Who benefits when dissenting doctors are dismissed as foolish and dangerous?

By Jerome Burne

Unless you have been down in the trenches of the Great Nutritional war, where low carb radicals are challenging decades of warnings from the nutritional establishment about the dangers of fat, you may well be confused about what a healthy diet is. Are carbs or fat the nutritional demon? 

The answer should come from good research. Too often a key factor is who pays for that research. 

A clear example of the misleading way this debate is being conducted surfaced in a recent edition of the Mail on Sunday (MoS) which had mobilised several senior supporters of the low-fat high carbohydrate (LFHC) school to discredit a small but interesting research project designed to test the benefits of the lhigh fat low carb (HFLC) or ketogenic approach with endurance exercise.

The project involved eight  people covering 100 miles in five days while fasting – so zero calories – using stored fat for fuel in the form of ketones.

Three were health professionals and two of the group were type-1 diabetics (T1D). The rest were healthy and knowledgeable about diet and exercise and included the retired Olympic rower James Cracknell. As the celebrity, he was the target of the MoS attack. 

Our diets are not in safe hands

The fact paper bothered to “monster” a small study into the biochemistry of energy use is at first sight, curious. First impression, if you were at all familiar with the ketogenic diet, was just how little these senior nutritional experts knew about it. 

 Given the amount of coverage the ketogenic diet has had and the number of positive clinical reports and studies backing its effectiveness as a treatment for type-2 diabetes (T2D), this does suggest that our diets are not safe in their hands.

From the opening paragraph, there was no doubt that this was an attack rather than any attempt at an expert exchange of views. The headline: “Was this James Cracknell’s daftest stunt ever?” – set the tone. The reference was to one of his previous physical challenges – rowing naked across the Atlantic. 

One expert was quoted as branding the venture as ‘dangerous, irresponsible and a really, really stupid idea.’ ‘Even two or three 60-minute sessions of exercise without eating before (sic), can dramatically suppress the immune system,’ claimed another.

Why attack serious research on nutrition? It’s so rare

So scary stuff, although the average reader might be puzzled as to why the Mail on Sunday was taking the sort of censorious tone usually reserved for models or Love Island contestants wearing a VERY skimpy bikini top. Why on earth was the tabloid so worked up by a study of real-time energy use? This is precisely the kind of research nutrition desperately needs and is rarely done. 

It was the brainchild of a GP called Dr Ian Lake who is a type 1 diabetic, which means he’s unable to make insulin to clear glucose, probably due to an autoimmune disease, and so has to inject insulin daily.

The low carb or ketogenic diet has already had a dramatic impact on the treatment of type-2 diabetes.  It turns conventional dietary advice – to get about half your calories from carbohydrates – on its head. Many with the disorder have been able to reduce or stop their drugs by changing their diet and greatly reducing the amount of carbs they eat. 

The aim of Dr Lake’s experiment – called ‘Zero Five 100 – zero calories five days 100 miles’ – was to investigate the safety and effectiveness of doing endurance exercise while fasting for T1D, healthy people and endurance athletes. 

As the website explains, ‘It was a serious scientific endeavour involving data gathering and health checks along the way.’ Before setting off, the participants, who included nutritionist Dr Trudi Deakin and NHS Practice Nurse Gayle Gerry, followed a low carb ketogenic diet for two to four weeks to put their bodies into fat-burning mode. 

The problems dietitians have with ketones

The body’s response to a drop in carbohydrate intake to less than 50 grams a day is to start releasing fat from fat stores, which can provide all the energy you need. Fatty acids can power the muscles and high energy compounds, called ketone bodies, made from the fat, can fuel the brain. You don’t need carbohydrates for energy.

‘The project,’ says Dr Lake ‘was intended to explore concerns raised by sports scientists and medical specialists regarding the safety and practicality of the ketogenic diet, especially as a treatment for diabetes. It was deliberately extreme to find out about the practical limits of the ketogenic lifestyle.’

Dr Trudi Deakin, who had trained dietitians in the NHS and then left to set up the charity X-PERT health specialising in diabetes, commented: ‘It’s well established that the ketogenic diet can halve the amount of insulin people with T1 diabetes need,’ she says. ‘Even so, traditional dietitians still have a real problem understanding ketones.

‘During the journey, I had a ketone level of 7.6, far higher than they would be comfortable with, and my glucose was 4. I felt absolutely fine; very positive and absolutely no stiffness.’ 

‘When I did my nutritional training, we were taught we all needed frequent meals and snack and carbohydrates to supply glucose for energy. It’s an idea that has been a disaster for diabetics particularly. The trip showed it is possible to safely not eat at all for five days and take a lot of exercise. The media should be celebrating this sort of research, not taking potshots at it.’

