By Jerome Burne
The Brexit effect – ideological conflicts, bitter disputes over facts, distrust of experts, trolling abuse on twitter– seems an apt description of what has been happening recently in the supposedly evidence-based world of nutrition. The striking difference is that it is the nutritional establishment that is resorting to insults and playing fast and loose with the actualité.
One dramatic and unbelievable example is still ongoing in Australia. The the main medical regulatory body – the AHPRA (Australian Health Practitioner’s Regulatory Authority) – has been holding secret hearings, from which there is no appeal, to investigate the work of an orthopaedic surgeon. And what has he been up to? Suggesting to diabetics that they could benefit from following a low carb diet to reduce the risk of having their feet cut off.
And what does he know about this matter? Dr Gary Fettke has been an orthopaedic surgeon for over 23 years and he looks after most of the diabetic food complications in northern Tasmania. Last month he told an Australian Senate enquiry: ‘My patients are lying around in hospital with obesity- related conditions, amputated limbs and non-healing rotting flesh. I believe that it is the nutritional advice they have been given that has put them there in the first place.’
Did he have any evidence for this radical claim? ‘I have studied the science and biochemistry of our dietary guidelines,’ he told the hearing ‘and found them wanting in substance and riddled with vested interest politics.’
Top journal concerned about evidence for low fat
Fettke may already be cheered to know that his view is strongly supported by the current issue of top medical journal The BMJ. It is both concerned about the vested interests in nutrition and supports a detailed critique about the failings of the healthy eating guidelines of the sort the AHPRA is relying on. A detailed analysis (see below) has found the evidence supposedly supporting low fat to be very weak and condemns the failure to properly asses the benefits of low carbs.
The pronouncements of the AHPRA are beyond satirizing and would be hilarious were it not for the damaging effects of the vicious campaign against him, his family and anyone seen to be a supporter. He has been ordered to no longer advise his diabetic patients on nutrition to prevent limb amputation. In particular he cannot tell patients not to eat sugar. And should his advice become mainstream in the future he must not talk about it even then.
Malicious harassment includes having a photo shopped picture of his family kitten being stabbed put up on his locker in the operating theatre, while a Facebook page dedicating to attacking the LCHF diet, with Australian doctors and nurses commenting on it openly, recently carried a post describing a nutritionist who advocated the diet as a ‘moronic money-hungry charlatan.’
The original complaint against Fettke, by an anonymous dietitian, was that he wasn’t qualified to give nutritional advice. The AHPRA told him that he wasn’t ‘suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic.’ Well which doctors are?
It is ‘inappropriate’ to reverse diabetes
Even more farcical is the most recent complaint, being seriously investigated, which involves ‘inappropriate’ reversal of someone’s type 2 diabetes. If it is upheld, will the patient be force-fed sugar to re-reverse it?
These highlights from the hounding of Dr Fettke are taken from an impressive blog Foodmed.net run by South African medical and health journalist Marika Sboros. She has been chronicling the injustices meted out to Dr Fettke as well as the events in another long running hearing of charges against the South African professor and top nutrition scientist Tim Noakes.
His crime was to respond to a mother on Twitter back in 2014, who had asked about foods suitable for weaning. He replied that good first foods for infant weaning are LCHF. In other words, he was suggesting meat, dairy and vegetables. My whistle-stop account of what happened next is heavily reliant on the work of UK nutritionist Dr (not medical) Zoe Harcombe,
who was awarded a Ph.D in public health nutrition earlier this year for a thesis arguing that there was no evidence to support the low fat guidelines when they were first set out and there is no evidence to support them today.
Alpha scientist hounded for unconventional advice
At the time of the original tweet Professor Noakes was already a far greater threat to dietary orthodoxy than Fettke. He had been an insider, a heavyweight academic with over 550 peer reviewed publications to his name and a couple of life time achievement awards. When he announced his apostasy a few years ago, saying that he had concluded that the low carb approach was more physiologically plausible and clinically more effective than the conventional low fat high carbs, his colleagues had shown no interest in discovering why this alpha scientist had changed his mind. This was war.
So when a dietitian complained about Noakes’ tweet in February 2014, the Health Professions Council of South Africa (HPCSA) wasted no time in going after him. In September it charged him with ‘unprofessional conduct’ for ‘providing unconventional advice on breastfeeding’. It must have seemed, wrongly as it turned out, an ideal opportunity to discredit Noakes. He, on the other hand, seized it as an opportunity to set out exactly why his opponents should change their minds.
Unlike the assault on Fettke, this hearing was in public and he was able to call witness so he energetically prepared his case. One of the witnesses was Dr Harcombe. It took over two years for case to be heard. Noakes eventually took the stand in February 2016 at the third hearing session. He continued his evidence in October.
Dossier of 4000 pages defends low carbs
He took more than four day to give his evidence, submitting over 4000 pages and 900 slides on the science. He began with diet and evolution, moving onto the shortcomings of the hypothesis linking heart disease to fat consumption energetically promoted by American scientist Ancel Keys in the 60’s and early seventies.
