opening shot in a revolution. I’m sure that the editors didn’t intend it as that and that the readers didn’t see it that way either. It was a story about shifting from the long recommended low fat diet to one that cut back on carbohydrates instead. Standard fare for the cuddly lifestyle pages, hardly material for social upheaval.

But I don’t think it is too fanciful to suggest that this may come to be seen as a Martin Luther moment for medicine. It may not split the profession as Luther’s divided the church but it does have the potential to dramatically change the way medicine is practiced.  To begin with it is significant that doctors were involved; nutritionists would never have made the front page. Insiders, such as the monk Luther or the aristocrats who signed the Tennis Court Oath before the French revolution, are often key to giving revolutionary change lift off.

The doctors had largely been convinced of the benefits of low carbs by trying it themselves and seeing the effect on their patients. But this is more than just another of those irritating nutritional U-turns: ‘Last year we had to avoid eggs because they were packed with cholesterol, now we can safely have six a week. Can’t they make up their minds?’

If there is a U-turn in official advice about fat/carb quantities, and the physiological case seems to me to be unarguable, the knock on effect would be far reaching; it could be the tug on a loose strand of wool that unravels a whole sweater.

The revolutionary charge of low carb

To begin with it would involve admitting that nutrition can be a safe, effective and cheaper treatment for some lifestyle disorders than drugs. One of the campaigners, Dr Unwin, has already cut 40,000 pounds a year from his practice’s drug bill as a result of the drop in diabetic drug prescriptions. Inevitably there would be pressure to make greater use of other nutritional approaches such as the Mediterranean diet to cut the risk of heart disease.  

Such developments seem sensible and unthreatening but they carry a revolutionary charge.  At the moment diet is regarded as a useful but relatively ineffective handmaiden to real medicine. But if diet is going to start growing medical muscles, that raises fascinating regulatory problems, that doctors, who may well have emerged from medical school with only a few hours of nutritional classes, are probably unaware of.

First there is what might be called a legal falsehood about food. The official position is that it cannot modify physiology – ludicrous and patently untrue but that’s fundamental assumption about diet that all nutritionist have to learn to tip-toe around. Even a skilled theological debater such as Martin Luther might have a problem with some of tangled food and medicine orthodoxy.

For instance: it logically follows from this that no food or natural substance can “prevent, treat or cure’ any disorder. Equally ridiculous, you cry, and ask: but what about if you run a big trial and show that low carb or curcumin or vitamin C can do just that? Well yes good point. Interestingly even the government healthy eating campaigns ran into problems here with their five-a-day fruit and vegetable promotion. It verged on claiming this was a way to prevent disease.

How food is transformed into a drug

Officially the only substances that can prevent, cure or treat are drugs/medicines. The implication of this is that if you do demonstrate the effectiveness of a diet, food or supplement – say curcumin for inflammation or B vitamins to lower the homocysteine linked with Alzheimer’s  - then it is logically a drug. This is a claim that requires a greater leap of faith than transubstantiation – the Catholic doctrine that the bread and wine given in communion literally turn into flesh and blood when eaten, which Luther thought profoundly wrong .

But then the substance has to be licenced which involves large and expensive trials, which are almost never done because food and natural substances are not patentable. Even doctors cannot properly prescribe non-drug remedies however good the evidence.

So the revolutionary potential should be becoming a bit clearer. Suppose a 100 or so GPs started using nutrition to treat their diabetic patients? What might come next? Once they start investigating nutrition physiology it would become clear that vitamins, minerals and other supplements also play a vital role in health. In the case of diabetes, for instance, there is quite a bit of good evidence that chromium and cinnamon help to improve blood sugar control.

Checking for vitamin and mineral deficiencies and topping up if needed would start to seem sensible. Could they all be hauled in front of the GMC for using unlicensed treatments or might the common slogan that you can get all the minerals and vitamins you need from a healthy balanced diet start to look as implausible as the low fat orthodoxy?  

But talking about a low carb diet and suggesting some supplements along with specific exercise regimes is still just splashing about on the surface of lifestyle treatments. If a growing number of doctors stay on the low carb path they will start to encounter much more interesting and unfamiliar dietary territory.

Generating a different form of energy

How low, for instance, should you go with your carbs? At the moment the definition of low carbs is pretty elastic. Compared to 300 or more grams of carbs that a conventional diabetic diet can provide, getting that down to 100 grams seems pretty low. But what if you go down to 50, 20 grams?

What we know for certain is that once you get below about 20 your metabolism makes a step change, like the transition from water to ice. It stops relying on carbohydrates (blood sugar) for energy – because you aren’t getting enough – and it starts to release fat from your fat stores (you can see why this would be popular) to provide a different source of energy. The fat is transported to the liver where it is turned into ketones which the brain and muscles can also use as fuel.

There are all sorts of debates around this – it’s hard to get enough food for your gut bacteria on very low carbs. So some claim a low glycaemic diet is preferable; fasting may be able to get you all the benefits of very low carbs. But I’m going ignore those for now and just mention a very radical but very plausible idea  – the ketogenic diet might one way to help you fight cancer.

It is a perfectly logical follow on from the idea that low carbs should help with diabetes. Low carbs makes sense for diabetes because it does what the drugs do – brings down blood glucose and insulin, because carbs get turned into blood sugar. And there are links between diabetes and cancer – having diabetes raises your risk of cancer and being treated with the diabetes drug metformin cuts that risk.

From low carbs to a new theory of cancer

So what is link between cancer and blood glucose and insulin? Simply that cancers use up a lot of glucose, far more than normal healthy cells. This makes very low carbs a reasonable option for cutting a tumour’s energy supply. Then insulin is a hormone involved in cell growth – not what you want too much of when you are tackling cancer. Known as the metabolic theory of cancer, this is out in the left field at the moment but it is generating a lot of fascinating research. It presents a challenge to the mainstream theory that cancer is all about genetic mutations. I’ve written about it here.

I bring it up to show that the physiology that makes treating diabetes with low carbs also applies to trying it to help with cancer. It would of course mean venturing into an area of medicine where the dogma that only medicines and medical procedures can prevent, treat or cure disease is enshrined in law in the form of the Cancer Act.

However there is preliminary but promising research to show that a ketogenic diet can make chemotherapy and radiotherapy more effective. What might be the effect of GPs using their new found nutritional confidence to start trespassing on the jealously guarded territory of oncologists? Would legal sanctions be rolled out?

