By Jerome Burne
On Monday I watched the C4 documentary ‘Food Unwrapped: Diet special’ because I’d been alerted to the fact that it featured Dr David Unwin and his success with the low carb diet as a way of treating diabetics.
I understood that the C4 team had spent a long time at his surgery in Southport and talked to a number of the people involved, so there was the hope, foolish as it turned out, that it might be a thoughtful and useful program. The intention of the production team, however, was for something else entirely. Words like thoughtful, informative or challenging, were nowhere on their story board.
What they created instead, with a remarkably generous budget, was a product packed with byte sized chunks of information that slid in one eye and out the other without troubling anything in between. Odd facts were at a premium such as one from Dr Unwin that a serving of supposedly healthy cereal can contain the equivalent of 19 teaspoons of sugar or the revelation that ram testicles are a popular breakfast item in Iceland.
No fact was more or less important than another and none was explored any further. To be ponderously serious for a moment – not something the cheeky-chappie, hyperkinetic presenters would have dreamt of as they switched between Iceland, Netherlands and Bondi beach faster than a costume change on the catwalk – telling people with diabetes that it’s OK to pack in 19 teaspoons of sugar equivalent at breakfast is not just mildly interesting; actually it is – culpable? dangerously irresponsible? a serious failure of the dietetic profession? Take your pick.
A program that’s part of the problem
Even with the entire population prostrate after the massive Christmas sugar/carb binge this was not a place this candyfloss vehicle was remotely interested in going. In fact it soon became clear that the program was simply adding to the confusion about diet that fuels the diabesity epidemic rather than being part of any solution.
Since it assumed viewers had an attention span with a 60-second half life the snippets of dietary information it flashed up were as nourishing as rendered meat. Any viewers who weren’t diet geeks could only conclude that so many people ate so many odd and different things that their own diets were probably OK too. A conclusion guarenteed to keep people eating and behaving in ways that ensure the diabesity stats, and all the expense and misery that accompany them, keep rising.
So just how spectacularly did the program miss the boat? For a start it went out on the same day that The Case Against Sugar by Gary Taubes was published. In essence it claims that sugar is not just another carbohydrate but that the body handles it differently from other carbohydrates so that it is especially likely to encourage a condition known as insulin resistance.
This in turn is strongly associated with not just obesity and diabetes but also cancer and quite possibly Alzheimer’s For an edited extract of the book see the Daily Mail.
It’s not the final word but it makes it very obvious that the appropriate response to being told that a’ healthy’ breakfast for diabetics and the overweight could contain 19 tablespoons of sugar is not to treat it as just one more “well who’d have thought it” fun fact.
Why low fat is not the way to lose weight
Taubes is also relevant to the diet that Dr Unwin is recommending – a low carbohydrate high fat diet (LCHF) – because he wrote a ground-breaking and serious critique of the idea that a low fat diet is the way to lose weight and protect the heart back in 2008 – The Diet Delusion.
His book was followed in 2014 by another rigorously researched dissection of the claim that fat is a factor in obesity – Big Fat Surprise – by another American science journalist Nina Teicholz. Along with many others, including several hundred thousand diabetics, who are reporting impressive results with the HFLC diet on the website diabetes.co.uk, I find it impossible to understand how anyone who relies of scientific evidence could have read both those books and still make statements such as: ‘following a low fat diet is in line with the best evidence we have at the moment’.
This was one of the comments made by Dr Alison Tedstone Director of Diet & Obesity, Public Health England in the program. Surely it’s not possible that she, the top nutritionist in the country charged with managing this disaster, hasn’t read them?
She of course wasn’t challenged on this in any way – it was just another fun fact, even though if she is wrong it’s a mistake that could turn out to be on par with the infamous claims by South African authorities that the HIV virus didn’t cause AIDS. For more details on the failings of the evidence base supposedly supporting the low fat approach, see a previous post on HealthInsightUK.
How many very similar anecdotes can be safely ignored – 10, 100, 1000?
At the very least you would expect that there would be some interest from the authorities about the experiment that Dr Unwin has been conducting with diabetes patients for four years now, and publishing on it, that is leading to an average weight loss of 9 kilos with a low carb high fat diet plus a significant cost-saving drop in drug use.
Dr Tedstone is after all director of **Public** Health England. But when the program, in a rare flash of curiosity did ask: What about Dr Unwin’s findings? She replied that you couldn’t base anything on that because they merely involved anecdotes. The obvious response would have been that a large number of very simiilar anecdotes are precisely what should trigger research by a public body such as Public Health England, rather than something to be ignored.
