Twitter hack on low-carb cruise – reprehensible! Updated.

Somebody appears to have hacked the Twitter account of Dr Jack Kruse who was to speak on the Low-Carb Carnival cruise ship. A tweet was sent out suggesting that he was planning some kind of bio-terrorist attack. The FBI searched his room and arrested him. Although he was eventually cleared, the ship’s captain refused to let him re-board. It’s unbelievable that some anti-low-carb nut-case would stoop to this kind of thing. Let’s hope the perpetrator is caught and punished.

http://www.wkrn.com/story/18169536/nashville-surgeon-removed-from-cruise-ship

Update: it appears that the Twitter account used was not Dr Kruse’s personal account but one called “shitkrusesays” whose major contributor is known and lives in New York according to this more recent report:

http://www.newschannel5.com/story/18169740/nashville-surgeon-target-of-cyber-attack-kicked-off-cruise-ship

Carbohydrate Intolerance, Institutional Intransigence

It is time for me to share with you the story of Jimmy. He is a respected leader among the Kwakiutl people of Vancouver Island. He is educated and cosmopolitan while also remaining down-to-earth and connected to his home community. He is a bright, intelligent and good-hearted man. I am honoured to count him amongst my friends.

Not that long ago he was also a classic example of the devastation that metabolic syndrome and type 2 diabetes are wreaking in the Canadian Indigenous population. At 48 years of age he had been taking insulin for 17 years. Even with four shots a day of two types of insulin he was not able to get his soaring blood sugars under control. He was medicated for high blood pressure, which also remained stubbornly high. His lipids were bad and his doctor wanted him to start taking a statin. He was significantly overweight and had already suffered from a stroke. He was definitely on track for a bad outcome and likely sooner rather than later.

At that time, I was speaking out about my own diabetic experience where I had corrected everything in very short order by simply removing carbohydrates from my diet. When addressing a First Nations audience, I would draw parallels between my modern low-carb diet and their ancestral diet which was very low in carbs in this part of the world. Jimmy heard me give this talk a couple of times and then the penny dropped. He decided to try eliminating carbs from his diet.

He went to his health centre and got weighed and measured and then he started sending me email updates. I got the first note after two weeks and he reported that he had lost 17 lbs and was now getting normal fasting blood sugars and had stopped taking insulin. Completely. Consider that for a moment. Years of struggling to control blood sugar with heaps of insulin, injecting four times a day, and failing. And now, after one simple dietary intervention, he is completely free of the needle and running normal values.

A couple of weeks later, he reported a total weight loss of 31 lbs and was now normotensive and free of his antihypertensive drug. At nine weeks, he had lost 37 lbs and was continuing to record normal blood pressure and blood sugar readings. At 18 weeks, his total weight loss was 46 lbs and all his markers were normal on no medications. He had his lipids done and those were also within normal range, now, as well.

I asked him if he had exercised as part of this intervention and he said “no”. All he did was take starch and sugar off his plate. And he did this without any books, videos or coaching. At this point, he was still very overweight, yet he was metabolically normal.

That was seven years ago. In the ensuing interval, he has been able to maintain normal cardiometabolic markers as long as he complies with his carb-restricted diet. Apparently there have been a couple of instances of relapsing to a carb-rich diet with predictable results. He reports that the first thing he notices when he eats carbs is that he is suddenly hungry all the time. Then everything goes sideways. His BP goes up along with his blood sugar and his weight. Then, once he gets back on the diet, everything normalizes again.

What I find really remarkable about his story is how clearly it defines the fact that type 2 diabetes is a food intolerance. He has an intolerance to carbohydrates. When he eats them he gets into all kinds of metabolic trouble. When he avoids them, he is fine. When I trained to be a doctor we had a lecture on how you diagnose a food intolerance. That is how it is done. Jimmy is intolerant of carbohydrates and so is everyone else who has diabetes and, I would argue, metabolic syndrome or any other manifestation of insulin resistance.