Of course the usual response to such an incursion is to cry “quack” and “selling false hope” on the grounds that the required randomised trials aren’t there. But this is not quite the trump card that it was since a key part of the radical doctors case is that the trials showing the benefits of low carb are there but they are simply ignored. Certainly oncologists are not known for their interest in investigating any evidence for the dietary route in cancer treatment.

How the heresy might spread

This challenge to the Manichean division between scientific medicine and the other fake stuff may be one of the biggest effects of a switch to low carbs. The idea that medicine is evidence based and scientific is fundamental to modern medicine. This means that trials are done openly and fairly and that practice changes when the evidence changes.

However the gap between doctrine and practice that drove Luther to action is equally wide in today’s medicine. There are strong suspicions that official food guidelines owe more to the influence of Big Food than to research evidence. Something similar is going on with increasing scepticism about, for example, the statin risk/benefit ratio and the value of treating elderly people with a number of disorders simply by stacking up the number of prescriptions.

This opens the door for doctors to interpret guidelines far more flexibly and focus on individual patients and their symptoms rather than blood tests. This is certainly not going to happen overnight but already there is a handful of doctors involved in the low carb campaign who are doing just that. Two of them are the TV doctor Rangan Chatterjee and GP Joanne McCormack, and there have been HIUK posts on both of them (Chatterjee post and McCormack post).

Dr McCormack described how she became increasingly disenchanted with the official low fat advice and then spent two years educating herself about nutrition. She now enjoys the extreme challenge of trying to do the same for Public Health England. Dr Chatterjee’s TV series was based on the idea, never tested in an RCT, that the best way to begin treating a patients’ chronic disease was to find out what their home life was like.

The princes of the medical church will disapprove of such heresy but the response of the parishioners seems much more favourable.

Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “10 Secrets of Healthy Ageing” was written with nutritionist Patrick Holford. He blogs at “Body of Evidence” – jeromeburne.com. 2015: Finalist for 'Blogger of the Year' award from Medical Journalists' Association.

40 Comments

  • Excellent. I was so pleased to see The Times article and the column a few days later by Dominic Lawson advocating the benefits of high natural fats and low carbohydrates.

    One question, though: why do we need to supplement with vitamins? I’m not against this and I’ve heard persuasive arguments for the benefits of vitamins, but when and why did this become necessary? I would be interested in people’s views.

    • Editorial

      Vitamins are a fundamental part of the biochemical processes by which we turn food into stuff the body needs to function = build muscles, handle free radicals, damp down inflammation etc. When we become deficient these processes don’t work so well. Without vitamin D bones don’t grow. without B vitamins an amino acid called homocysteine can’t be turned into various useful brain chemicals etc. For various reasons vitamins have been variously characterised as ineffective but also quite possibly dangerous although actual victims are hard to find. It is also regularly asserted that you can get all the vitamins and minerals you need from a “healthy balanced diet”. This may well be true but since many people don’t get such a diet taking vitamins seems a sensible option especially when deficiencies are present. Interestingly something that can significantly reduce the ability of the body to absorb minerals and vitamins from food is prescription drugs.

      • I certainly agree that an essential part of diet are vitamins, however, as Professor John Yudkin pointed out in ‘This Slimming Business’ (1958, probably one of the first low carb diets advocated after Banting), in cutting out carbohydrates it is likely that the food groups which will be eaten (Yudkin has four groups 1) milk and cheese, 2) meat, fish, eggs, 3)fruit and vegetables and 4) butter and margarine) will likely provide a more abundant source of nutrition which is unlikely to be deficient in vitamins and minerals. Also, as seems to have been (conveniently) forgotten by nutritionists, meat was once described as first-class protein: it is abundant in vitamins, minerals and amino-acids. It goes without saying that there is no such thing as an ‘essential’ carbohydrate! Further, in 1928, Vilhjalmur Stefansson together with Karsten Anderson were the subject of a year long experiment in which they ate an exclusively meat diet and, at the end of the experiment both himself and Anderson were in better health (and slimmer) than at the start of the regime. Neither exhibited any symptoms of vitamin deficiency (even vitamin C).

  • I tend to agree Jerome, a change is in the air at last. Of course there will be huge resistance but doctors appear to now be as sick of the doctrine as patients are. I had an interesting chat with my GP today about the benefits of cinnamon and raw honey, which genuinely fascinated her. She shared her grandfather’s ayurvedic turmeric tips for pain and inflammation. We chewed the fat for quite some time as she had a cancellation and wasn’t rushed. I was there for a referral to a chiropractor and left with that, no drugs and very happy. Pharma’s worst nightmare.

    Now we have to worry about the price hikes of crucial drugs, including liothyronine. There’s always something.

  • Sad that the whole initiative has been clouded by resignations of about half the members from the board of National Obesity Forum over the way this was published, and the revelation that the NOF is at least partly funded by the food industry.

    This leaves a suspicion that the dairy industry may be counter-campaigning against the sellers of low fat foods via non-profit organisations.

    However the message is out there loud and clear despite the foot dragging from NICE and Diabetes UK.

    It should be fairly obvious that carbohydrates turn rapidly to glucose (school biology experiment was to hold a cube of bread in your mouth and wait whilst the enzymes in saliva turned the starch to sugar). Certain tribes even start the fermentation of starch into alcohol by chewing the starch and letting the saliva convert it into sugar!

    So treating Diabetes with a load of “healthy carbs” may not be the most sensible thing.

  • You make quite bold claims, but there are insufficient data to support them and the data shown – e.g. by the National Obesity Forum – combines in a rather confusing way diabetes treatment with weight management. Regarding weight management, even the studies included in the NOF report don’t support their claim of a superiority of a low-carb diet – indeed, all long term (>6 month) studies that provided sufficient data for a meta-analysis did show no difference between both arms. (The review included studies for which weight-management wasn’t a primary or secondary endpoint and therefore shouldn’t use for analysis anyway.) The PREDIMED trial that was published today – and which is often used to support a high fat lifestyle did not show any benefit regarding weight management (but also was neither low-carb nor high fat with 40% of each).

    For overall health, there are simply no data supporting a change from the current recommendations to a ‘low-carb-high-fat’ recommendation as the evidence available neither shows any superiority nor has assessed potential long-term adverse effects. Interestingly, the proponents of a low-carb diet complain about the demonisation of fat while doing the self-same thing with carbohydrates – wouldn’t it be much more sensible to have a balanced approach (and realise that there is neither one fat nor one carbohydrate).