Noakes showed how Keys had cherry picked the data for his famous Seven Countries study and ruthlessly rubbished the work of his contemporary, the British Professor Yudkin, who was putting sugar in the frame. He then introduced a new generation of researchers such as Gerald Reaven and Jeff Volek who are following in Yudkin’s footsteps. Their hypothesis is that insulin resistance (raised by sugar) is at the root of heart disease, along with other chronic diseases, and that cutting carbohydrates is the key to preventing it.
Zoe Harcombe spent two days in the witness box and wrote about it here. (Accessing it needs a modest subscription to her site which is well worth it.) She describes the complex legal and other shenanigans going on in the background, testimony from other witnesses and refers to the amount of personal abuse directed at Noakes himself.
Some of these manoeuvres involved a research paper by Dr Celeste Naudé, head of the Centre for Evidence-Based Health Care at Stellenbosch University, which was trailed as the definitive rebuttal of Noakes’ case.
Key prosecution paper full of holes
Harcombe thought otherwise. ‘It contained more errors than could easily be counted,’ she writes. ‘When these errors were corrected for, diets that were not low in carbohydrate but simply lower in carbohydrates than the standard LFHC diet did better.’ For a full version of Harcombe’s critique see here.
Noakes’ other star witness was top American science journalist Nina Teicholz author of the best-selling and painstakingly researched demolition of the low fat diet hypothesis – ‘The Big Fat Surprise: Why Butter Meat and Cheese Belong in a Healthy diet.’ As well as sales, the book has also garnered rave reviews from the likes of top nutrition journals, The BMJ’s former editor-in-chief, and The Economist.
In the witness box, according to another post from Sboros, Teicholz told how her research into the science supporting the original guidelines had revealed that: ‘top scientists knew there was evidence to the contrary but ignored or suppressed that data for decades.’ She also revealed another little known fact: ‘The US Dietary Guidelines Advisory Committee now warns that low-fat diets cause atherogenic dyslipidaemia. In other words they raise the risk of heart disease.’
Sboros provides more extracts from Teicholz’s testimony in another post all devastating to the low-fat hypothesis. For instance, she explained how one of Ancel Key’s original collaborators went back and reanalysed the data from the Seven Countries Study in 1999. ‘He found that the food that best correlated with heart disease was not saturated fat but sweets.’
Billions fail to prove high fat dangers
She described how the National Institutes of Health in America had spent billions on highly controlled studies, trying (and failing) to prove Key’s hypothesis. ‘In recent years there have been more than a dozen meta-analyses and systematic reviews looking at this data. Nearly all have concluded that saturated fat and dietary cholesterol do not cause death from heart disease.’
Sboros’ gives many more striking examples of why it shouldn’t be Noakes in the dock, (do read her posts) but I have to get on to the latest bombshell that Teicholz’s careful research has detonated under the official litany that the low fat diet is evidence-based and scientific unlike this new faddy low carb imposter.
It was put in place in September last year ago in the form of a detailed critique of the latest Dietary Guidelines for Americans (the DGAs), published in the BMJ. ‘After doing the book I couldn’t understand how they yet again supported the caps on saturated fats and failed to mention the benefits of low-carb diets for those battling obesity,’ she told me. ‘Looking at the report in detail I found this was done by ignoring dozens of rigorous studies on low-carb diets.’
These ignored studies, as she set out in the article, included: ‘Several long term trials of 2-years duration demonstrating that these diets are safe and highly effective for combatting obesity, diabetes and heart disease.’
Top guidelines committee used weak methods
The failure to properly assess the low carb diet, she concluded, was because the body responsible for gathering the evidence for the DGA – the US Dietary Guidelines Advisory Committee (DGAC) – had used ‘weak methods’ and didn’t reflect the ‘best and most current science’.
Her paper also found that that the government’s recommended diets are generally based on a ‘minuscule quantity of rigorous evidence that only marginally support claims that these diets can promote better health than alternatives.’ Among the reasons put forward for this mess, she hypothesises, were ‘financial conflicts of interest, outside agendas and a desire to confirm existing advice.’
The paper generated a furious response. A Washington, DC-based advocacy group, the Centre for Science in the Public Interest (CPSI), issued a call for a retraction signed by more than 170 researchers and academics – including all the members of the DGAC – claiming that it contained eleven errors and should be withdrawn.
A remarkable vindication
According to its standard procedure, The BMJ commissioned an outside review to assess whether this was necessary. Just over a week ago on December 2 the BMJ announced that having corrected a couple of minor points Teicholtz’s article would stand.
The review concluded that Teicholz’s criticisms of the methods used by DGAC were ‘within the realm of scientific debate.’ Not only that but they merited ‘further investigation of the composition of the committee.’ The review also agreed that the way the DGA came to its conclusions were out of date and lacked sufficient detail.
It was a remarkable vindication of her work. A lone journalist had taken on the most influential nutritional body in the world along with 170+ nutritional experts and exposed their shortcomings. The impact of this should be huge. It is hard to see how the two ongoing trials can survive this major challenge to the prosecution in both cases. Teicholz formal response to the review’s finding is here.
The Brexit-effect distrust of experts is obviously not a sensible policy in general but as far as those in the diet and nutrition establishment are concerned it seems justified. We obviously don’t have a scientific evidence-based system for deciding complex nutritional issues. Instead it falls to courageous and independent clinicians and journalists to put their careers on the line in a push for a long overdue change.