But all of these strands of evidence suggesting that there is indeed a strong case to upend the Food Pyramid are but small and feeble blows against the nutritional empire presided over by Dr Tedstone compared to what is coming her way in the battle over evidence. If I were Dr Tedstone I would be very afraid. (What follows is taken from a post just published on the excellent health blog run by the journalist Marika Sboros writing at FoodMed.net.)
A clash of titans on the way
Two global companies, one earning 23 billion dollars a year and the other 35 billion dollars, have become very interested in findings of clinicians like Dr Unwin and investigators like Teicholz and they are both putting their money on the low carb approach.
For years a standard explanation for the resolute way the nutritional establishment has clung to the low fat theory is that it suits the big food manufacturers. Many of the leading nutritionists work for big sugar and grain companies and the companies fund research. The list of these companies sponsoring the British Nutritional Foundation goes on for pages. How can a couple of American science journalists and some maverick GPs prevail against that sort of financial muscle?
The answer seems to be by having a major Swiss bank, Credit Suisse, and the global reinsurance company Swiss Re to ride into the lists on your side. In 2015 Credit Suisse issued a report which concluded that the growing popularity of high fat foods, together with research showing that they offered a safe and effective way to prevent and treat obesity, diabetes and heart disease, ‘offers powerful investment ideas’. When that sort of finding is backed by serious money, things can start to happen.
And this becomes even more likely when it was joined towards the end of last year by big brother Swiss Re. Reinsurance companies are where other insurance companies insure their policies and life insurance companies have many billions of dollars riding on how long people are going to live. So they really need to have the best information about life expectancy and long term illness. They also need to know how big their reserves should be to be to pay future claims.
Banks and insurance companies back winners
So if the research that Unwin, Taubes and Teicholz are relying on is correct and if it has the potential to prevent and reverse diabesity on a large scale, that will have a major financial impact on the whole health insurance business. Companies will be able to cut their rates for new business (people less likely to die or be expensively ill for years) and they won’t have to hold such large reserves making them more profitable.
The banks also have an interest in backing winners because they make their money by providing sound financial advice. And that include which food and medical companies to invest in. Marika’s blog goes on to identify some of the research that the big companies were persuaded by, including one showing how sugar companies wrongly promoted fat as the dietary danger and Teicholz’s study in the BMJ questioning whether the American guidelines supporting the low fat approach were scientific.
As if this were not enough “food for thought” cooked up by Dr Unwin’s maverick approach to his patients, the wider picture is evern more packed with possibilities. By just offering the low carb diet to his patients several years ago he was bravely ignoring the official guidelines for treating diabetes. This is something doctors are hauled before disciplinary committees for doing. Two such cases are ongoing in S. Africa and Australia at the moment.
Now nearly 100 UK GPs have contacted him asking for more information on the low carb diet so they can offer it to their own patients. This looks like a growing grass roots revolution. If doctors are going to start being more relaxed about guidelines and relying more on their clinical judgement, what happens to formal scientific evidence based medicine? Does it mean that hugely expensive randomised trials should no longer be regarded as the only way to test out lifestyle approaches to health and prevention?
It’s the human touch that makes the difference
And then there is a very important element in Dr Unwin’s approach, which the gold-standard randomised trials appraoch doesn’t even begin to take into account, the way he gets such a high compliance rate. It’s almost certain that Dr Unwin’s success is not because he simply replaces low fat diet sheets with ones for low carbs.
His consultations with patients are unusual and apparently very effective. Rather than the patients explaining their problems to which he offers a solution, usually in the form of a pill, Dr Unwin listens to the problems and then responds by asking questions along the lines of: What would it be like not to have that problem? How could you start to achieve that? It’s a way of leading patients to uncovering and becoming involved in the solutions themselves.
The other element of his technique is to have regular meetings with ten or so patients in a group. It’s impossible to explain why the low carb diet makes sense in a seven minute consultation. In an hour or so it’s much more feasible. What’s more, patients start to make connections and support one another. Getting patients informed about lifestyle changes and motivated to make them sounds like a brilliant way to begin to tackle an epidemic of lifestyle disorders.
Is there no one at C4 who can see what a heartening and uplifting New Year story this could have made? Heroes and villains, clash of titans and a happy ending that could put the human touch back into medicine.