    Type 2 diabetic patients are often included in these discussions to emphasise the benefits of a low-carb diet – but this confuses the picture: a recommendation to the general public and a recommendation to patients is obviously different. Reducing the intake of easily available carbohydrates to diabetic patients is nothing new and part of (many) dietary approaches to treat patients. But again, the evidence for a low-carb diet is not as superior as is claimed, which is partly due to the rather inconsistent definition of ‘low carb’ (I was told that the definition by the American Diabetic Association was not suitable by some.).

    Finally there, is the ‘groundbreaking’ study the Times has published – this is of course very interesting, but why is it so difficult to obtain the data? From what I understand it is a study with self-selected participants which already introduces a bias unless there has been a proper control.

    I don’t quite understand why a discussion via press briefing and with personal insults is necessary – especially given the rather weak evidence. Wouldn’t it be better to have a sensible conversation, identify what needs to be done and do it?

    • Editorial

      Welcome Dr Kuhnle, delighted to have you commenting. As an associate professor in nutritional biochemistry at Reading you will obviously have a firm grip on the data so I should make it clear that I an a journalist not an academic. As such I translate research, sometimes quite technical, into popular language. To do this I rely on my academic contacts for the specifics. You have summarised the the conventional position which is the one with which the experts whose work I am relying on profoundly disagree. They report being frustrated by what seems like an official refusal to consider data which contradicts this view.

      These include Dr David Cavan Director of Policy and Programmes at the International Diabetes Federation, Professor Richard Feinman Professor of Cell Biology at the State University of New York and an expert on carbohydrate biochemistry and Dr David Unwin a Southport GP who earlier this year won the NHS Innovator of the Year award for his use of the low carb diet. I have also interviewed a senior UK dietitian Trudi Deakin, who runs a charity called X-PERT Health which trains nurses and dietitians in 84 NHS centres to educate people with diabetes about food. She believes the latest NICE guidelines advising them to cut back on fat have got it wrong. Her position is similar to that of American science journalist Nina Teicholz author of a recent book that mounted a strong a detailed critique of the low fat position in her book Big Fat Surprise. Her critique of the latest American dietary guidelines advocating low fat was recently published in The BMJ

      You have made a number of points such as the difference between broad brush advice on diet for the general public and advice that would be appropriate for those with diabetes. Also so the difference between advice for weight loss and for diabetes and you claim there is no difference between low carb and low fat for health or weight loss at six months. For the general public you say that there is also no evidence to suggest a switch to low carb would be beneficial.

      These points have been made by the establishment for years. What has changed and what I was referring to in my piece is that all of the clinicians and researchers I mentioned, along with several dozen more, feel strongly enough that those in official positions are at the very least ignoring or unaware of relevant data supporting low carbs. As a result they have formed a loose alliance to both publicise the evidence supporting the low carb position and to help GPs to deliver a low carb diet to their diabetic and other patients.

      This is a serious and unusual step; reiterating that there is no evidence for low carbs doesn’t seem adequate. The Times article to which you referred was derived from a web site designed for people with diabetes – diabetes.co.uk – over a 100,000 of whom have followed the low carb diet and reported benefits far greater than they have previously obtained on the conventional low fat one. You dismissed it as a being made up of “self-selected participants”. Selection bias is obviously an issue but while this is not a rigorous RCTs it cannot simply be dismissed as an aggregate of anecdotes.

      I’m not sure what the “personal insults” refers to (the Obesity Forum’s report?) but I am sure that the nutritional experts I’ve named would be happy to discuss with you. Professor Feinman, for instance has written extensively on this topic and is very approachable.

      One point you made intrigued me. You declared that a low fat diet was entirely appropriate for the the general public but you seemed to hint at the possibility that low carbs might be more relevant for diabetics. At which point would the change over take place? Can a diet high in carbohydrates lead to diabetes? If it can at what point would it make sense to stop eating it and eat low carbs? And if a high carb diet doesn’t lead to diabetes, how can a low carb diet reverse it?

  • I believe the evidence for low carb diets far outweighs the evidence for low fat diets. In fact, there never was any evidence for low fat diets, and they continue to fail in every respect.

    The Women’s Health Initiative, Dietary Intervention Trial, where 49,000 women were split into two groups, one of which was control and one of which was actively counseled to reduce their fat content, saturated fat content, increase fruits and vegetables, etc. They did so. They reduced their overall fat content, their saturated fat content, their red meat, increased their fruit and vegetable amounts, reduced their calories, did everything we’re supposed to do. The result after 8 years and over 420 MILLION US dollars? Nothing. A complete failure.

    https://www.nih.gov/news-events/news-releases/news-womens-health-initiative-reducing-total-fat-intake-may-have-small-effect-risk-breast-cancer-no-effect-risk-colorectal-cancer-heart-disease-or-stroke

    This lack of evidence for the low fat diet has been shown to occur since the beginning of the low fat movement:

    http://openheart.bmj.com/content/2/1/e000196.full

    We’ve been looking for evidence that saturated fat is good and low fat is good for over 40 years…and we’re still looking.

    The establishment has been using unscientific data for many years. The low limits on saturated fats is one point:

    “One of the biggest myths in nutrition is that saturated fat intake above a certain level—say 10% based on most dietary guidelines—significantly increases your risk of heart attack. This conclusion that has held for almost half a century is inconsistent with the wealth of epidemiological data or scientific evidence in the form of clinical randomized trials. Plenty of research funding has been earmarked to study and back this hypothesis, yet we cannot find a single research paper written in the last ten years that supports this conclusion. On the contrary, we can find at least 20 studies that dismiss this hypothesis.”

    https://doc.research-and-analytics.csfb.com/docView?language=ENG&source=ulg&format=PDF&document_id=1053247551&serialid=MFT6JQWS%2b4FvvuMDBUQ7v9g4cGa84%2fgpv8mURvaRWdQ%3d

    I could go on. However, the current emphasis on high carbohydrate diets while ignoring low carbohydrate diets is unsupported by scientific evidence.

    I’ll give you an n=1 study. Me. I’ve lost 50 pounds solely by reducing my carbohydrate content, stopping eating grains, changing WHEN I eat, avoiding all seed oils, and eating as much fat as possible. And I am by no means alone. There are thousands of us, perhaps hundreds of thousands. And we no longer believe in anything the “establishment” says about this subject. We analyze the references and the books ourselves and reach our own conclusions.

    My personal conclusions: eating a high carbohydrate diet (and high amounts of seed oils) causes insulin resistance, which leads to or exacerbates heart disease, cancer, cardiomyopathy, cataracts, tinnitus, skin tags, tooth decay, and many diseases of civilization. It’s time for the “establishment” to begin realizing this too. The data is out there and agrees with this. You just have to turn off your “fat is bad and carbs and seed oils are good” filter.