The excellent series of studies done by Jeff Volek at the University of Connecticut have demonstrated quite clearly that all the features of metabolic syndrome get better on a low-carb diet. Eric Westman at Duke has published evidence that type 2 diabetics do very well on a low-carb diet, much better than on a low-glycemic index diet or a conventional diet. Others have published similar findings in the past, Frank Nuttal and Mary Gannon at the University of Minnesota, for example, who showed that type 2 diabetics can achieve normal blood sugar control by simply restricting carbs and that this can be done in the absence of weight loss.

So the evidence is out there and has been for awhile. Yet, we have a medical establishment that insists that people with profound manifestations of this food intolerance should eat more than half their calories from the very foods they cannot tolerate. And to accomplish this, that they should take a plethora of medications and eventually start injecting insulin, as well.

What’s wrong with this picture?

I was in Denver last week at the annual conference of the Nutrition and Metabolism Society. One of the speakers was a professor of nutrition and medicine, a high ranking functionary in the American Diabetes Association and somebody who is directly involved in producing the guidelines that I find so perverse. I was the moderator of the session in which she spoke and was invited to join her, along with Richard Feinman and Eric Westman, for lunch. I think it was perhaps a little bit inhospitable and maybe even unfair to expect her to defend the whole corrupt edifice of conventional diabetes management but that is essentially what happened as we ate our various salads in the hotel dining room.

Her position was that the ADA relied on the available evidence to make care recommendations and that there wasn’t sufficient evidence to support a low-carb recommendation at this point in time. Okay, fair enough, I guess. They shouldn’t run off half-cocked and should do their due diligence to make sure the recommendations are soundly based in good science. The problem, however, is more nuanced than that. The problem is that the system is exquisitely designed to protect the status quo and it does this in many ingenious ways. The typical review process will set boundaries in terms of which studies can be considered as valid evidence. A typical requirement would be a minimum size for the cohort studied. Obviously, larger numbers give you more accurate information on whether something works, is safe, etc. so this is done for valid reasons. To a point. This is a big problem for the low-carb studies because the researchers who know how to do a proper low-carb trial, who get good compliance and whose results show the true benefits of the diet have real difficulty getting funded from conventional sources. There is a strong bias against this kind of diet, it is viewed with a lot of disdain among conventional nutritionists and some people think it is downright harmful.

Richard Feinman argued that the cut-offs are arbitrary, that there is no evidence that data from a cohort of 10 is any less valid than a cohort of 100. While there is an argument for larger numbers in order to generate sufficient statistical power, he is right in the sense that when the effect size is great (as it is with a low-carb diets) the results from a small number of subjects can be statistically significant and should not be ignored. I would argue that even case studies, like Jimmy’s story, are valid evidence, surely valid enough to justify further research, if not a policy change. Consider Banting and Best. How many subjects did they try their newly discovered insulin on before it became the default treatment for diabetes? How many randomized clinical trials did they run? How many review committees sorted through the studies and generated recommendations?

In any branch of science it is always hard to advance research that supports an idea that is orthogonal to the currently accepted paradigm. To get funded from conventional sources, your research proposal is reviewed by a committee of “experts” who come by their status having advanced through the ranks of believers in the current dogma. They are not going to look favourably on a research proposal that challenges the fundamental basis of their belief system. In this respect, the business of science looks more like a faith-based endeavour than a rigorous attempt to find the truth. At any rate, the upshot is that good research in support of low-carb diets will be under-funded and, thusly, will have smaller numbers. And when the research reviews are conducted, they often fall below the cut-off and their findings are therefore ignored in the setting of policy. (By the way, I have intimate knowledge of how this works as I have sat on research review committees and have watched the defenders of conventional dogma in action.)

So, my ADA colleague’s response to our pleas for the inclusion of a low-carb diet in the guidelines was easily brushed aside for lack of evidence. The system preserves itself at the cost of how much human suffering?

Richard was practically choking on his bunless burger in a fit of apoplexy during this part of the discussion so I whipped out my laptop and pulled up my PowerPoint slides which detail Jimmy’s story. I told her that there was an inexplicable disconnect between the clinical “coal face” and the echelons where research agendas are set and where evidence gets translated into policy. I talked about how his story was not unique, that there are plenty of others like him. Eric confirmed that, in his clinic, he sees these kinds of results all the time. And yet, there is an apparent total lack of curiosity in the research establishment to explore the potential of this powerfully therapeutic intervention. I said that if I had administered a drug to Jimmy to get those results, the research establishment and drug industry would have been all over this in a heartbeat. Richard added that we would all be wealthy from buying stock in the company that brought such a drug to market.