Ketones are found in breast milk

 A major concern of the experts quoted by the MoS was that going without food for that long would be very damaging especially while doing hours of aerobic exercise. But this ignores the large stores of energy in our fat available to be turned into ketones. For example, a 60kg woman with a typical 25% of body fat is carrying 135,000 calories. The five-day event would use up around 20,000 calories from fat from released from storage. 

Another of the dangers the MoS experts claimed made the project irresponsibly dangerous was that a low carb/ketogenic diet creates a state called “ketoacidosis” when the blood becomes acidic, “which can put you in a coma within hours.”

 It’s true that this can happen to diabetics under certain conditions but as Dr Lake points out, harmful ketoacidosis should not be confused with ketosis – the production of ketones – in T1D diabetics. This is an entirely natural and healthy state. Babies are born in ketosis; ketones are found in breast milk. 

There were other technical issues that the two sides disagreed about but what was clear was that those engaged in the MoS finger-wagging were official experts on diet and nutrition who knew little about ketosis. Not that their favoured LFHC model was performing well in the real world. 

‘Fewer than 10 per cent of people with type 1 reach the NICE guidelines target for blood sugar levels,’ Dr Lake points out. In contrast, 90 per cent of those on a ketogenic diet hit it.’ This is not just about competing theories; there are lives at stake.  

Editor’s speciality in mocking takedowns 

But this mocking and dismissing of ideas that challenge officially sanctioned treatments is a speciality of the health editor of the MOS Barney Calman. Last year he attempted to take down three doctors who had been highly critical in medical journals and the press of the long-running official advice to take statins to cut your risk of heart disease. Under a headline in large type reading – “Statin Deniers” – pictures of the three were lined up as if in a wanted poster. This can now be seen as a precursor to the attack on the ketogenic diet.

There is a good reason to be sceptical of statin’s effectiveness and safety as a way of reducing heart disease deaths and related illness. The evidence from the trials that claim to support cholesterol-lowering with statins has never been seen by any independent researchers and the side-effects,. such as muscle pain, new-onset diabetes, fatigue and loss of libido, are regularly downplayed. 

Identifying cholesterol as a killer was part of the very dubious theory that saturated fat – found in high cholesterol foods – caused heart disease. So downplaying the risks of saturated fat threatens the statin market. As with the attack on the ketogenic research, Barney Calman’s assault on those challenging the wisdom of statin prescribing took no prisoners. Criticising the drugs was wrong, ignorant and threatened health. End of. 

This time UK Secretary of State for Health and Social Care Matt Hancock was wheeled out to dismiss the ‘deniers’ claims as  “pernicious lies”, “conspiracy theory“, “reckless and ignorant misinformation”. Followed by the unsupported claim that: ‘hundreds of thousands could be persuaded to stop using the drug, causing thousands of extra heart attacks and strokes.’

A special place in hell for statin deniers

To ram home just how evil and malicious the deniers were, a quote was placed on the page above a picture of Calman warning, bizarrely: ‘There is a special place in hell for the doctors who claim statins don’t work.’ 

Any pretence of following evidence-based medicine had vanished in a puff of satanic smoke. This is worrying since the man laying into scientists who had looked at the data for statins and found it very unconvincing, is now making policy and ‘following the science’ over Covid-19. Uncertainty about the benefit or safety of a vaccine must have long been dropped in the box marked ‘devil’s work’. 

Lurking behind this ramping up of a crackdown on dissenting science is the issue of money. It seems that in the scientific approach in medicine, supposedly rooted in debate and testing rival hypotheses, has been hardening into dogma. If ‘science’ says something is true, then disagreement is not only wrong but also unscientific. So what matters is who controls or funds the science. 

It’s widely assumed that the major players are the drug companies. They sell an estimated 10 billion pounds of drugs to treat diabetes and the ketogenic diet not only threatens that but also the statin market if cholesterol emerges as barely a factor in heart disease.  But clear evidence is hard to come by. 

Was big money behind the monstering?

However, a study reported in the BMJ last year, under the title: ‘Exposing drug industry funding of UK patient organisations’ (BMJ 2019;365:l1806), provided clear evidence of a link between drug company funding and by far the largest charity Diabetes UK and claimed that this connection is damaging to patients.

The researchers found that drug companies provided over £3 million to Diabetes UK and points out that such charitable organisations: ‘are increasingly involved in policy and research. With a few exceptions, this study underscores that financial ties to an industry driven by profit, risk turning patient organisations into seemingly independent “third parties” that promote novel medicines, often with problematic clinical profiles, cost, or cost-effectiveness.’ 

The Times claimed that Diabetes UK had failed to reveal this funding, in its accounts as it is required to do.

Is it really a conspiracy theory and fake news to suggest that Barney Calman, Matt Hancock and supporters of the LFHC healthy eating advice were, albeit possibly unknowingly, not following the science but dancing to the tune of an ‘industry driven by profit’?