    • Editorial

      Thanks for those links.
      You say: ‘We’ve been looking for evidence that saturated fat is good and low fat is good for over 40 years…’
      I assume you mean ‘saturated fat is bad’…..
      I can change it if that is what it should be.

  • I’m not sure whether this reply will end up at the correct position, but I assume that it will be clear what statement I reply to. First of all, I would like to question your decision to publish my full name and place of work – even though I have chosen not to. I don’t mind – it does however contradict the spirit of such a discussion. I believe that a discussion of scientific questions should be based on facts and facts alone – not the person.

    The data I was referring to (regarding weight management) where the self-same that the National Obesity Forum has used in their report – I have used the table they have shown, retrieved the missing data (they did not include a measure of variation) and conducted a meta-analysis; the results very clearly showed no significant difference between either diet. This is largely in line with other meta-analyses – even if there are statistically significant differences (there are in favour of carbohydrate restriction), they are very small. Most of these studies have been cited in the report by the National Obesity Forum and it is difficult how – based on these data – they suggest a complete change in dietary advice.

    It is of course important to question established ideas – it is what most scientists do – but simply questioning it is not really sufficient as one also has to try to find answers. You say that those questioning the low-fat approach belief that officials “are at the very least ignoring or unaware of relevant data supporting low carbs” – but why don’t they provide the data? As I have outlined above – and as you can easily confirm yourself by reading the original studies – there are no data suggesting that a low-carb approach is in any way vastly superior to a low-fat approach with weight management.
    The PREDIMED study, which is often used as an example, did not compare low vs high fat, indeed, all arms had a very similar fat intake (around 40% of total energy – and 40% of total energy came from carbohydrates).

    The data currently available suggests that the most appropriate diet for the general public (i.e. excluding those with special dietary requirements, and this includes patients with diabetes) uses carbohydrates as the main energy source. This advice might change in future – it would be foolish to assume otherwise – but the data we currently have does not support such a change and the proponents of such a change regularly fail to provide data.

    Two more points: the study I referred to would be interesting if more data were available. The information I was able to obtain don’t allow any scrutiny. Dietary intervention studies are notoriously difficult to conduct and results are even more difficult to interpret in the absence of strict controls – one reason for this is that the fact of participating in such a trial often has a very strong effect. Participants who have decided to take part in this study have probably already been biased in favour of such an approach and were therefore more likely to be compliant and – subconsciously – biased the outcome; there is a reason for conducting double-blinded randomised studies. But without having been able to see the results, any comment is pure speculation – and it is somewhat unfortunate that a study which is hailed as such a break-through is not published in a more transparent way.

    The last point are the personal attacks, and I consider them one of the most unpleasant aspects of this. The publication of the NOF report was accompanied by claims that the food industry were ‘buying’ scientists and that one should therefore never trust them – one of my colleagues was accused on air for having received funding from a soft-drink and a weight-loss company. Similar accusations can be found by various proponents of the ‘low-carb’ movement – while they are much more relaxed about their declaration of links with industry or other potential conflicts of interest (the National Obesity Forum receives support from a wide range of industry and also has links with a weight loss company). Whether external funding affects outcome or not is a complicated question that can’t be answered easily – many people have tried and failed. Personal convictions can be much more powerful (and harmful) than financial incentives and most people find it difficult to admit that they have been wrong. However, to disqualify another person’s opinion solely on the fact that they have received funding and not the data is simply lazy. The data should be available and it should then be easily possible to decide whether they are biased or not – and if not, one might have to reconsider ones position (or not).

    As I said at the beginning, I don’t believe in the idea of ‘eminence based science’ – we should look at the available evidence and base decisions on that. For low-carb, I haven’t seen evidence that supports it.

    • Editorial

      Thank you very much for your full and rapid engagement in this issue. I meant no offence by identifying you, in fact the information was all there in your email. My intention was simply to establish that you were someone in a position of authority and influence in this debate. The ideal may well be that every opinion should be judged on its merits, the reality is that some opinions are according more respect than others.

      I mentioned Professor Richard Feinman in my earlier reply as someone who is an expert in this field and who I thought would be happy to respond to your specific points about the almost complete lack of evidence on the benefit of of low carbs. I checked with him that this was OK and this was his response:

      ‘Gunter says in his comment: “Wouldn’t it be better to have a sensible conversation, identify what needs to be done and do it?” I am ready for a discussion. The medical establishment has indicated very little interest in dialogue but I’m ready when he is. Alternatively, he could look at the 12-points of evidence paper and say what is wrong. We don’t have all the answers and I am quite willing to change my mind. I would love to discuss things with somebody equally open-minded.’

      This is the link to the paper Dr Feinman mentions which was published nearly two years ago:

      http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/abstract?cc=y=

      This is what he said about it in an article on this blog at the time:

      “The paper throws down the gauntlet to the diabetes establishment. “We set out 12 ways in which the low carb diet is the better option. They represent the best documented and least controversial results. They are sufficiently compelling that we feel the burden of proof rests with those who are opposed. In other words, put up or perform a major U-turn.”

      I published a layperson’s guide to this paper which may or may not be useful to you:
      http://healthinsightuk.org/2014/08/31/twelve-reasons-why-diabetes-charities-should-ditch-the-low-fat-diet-and-recommend-low-carbs/

      Do hope you will be sufficiently interested to respond.

  • I look forward to discussion with Gunter if he is interested. For the moment, one point of agreement:

    It is completely inappropriate to accuse scientists of trying to please the sponsor unless they say so. Science doesn’t work that way. Journalist, including Gary Taubes and Nina Teicholz do not seem to understand this. If the author says that the sponsor had no role, you must take them at their word. Otherwise, you have nothing. All granting agencies have interests and agendas but once a grant is made, the scientist has no obligation except to the data (and, of course, their own opinion). That is not to say that conflict of interest doesn’t happen but only that it is a very serious charge of breach of research integrity and cannot be made without proof.

    This is especially important with agencies that are related to special interests although, in practice, they are the most sensitive about keeping hands off. The most biased agency, in my view, is the NIH. It was almost impossible to get a low-carb diet study funded and mostly it still is. We would know nothing on low-carb if it were not for the Atkins Foundation which is a foundation, separate from Atkins Nutritionals, the company. They funded Dr.Fine’s study of advanced cancer patients which even a year or two ago was the only human trial of low-carbohydrate diets.

    Science is continuous with common sense and logic and you do not have to be a scientist to do science but you do have to understand how it works. Similarly, journalists can understand the sociology of science — how we work — but they have to report the news, not make the news.