She was unmoved. Her immediate response on hearing Jimmy’s story was that “everyone is different”. Her more extended response was that low-carb researchers should continue to submit proposals to the hostile (my word, not hers) review committees and hope to eventually get funded and then included in the evidence that is deemed substantial enough to influence the guidelines.

Lunch ended shortly after that and she left as expeditiously as she could without actually breaking into a trot. I felt a little badly that we had thrust the whole burden of defending the indefensible onto her shoulders. On the other hand, I don’t know what else we can do at this point but to shout from the roof-tops that an inherently corrupted establishment is ignoring a simple, safe and effective intervention that has the potential to relieve an enormous amount of human suffering while saving the health care system from bankruptcy, even when the evidence is in their face. At some point there has to be some kind of reckoning, some form of accountability for this enormous malfeasance. I hope I see it in my lifetime.

And so, back to my friend, Jimmy. A lot of people will concede that amazing results can be achieved by a low-carb diet in the short term but will argue that nobody can sustain such a “restrictive” diet over the long haul. A few months back, Jimmy sent me this photo along with a report that, after seven years, he has lost another 50 lbs and is consistently maintaining normal cardiometabolic markers on no meds.

Have a look and decide for yourself whether this is evidence that a low-carb diet should be considered a valid therapy for metabolic syndrome and type 2 diabetes.

 

(Jimmy has given me permission to share his story and show his photo)

 

Personal Best

Ski season is winding down. Issy did 25 days. By the end she was getting bored with the usual runs and started demanding to go over the jumps in the terrain park. We looked a sight with her getting a little air on each jump and me following behind hanging onto the tether. Alex and I did about 35 days and had some good double black diamond runs and I was able to shave another minute off my Peak to Creek time.

Here is the latest – 7 km in 5 minutes for an average speed of 84 kph (52 mph).

I added some suitable music. Enjoy!

Finance and Nutrition

The Republicans and Democrats share two key characteristics. The finance industry is the leading political contributor to both parties and both parties’ views of finance are largely shaped by neoclassical economic views that are false, destructive, and so dogmatically held that they have remained immune to repeated falsification by reality.

– William K Black

(Read more: http://www.benzinga.com/general/topics/12/03/2445916/bluto-please-smash-the-guitar-and-end-the-bipartisan-deregulatory-kumba#ixzz1qo3nTze4)

When I read this comment by Prof. Bill Black, an outspoken critic of the out-0f-control US financial sector, it struck me that he is describing a situation very similar to what we see in the nutritional science and agri-food sector. The way that the influence of monied industry interests has distorted the process in their favour at the expense of the general public is eerily similar in both cases, IMHO. We go on clinging to an obviously discredited paradigm in the face of compelling evidence to the contrary while chronic disease rates rise and health status goes into decline. Why?

I shall be blogging more on this topic soon.

White rice = DIABETES!

This is becoming humorous. Earlier this week the media was full of stories about the Harvard study published in the Archives of Internal Medicine, which purported to show a link between meat consumption and early mortality. The gleeful dancing of the vegan lipophobes was evident everywhere. One of their leading gurus, Dr Dean Ornish, was moved to write an editorial which opened with this statement: “Is meat bad for you? In a word, yes.” (http://archinte.ama-assn.org/cgi/content/full/archinternmed.2012.174).

The story had prominent exposure in the Huffington Post (http://www.huffingtonpost.com/2012/03/12/dean-ornish-red-meat-heart-disease_n_1339964.html) where Dr Ornish is the medical editor. Even though the study is deeply flawed and proves exactly nothing, it is being heralded everywhere as if it were proof of the second coming.

So, it was interesting to find another similar study reported in the Huffington Post earlier today. Featured on the front page was this: http://www.huffingtonpost.co.uk/2012/03/15/white-rice-increases-type-2-diabetes_n_1347972.html.