  • Thank you both for giving this opportunity for a discussion in a civilised environment – I don’t think that anything is achieved by accusing each other of all sorts of wrongdoings …

    My problem with the low-carb diet for weight loss and management (and I deliberately exclude diabetes here as this affects the CHO metabolism directly) is, that the result of most studies I know are not very convincing. Most longer term studies I know of seem to show that people who follow a dietary intervention lose weight – no matter what the intervention is. The PREDIMED study (the weight-maintenance one published this week) shows exactly that – and all of the (long-term) studies the National Obesity Forum included in their report say essentially the same. There are of course differences, but they are small and I don’t think they justify the iconoclastic approach by some. The same about CVD risk – PREDIMED and the Lyon Heart Trial didn’t show that a low-carbohydrate diet is the only approach to reduce CVD risk.

    I can understand that people are excited by results and I can understand that especially those working directly with patients want to help them – but telling everyone to reverse dietary guidance completely (and accusing everyone who doesn’t share this opinion of various misdeeds) is counterproductive and increases resistance to change.

    The role of fat is difficult, and even without resorting to conspiracies about the role of different people 40 years ago, it is obvious that we have learned much more in the last decades. Our analytical methods have improved, we have much better data and a much better understanding of physiological and biochemical processes. One problem with fat is that it is extremely complex and it is difficult to apply simple rules – but it seems that some people like to move from the over-simplistic ‘fat is bad’ to the equally simplistic ‘fat is good’ dogma without considering that it is the dogmatic approach in the first case that caused problems.

  • First, we are ignoring people who ” like to move from the over-simplistic ‘fat is bad’ to the equally simplistic ‘fat is good’ dogma,” whoever they are (and ‘simplistic’ means ‘over’ or used to). We have to go back to beginning and I am speaking for myself and we have to agree on what is to be discussed (I do not consider PREDIMED or Lyon heart as low-carbohydrate studies — there is a definition in our diabetes paper).

    Along which lines, my opinion is that you can’t exclude diabetes. It is, as I see it, the clearest example of metabolic disruption involving the glucose-insulin axis. I see obesity, NAFLD and possibly CVD and all the effects included in the metabolic syndrome as parallel, if less striking, effects of the same disruption of glucose-insulin. So, whereas it is standard to target diabetes by targeting weight loss, the data show that they are not universally connected — again, reasonably parallel, rather than serial effects of the same metabolic state.

    The discussion has to start someplace. I suggest Volek’s classic study of people with metabolic syndrome. This represents my position. What do you think?

    1. Forsythe, C. E., S. D. Phinney, M. L. Fernandez, E. E. Quann, R. J. Wood, D. M. Bibus, W. J. Kraemer, R. D. Feinman, and J. S. Volek. 2008. “Comparison of low fat and low carbohydrate diets on circulating Fatty Acid composition and markers of inflammation.” Lipids 43 (1):65-77.

    2. Volek, J. S., M. L. Fernandez, R. D. Feinman, and S. D. Phinney. 2008. “Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome.” Prog Lipid Res 47 (5):307-18.

    3. Volek, J. S., S. D. Phinney, C. E. Forsythe, E. E. Quann, R. J. Wood, M. J. Puglisi, W. J. Kraemer, D. M. Bibus, M. L. Fernandez, and R. D. Feinman. 2009. “Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet.” Lipids 44 (4):297-309.

  • Thank you very much for the references – I will need to read them more carefully, but I think the question whether diabetes (or any other disease) is relevant or not as this is in my opinion an extremely important question as it essentially defines the nature of recommendations. An important objective of dietary recommendations is the primary prevention of disease and maintenance of health – not the treatment of diseases (this can be done much better by personalised interventions by the appropriate health-care professional). It is therefore somewhat misleading to base them on data that have been collected from studies people with diseases, even though this is of course much easier.

    Your data (and others) show a beneficial effect of CHO reduction on risk marker in patients with existing diseases, and this is important for the treatment of disease – but does this automatically mean that it is also beneficial for healthy people and should therefore be recommended for everyone? This is what I doubt – I haven’t seen convincing data that suggests that recommending such a large change in general advice is justified (and also whether it is justified to confuse the general public by having this discussion in newspapers …).

    The only way to test this would probably be in a large, long-term trial comparing different dietary approaches, and I assume that this is unlikely to happen as it isn’t considered to be a priority by most funding agencies.

    I would like to thank you for your time – I really appreciate that someone makes the effort to explain the situation in a friendly and non-confrontational way, it is something I haven’t experienced in this discussion before! We enter a rather busy time with exams etc, so I don’t know how quickly I can reply – but I would be happy to continue this.

  • I find it difficult to believe that a scientist like Gunter can continue to discourage the use of a LCHF diet for weight loss when he continues to point out that in a number of meta-analyses, there was no difference in outcomes between a LCHF diet and a low fat diet and no adverse effects from the LCHF diet.

    Gunter does not want to change the current advice. BUT if there are no difference in outcomes for normal healthy people undertaking weight loss, then why cannot dieticians and nutritionists and medical practitioners recommend both diets, and let people choose? Why stick to advocating the low fat diet, when the supposed causative links between animal fat and CVD have been thoroughly disproved?f

    Gunter seems to be ambivalent on the LCHF diet as treatment for T2 Diabetes. He does not like the collection of data from 100,000 diabetics by diabetesco.uk because they were self selected. Such clinical studies have been done before, in hospitals, and regarded a providing relevant information, tracking known disease markers. If this was the only study, then Gunter may have a point, but there are various studies that extract population data ( eg Women’s Health Study) that confirm these findings.

    I would point out that, rather than researchers or academics, medical practitioners who actually deal with patients would say that medicine progresses when medical practitioners discover better outcomes. If it works for one then they trial the treatment for another.. In this way, doctors like Dr Unwin, across the world, are advising diabetics to adopt a LCHF diet, because it works – normalising all markers for diabetes T2 over time.

    I cannot endorse tha attitude that weight loss studies show no difference in outcomes between a LF and LC diet, so we stick with the LF diet and actively campaign against the LC diet and call it “dangerous”. That is dishonest.

    Neither can I accept the active campaign against a LCHF diet to treat diabetes, when the evidence of well over 100,000 patients and many more, show positive outcome for those patients and the slowing or prevention of diabetic secondary complications.

    The LCHF diet has shown a positive saving in medication costs for diabetics, $45,000 in one UK practice alone. Is not that significant?

    This is at a time where the health system is seriously considering forking out $50,000 per obese diabetic patient for bariatric surgery. Why not recommend the LCHF diet, with adequate support, first? Is that not a massive saving to the Health system?

    To me, it appears that the scientific objections to a LCHF diet have been disproven scientifically. In fact, the LC diet was the go to diet for weight loss before the 1970s. Back then, it was the conventional wisdom. Back then, diabetics were told to cut down their carbohydrate intakes. Back then, saturated fat had not been wrongly demonised.

    Now we have an obesity and diabetes epidemic, probably caused by the overconsumption of sugar and simple starch in refined and processed products.

    If a LCHF diet can provide effective and continuing lifestyle treatment for obese diabetics, diabetics and others with insulin resistance diseases, the results would be $ billions in savings for the health system and the overall economy.

    So then, the “authorities” should support the LCHF diet as another treatment for obesity diabetes and other insulin resistance diseases, and allow medical practitioners and patients, a choice.

    • Nero fiddles while Rome burns.

      Thyroid diseases is endemic and an acknowledged link to insulin resistance and diabetes. While thyroid function tests are based on ‘generally poor quality evidence’ (assoc of clinical biochemists 2006), it’s obvious to me, a patient, that the poorly medicated patient on synthetic T4 will ‘progress’ to diabetes. The literature supports this.

      I have long lost patience with the scientists who wish to argue the toss while ignoring bad evidence.

  • Gunter,
    I will wait until you read the references or more generally know who and what we’re talking about. There are many opinions and it will only be productive if we have clear focus. So, you have the diabetes paper and the papers on Volek’s study. When you’re ready on those, we’ll go to the next step.

  • GillianQ – I would love to say more about the diabetes UK study, but there appear to be no detailed information available except for the fact that it is an online survey (that is what the Times article says). I have seen similar approaches in other areas (notably vaccination) and so far they suffered from two big problems: there is no proper control and the participants are self-selected and often biased.

    Why do I not support a low-carb approach: for a very simple reason. It does not appear to be superior to low fat with regard to weight management or primary disease prevention. What we don’t know is whether there are any adverse effects from such a recommendation to _healthy_ people. Many supporters of LC claim that the LF recommendation resulted in considerable damage to the general public – and while these claims are unsubstantiated, they should explain why a sudden change of guidance should only be done once all risks are understood, and they haven’t.

    I will peruse the studies suggested by Richard (and others) and welcome of course other suggestions. But I’d like to see reasonably convincing data that suggests that low carb is not only a suitable alternative to a high carb diet, but should also substitute advice.

  • Richard, I have read the studies and review – and remain confused as they deal with the effect of CHO restriction in individuals where the carbohydrate metabolism is dysfunctional. But as I have explained, this is not really my concern – treating patients is something quite different from maintaining health and advising the general public.

    So far – I have not seen that recommending a low-carbohydrate diet to _healthy_ individuals results in any benefit, but an increased fat intake can – depending on FA composition – result in increased markers of CVD risk.

    Dietary recommendations are targeted at the general public and are intended to maintain health – not to cure diseases. It is therefore misleading – at least in my opinion – to base this advise on data about the physiological of carbohydrate restriction in people with disease and it does not help the discussion. Some of the most vocal supporters of low-carb diets are people with diabetes who claim to have achieved great results with this approach – but that is hardly a justification to apply this to everyone else.

  • Gunter,
    “So far – I have not seen that recommending a low-carbohydrate diet to _healthy_ individuals results in any benefit…”
    I am sure you haven’t but here are many papers. If you are interested you can find them. Then when you have seen, we can talk. You have four good references that will get you started.

    “…but an increased fat intake can – depending on FA composition – result in increased markers of CVD risk.”
    In fact, that is not what the data show. Increased fat intake in the presence o high carb is different than in the presence of low-carb.

    On prevention, you seem to have the idea that there is an accepted well-tested diet that has been shown to maintain health. What is that standard that low-carb is supposed to meet and what data support it?

    Further discussion depends on your coming up with studies or facts that we can discuss. We know your opinion and we know you have the health agencies behind you, but you are not an expert on low-carb. If you want to discuss it on a professional level, do the research.

    And lose the attitude. You are talking as if you are the expert and I have been wasting my time for the past ten years and you are going to enlighten me. Do it with the idea in your mind that my credentials are just as good as yours and I may even be smarter and ask yourself why I might hold to my opinion on low-carb. Don’t assume that because our ideas are not the majority, that we must be wrong. In science, you try to disprove your own theory, not the other guy’s.

    Alternatively, if you simply don’t like low-carb, don’t do it.

  • Richard – I don’t quite understand your comment. It was never my intention to be patronising and if you have perceived this as such, I am very sorry. The references you have given me focus on the effect of carbohydrate restriction in study participants with a metabolic disorder – or so it is at least explained in the description of the study; the Volek, 2008 paper is – as I read it at least – very clear about this.

    You say that the data don’t show that tat intake can increase markers of CVD risk – but contradict this statement in the same sentence by explaining that the background diet (e.g. CHO intake) plays an important role – I’ve never questioned this. I’ve also never questioned that the type of fat consumption is very important – but this will have to be communicated properly in dietary advice to the general public.

    In Volek, 2008, you write (or cite a study to be more accurate) that CHO restriction induces ketogenesis in healthy adults – is this something which is desirable in the general population? What are the potential long-term implications of such a change?

    If there are numerous studies testing carbohydrate restriction in health volunteers long term, I would really like to read them. I appreciate that you are an expert, so I am somewhat flummoxed that you refuse to introduce them.

  • You are arguing with me. I don’t need to defend anything. If you have something that works, go for it.

    When you ask whether ketogenesis is desirable in healthy adults, it doesn’t sound like you are asking for an explanation the way a student might. You are asking for a sound bite so that you can jump on the answer because you know there are “long term implications.”

    I did not refuse to introduce anything. I gave you a small number of good studies because I thought that would be easier. There is a huge literature. But, you can look at this:

    https://static-content.springer.com/esm/art%3A10.1186%2F1743-7075-10-45/MediaObjects/12986_2013_551_MOESM1_ESM.pdf

    We are not on the defensive. There are a million excuses as to why the medical-nutrition establishment bears no responsibility for the epidemics of obesity and diabetes so if you are happy with that, go with it. Here’s what you need to read:

    bit.ly/1Utx6pk

    Also good is: bit.ly/1Utx6pk

  • Richard – you have obviously no interest in a discussion about the implication of recommending a low-carbohydrate diet to the general (healthy) public. You get defensive when I ask about the long-term implications of ketogenesis and when I ask for a single study where a low-carbohydrate diet has been tested in healthy individuals you provide me with a list of publications where I have to look for a long time to find at least a title that does not exclude the study.