This article originating in the UK edition, cites a study which linked white rice consumption to type 2 diabetes. Even though it uses basically the same methodology as the meat study, it doesn’t have all of its flaws and it found a stronger association. Not only that, but it found a dose-response relationship, something missing from the meat study until the statistics were manipulated. The white rices paper was a meta-analysis of a number of individual studies, all but one of which found some degree of association.  Since it is a meta-analysis, it is arguably better quality evidence than what one would find from a single observational study. So, on balance, from a scientific perspective, the evidence for the white rice link to diabetes, although still observational, is stronger than that which links meat to mortality.

To further add to the irony, the study in question was produced by the same Harvard researchers that produced the meat study. It is published in the British Medical Journal (http://www.bmj.com/content/344/bmj.e1454).

Naturally, the comments section at HuffPo is full of disbelief from the folks who subscribe to the ideology that meat is the root of all evil and no plant food could possibly do harm.

Although the white rice article was featured on the front page of the US edition this morning, it has entirely disappeared now. It can still be found in the UK edition. I guess it had slipped through before Ornish got out of bed.

I suppose it would be futile to expect another accompanying Ornish editorial which says: “Is white rice bad for you? In a word, yes.”

Sound of crickets …

Red meat = DEATH!

I am sure everyone has heard about the latest Harvard study which suggests there is harm associated with the consumption of red and processed meat. Don’t panic. It, like most other epidemiological studies on nutrition and health, is deeply flawed. There are some excellent critiques already in circulation so I am not going to write another.

I highly recommend Gary Taube’s take on it at:

http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/

Also, somebody new to me, Zoe Harcombe, an enlightened nutritionist in Wales, who has also studied math and economics:

http://www.zoeharcombe.com/blog/

And, if that hasn’t convinced you not to worry, see what J. Stanton has to say at:

http://www.gnolls.org/2893/always-be-skeptical-of-nutrition-headlines-or-what-red-meat-consumption-and-mortality-pan-et-al-really-tells-us/

It’s disappointing but not surprising to see this kind of poor quality research being published. As I have often said, if poor quality results like these went against the conventional wisdom, they would not make it into the high impact peer-reviewed publications. It’s a bit of a rigged game, unfortunately. Luckily for us we have intelligent, incisive folks, like those above, who can pierce the veil of BS and give us comfort that we are, in fact, on the right track with our LCHF dietary choices.

Enjoy your steak and bacon!

It’s not just about weight loss.

I read with some amusement the debates in the blogosphere about whether the insulin/obesity hypothesis (as espoused by my friend Gary Taubes) accurately explains the obesity epidemic or whether some other mechanism is at work, like the food reward hypothesis (as promoted by Stephen Guyenet). Although I clearly fall into the Taubes camp on this, I also think there is a lack of real world sensibility in having the debate at all (I think Gary might agree with me on this). So far, as I see it, the whole argument revolves around what causes obesity. While I agree that obesity is a big problem and that there must be some kind of valid explanation for why this epidemic has taken off over a few recent decades, what is missing is recognition that it’s not just about weight. The weight gain is associated with other chronic conditions which are actually the real issue. The current paradigm implies that weight gain is a causal link in the chain that connects to diabetes, cardiovascular disease and a host of other common conditions. I think that weight gain is not, in and of itself, causal. It is another of the conditions that are symptomatic of the underlying cause which is related to carbohydrates in the diet. The fact that you can have thin people develop hypertension, diabetes and heart disease suggests that weight gain is not causal. The fact that you can have obese people with normal cardiometabolic markers and outcomes reinforces this observation. So, when it comes to applying a therapy that is effective in offsetting the harms associated with weight gain (note I said “associated with”, not “caused by”) it is important to address the actual underlying cause. The evidence supporting the highly effective therapeutic use of LCHF diet for these conditions reinforces the idea that dietary carbohydrates are, in fact, the cause. Perhaps we need to add the qualifier, “in susceptible people”. In any case, clinicians who use this approach report remarkable results that go beyond the effectiveness of the usual drug based therapies. It all hinges, of course, on compliance.

The benefits of LCHF actually extend into other realms of pathology that have been hitherto unexplored in terms of a potential dietary cause. I have collected a few anecdotal reports of the kinds of things that continually amaze me when it comes to the benefits of LCHF.