    I don’t quite understand the hostility: I have tried to be polite and I have tried to understand why you want to expand a diet which might be suitable for people with diabetes to the general public without (as far as I can see) any proper assessment of risk and benefits.

    Perhaps I was a bit too optimistic that a fruitful discussion can occur (I was sceptical because the the last author on your opinion paper, NW, seems to like to use personal attacks to discredit others) – so it might be best to leave it at this. At least we both can feel satisfied that our prejudices about the other side were confirmed.

  • I’m just a chemist.

  • As always, I adore your intelligence, patience, and sense of humor, Dr. Feinman!

  • Gunter,

    I think you need to explain exactly how eating a high carb diet differs from eating a diet containing the equivalent amount of glucose spaced out over the day so as to avoid spikes in blood glucose! Would you recommend that for anyone – diabetic or not, and if not, can you explain exactly what the difference would be from the high carb diet that you do seem to recommend!

  • David – in a very simplified model, that is probably the case; complex carbohydrates release glucose slowly. I fail however to see why this is supposed to be something unwanted – the body requires glucose as energy source and a slow release of glucose from the digestive system does provide exactly that. Wouldn’t it especially for a diabetic be important that glucose is released slowly and not rapidly?

    Dietary carbohydrates do however also have a number of other roles, most importantly as substrate for the microbiome. I find it fascinating that on one hand the overly crude classification of “fat” is criticised (we all know that there are many different type), but on the other hand all carbohydrates are seen as being the same. Even sucrose consists of two different sugars with different physiological fates.

  • Gunter,

    I specifically suggested eating glucose spaced out over time, to get over the major point that carbohydrates deliver their glucose slightly more slowly.

    I am not a biochemist (though I took chemistry to PhD level) but I understand that a great deal of the belief that saturated fats were bad came from Ancel Keys, who cherry picked seven countries out of a total of 20+ to ‘prove’ that saturated fats caused CVD! Is there some convincing proof that he got the right result by accident, and that saturated fats are indeed harmful, because otherwise, as has been pointed out here, saturated fats can provide energy via an alternative route that does not involve glucose!

    I mean you guys seem to become so obsessed by meta-analyses of studies that the basic biochemistry gets lost!

    Regarding your last comment, is there a particular type of carbohydrate that you think is good for the gut bacteria? I got a raised blood sugar reading while taking Simvastatin, and so went to see a dietician. Her advice to eat lots of carbohydrates (unspecified except that they should not be sucrose!) seemed very strange to me at the time, but shortly afterwards, the statin caused nasty muscle side effects in my polio leg, so I stopped taking them, and my blood sugar levels returned to normal (very fortunately, my leg returned to normal too, because I understand that the muscle side effects of statins are not always reversible)! I have now lost a lot of confidence in conventional medicine!

  • David – the problem with fat is that there are so many different ones with different physiological effects. Odd chain fatty acids (mainly from dairy as they are produced by bacteria in the stomach of ruminants) seem to have a very different effect to even chain fatty acids (which are still associated with increased risk markers). I’m a bit reluctant to believe in the big conspiracy – I rather think that methods have improved and science has progressed, as it has done in many other fields.

    I agree that the biochemistry gets lost too often (I am after all a biochemist), but there is a severe paucity in good biochemistry studies, they seem to have gone out of fashion in the last decades. This seems to be mainly part of clinical nutrition (and the much maligned dieticians), but there should be more links.

    However: there is a big difference between research into the effect of nutrients, the treatment of specific diseases by a health-care professional and recommendations for the general public. A recommendation for the general public should be based on fairly conclusive evidence, preferably with multiple long-term studies (in healthy people).

    The problem I have with the recommendation of a low-carb diet for the general public is that a fundamental change of existing policy is suggested without the evidence showing that it will have a significant benefit over the current system. Richard has cited many studies of beneficial effects in people with diabetes or who are obese – but they also seem to have a dysfunction of the metabolic pathways that metabolise carbohydrates. By definition, this doesn’t apply to healthy people and we don’t know whether such a diet has any long term benefit or risk. From what I have read, I don’t think it has a benefit, but I don’t think there is any shame in being convinced by good arguments.

    The main problem I have however is with the mode of communication: many proponents of a low-carbohydrate diet seem to believe that this is the solution to all diet-related health problems – and promote this idea very aggressively. The data I have seen regarding the claims of weight maintenance are rather sobering – there is not much difference between low fat and low carb diets and definitely not enough to justify (in my opinion) a claim to vast superiority. Some studies show a benefit of carbohydrate restriction on CVD risk markers, but others do the same for fat restriction. It seems to be much more complicated than a simple eat more/less carb or more/less fat, and I think it would be fair to accept this.

    Most of all, it would be nice to move this discussion away from personal attacks to a discussion of scientific ideas, because in the end it seems that both sides have the same objective, i.e. to develop dietary recommendations that benefit everyone.

  • Gunter,

    I wonder if part of the problem here, is that the philosophy of EBM is based on randomised trials, and you can’t randomly assign people to a low carb diet while the official advice is the opposite. This means that all the people who claim to have improved their T2D and/or lost weight on a LCHF diet, don’t form evidence because they selected themselves, but there is no way to collect that evidence!

    I mentioned Ancel Keys, whose fraudulent (cherry picking the data) paper seems to have initiated the demonisation of saturated fats, and it seems really strange that this became the foundational paper for the low fat movement – indeed that his career flourished even after it was pointed out that he had picked 7 data points out of 20+.

    As regards the differences between even and odd chain lengths, isn’t there a danger of treating saturated fat as a large number of individual chemicals – each of which needs assessment – and forgetting that fat has been a staple food of humanity! By analogy, protein contains a vast number of individual types of molecule, and clearly these cannot be tested individually!

  • David – if we talk about biochemistry, we need to be more specific and shouldn’t combine all fat into one group because it’s not all the same. There are huge differences not only between SFAs and others, but also between different chain lengths and odd- and even-numbered FAs. We do the same for proteins – there is a large amount of literature on the effect of different amino acids, especially in clinical nutrition.

    You mention fat and protein as staple foods – but so are carbohydrates. Our diet has always included all three macronutrients and humans seem to be quite capable of living with a wide range of different diets.

    Randomised trials could be conducted – there seem to be enough people who would willingly follow a low carbohydrate diet, but it might be difficult to get funding for such an endeavour as it would be very expensive. We could look at observational data, but I’m not aware of any data supporting a beneficial effect of low overall CHO intake. However, in order to tell the entire public to change their diet, I think we need a bit more than a few long term studies with (in my opinion) inconclusive data. You mention Keys, and while I can’t comment on the accusation towards him, one criticism is the lack of quality of the data and the controversy surrounding the results: the self-same people who do this are happy to recommend a complete reversal of dietary recommendation based on a few studies. I find this rather odd, because if there is anything we can learn from this it should be to be more careful with dietary advice.

  • I am zealous of my health ,and I intend to protect it until my last breath

  • Gunter,

    I think we should put this into perspective. Throughout most of my adult life, I like others, have been told that SFA’s are hugely bad for us – leading to people describing fry-ups as a “heart attack on a plate”. Only a few years back, we were told that it was “time to get serious about salt and saturated fat” (i.e. the further reduction of these in the diet). On that basis, people assumed that this was a well-proven medical risk – something akin to smoking – and many of us moved our diet towards carbohydrates, and avoided fats, including butter and cream. In those days, sugar was barely mentioned, so people put sugar on their strawberries rather than cream – demonising one type of food inevitably lead to the consumption of other food.

    The problems with medical advice seem frighteningly widespread. Thus, regarding salt, I was very surprised to read this in Scientific American:
    http://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/

    Note that what amazed me, was not so much that there was a difference in scientific opinion on this issue, but that a piece of emphatic advice to the public was based on very little if any hard evidence!

    I have already described my personal problems with statins, but what amazed me, was that the muscle problems were well known by non-medical people, and yet learned articles were being written assuring us that statin side effects were no greater than placebo side effects!

    Getting back to SFA’s – surely the point is that if the danger of SFA’s has been over-stated, it would be better to simply withdraw the advice not to eat foods containing a lot of SFA’s – not agonise over the number of distinct chemical constituents (some natural SFA’s have branched chains, so the potential number of different SFA’s is vast).

    Regarding metabolic disease, surely there is a continuum here. You can’t cleanly separate the population into those with or without metabolic disease. Thus, the fact that so many people with T2D have done so well on LCHF diets has relevance to us all. I don’t follow a LCHF diet, but I certainly don’t try to exclude SFA’s from my diet. I know a man who is a GP, and his family eat butter, not margarine – as we do.

    When you say that there is no evidence that the LCHF diet is beneficial to those with T2D, does anyone take data from Sweden, where I understand a large number of T2D patients are treated successfully with LCHF?

    Am I completely wrong to suspect that this data is not used because it cannot be fitted into the framework of a randomly controlled blind trial? Alternatively, can you explain how it is that so many T2D patients appear to recover from their disease, and even come off their medication based on blood tests?

  • David – I think I need to make it clear that I’m not talking about people with diabetes (or any other disease that affects carbohydrate and fat metabolism). I find it very confusing that dietary advice for a very specific group is generalised when I can’t – one wouldn’t advice against the consumption of dairy based on people who are lactose intolerant. For healthy people – or people who are just overweight – the data I have seen don’t suggest that LCHF is better than any other dietary approach tested. Many dietary studies show an effect simply because people watch their diet and therefore avoid snacking etc – good controls are therefore crucial to ensure that it is the dietary intervention and not something else that is detected.

    The ‘war on fat’ and ‘war on salt’ are – in my opinion – rather an example of poor communication than poor science. A lot of data on salt and mortality is quite convincing – as is data on fat and disease, despite what people say today. We have better data today and therefore can refine results – but as with most complex questions there are no easy answers (saturated fat from different sources is an excellent answer, but so are links between sodium intake and heart disease).

    The problem is to translate this into public health messages that are easily understood and followed. Most nutritionists I know don’t like the idea of demonising any food (with the exception perhaps of trans-fats) and think that a healthy dietary pattern is the best approach.

    I don’t believe that the ‘war on xy’ is the best approach – but that is also the reason why I dislike the current ‘war on sugar’ or ‘war on carbs’. Consumed in sensible amounts, neither is good or bad. And I find it somehow strange that the self-same people who criticise that the advice on fat was based on flimsy evidence (or so they claim – I don’t agree) now do exactly the same with sugar and carbohydrates. What is the difference between saying ‘fat is evil’ to ‘carbohydrates are evil’?

    If the current discussion shows one thing it is that the data are not as clear as either side claims: so we have to options: we can shout at each other until the public is bored, or we can try to talk and find out what is best. I prefer the second approach, but this seems to be a minority opinion.

  • we have unlimited potential.The important of questioning.The evidence is not cast -iron proof.It may be unreliable,or from a biassed source,or based on too narrow observation.I am not gullible.I always question the evidence.
    CURE MYSELF
    Aiming for balance cure myself ?that is exactly what I have to do .Some people may have brought on the troubles because they were ignorant of the great Nutritional laws of life .Some know that following the programme of Natural nutrition is the most important factor regaining and maintaining health,but they do not have the inner strength to battle their false desires for foodless foods.For they are wilful and persist in building up the toxic poisons in their body through the wrong diet .Each individual must face the issue that only through their own daily constructive healthful actions can the HEAL THEMSELVES!

  • Gunter,

    You said:
    “If the current discussion shows one thing it is that the data are not as clear as either side claims: so we have to options: we can shout at each other until the public is bored, or we can try to talk and find out what is best. I prefer the second approach, but this seems to be a minority opinion.”

    Yes, that certainly seems like a good idea. I wish science was still presented to the public with its uncertainties – and that if (say) the various medical studies don’t agree, or give an unexpected result, this is made clear as a point of honour.

    The medical authorities have undoubtedly shifted many people’s diet away from saturated fats (and I suppose encouraged the consumption of partially hydrogenated oils, which gave us trans fats, and resulted in more synthetic food), and I do think they should be really open about the raw epidemiological evidence for what they say, because there can be unintended consequences.

    I also wish that someone such as yourself and people like Dr Kendrick and Jerome Burne could engage in some sort of public dialog about the issues. This doesn’t happen at the moment – the establishment likes to ignore those it considers mavericks!

  • Gunter, I understand that the expensive and rigorous trial of a low carbohydrate and low fat diet that you advocate began some time ago. It’s been carried out by Stanford University, funded by NuSi, who are in turn funded by two philanthropists.

    http://nusi.org/science-in-progress/stanford-university/

  • Excellent and fruitful information
    Thank you .

  • The least work the pancreas has to do in Diabetes 2 patients the better. You can clearly see the more work it has to do, the worse its condition, so why persist with carbohydrates rich diets!?

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