Arthritis

A few years ago, after I had just figured out that a LCHF diet had fixed my own diabetes and metabolic syndrome, I began to speak out about its potential benefits for others. At the time, I was the Regional Director of the Pacific Region of First Nations and Inuit Health Branch of Health Canada. I was asked to speak at an annual meeting of the nurses who worked in rural and remote First Nations communities so I gave a talk about my experiences in reducing carbs and proposed that it might be useful for the management of their diabetic patients. After the meeting ended, I was approached by a nurse who told me a remarkable story. She was caring for a First Nations woman who had severe, debilitating osteoarthritis. The disease was so severe that the woman could not get off a chair without assistance. The woman was overweight so, for whatever reason, the nurses put her on the Atkins diet. After an initial weight loss of a few pounds, the woman relapsed and regained the weight and then tried the diet again. What was remarkable about this was that, as soon as the diet was started the arthritic pain virtually vanished. It returned when the diet was discontinued and vanished again as soon as it was re-started. Clearly this amazing recovery was not associated with weight loss, but rather was directly attributable to the diet. Later, when I met with Dr Eric Westman for the first time, one of the questions I asked was whether he had seen anything like this in his patients. He said he had. I have since heard similar case reports from others who use LCHF diets in their research or clinical practices. So far, I am not aware of a study that has looked at this specific finding but I continue to hear anecdotal stories of this kind of benefit from LCHF.

Milroy’s Syndrome

When we did the trial in Alert Bay, one of the subjects was a man who suffered from Milroy’s syndrome. This is a rare condition where the lymph system malfunctions and fluid accumulates, usually in the lower limbs. The only treatments are mechanical massaging to force the fluid out and the use of devices such as support hose to minimize the accumulation of fluid. In this man’s case, the condition had progressed to the point where he didn’t want to be seen in shorts because of the disfiguring swelling of this legs. After a few months on the LCHF study diet, his condition had almost completely resolved.

Hemochromatosis

Recently, I was contacted by a physician who has implemented a successful diet program in the small village in which he practices. We have been collaborating in an effort to ensure that the considerable weight loss achievements of his patients is sustainable over the long haul by re-introducing fats into their diets once they reach their weight loss targets. He has more recently been starting people on a LCHF diet at the outset. He contacted me to share the details of a woman who he was treating for hemochromatosis. This is a pathological condition where the body has excess iron stores. Left unchecked it can damage major organs and leads to other serious diseases including diabetes, cirrhosis, cardiomyopathy and arthritis. The most effective treatment is phlebotomy, ie blood letting. The woman he was treating was in constant pain and needed phlebotomy every 2 to 4 weeks. After she started the Atkins diet, she went into remission. The pain went away and she no longer needed phlebotomy. She relapsed on the diet and the pain and hemochromatosis returned. After some more phlebotomies, she re-started the diet and has been symptom free and has required no phlebotomies now for the past eight months.

Crohn’s Disease

I received a recent update from another successful diet project that I have been assisting in another small community. The results are pretty good for weight loss but, again, the most remarkable story is about a different condition. In this case it is Crohn’s disease. This is a very debilitating inflammatory condition of the bowel that makes life miserable for the sufferer and which is treated with a variety of drug and surgical interventions. There is no cure. A woman who had suffered from Crohn’s for twelve years went into complete remission after switching to a LCHF diet. Her symptoms completely resolved and her most recent endoscopy found no signs of the disease. She apparently cried upon hearing those results. I can understand why.

 

Obviously these are just case reports and more research would be needed to verify that these and possibly other conditions can be treated or cured by switching to a LCHF diet and to rule out other possible confounding factors. For the time being, however, those who suffer from these conditions should be encouraged to try the diet. As we now know, there is no downside and the potential upside could be seriously life-altering.

LCHF is about so much more than just weight loss. Eventually the research will be done to explore these other benefits. In the meantime, these squabbles about the various arcane explanations for weight gain that overlook both the well-documented and the anecdotal accounts of the other benefits of LCHF are seriously missing the mark. The proof is in the LCHF pudding, IMHO. And, as you can see from the photos of what I eat in earlier posts, you would have to agree that there is no shortage of “food reward” in the LCHF diet that I follow.