The Diabetes.co.uk saga just won’t go away. There is a group there, posting on the low-carb forum, who are engaged in a battle of epic proportions (in their minds) with their arch-nemesis, Eddie, who runs his own counter-blog at http://thelowcarbdiabetic.blogspot.com/. If you have read my earlier posts on the subject you are familiar with this situation. There is obviously a long history of discord there and a lot of sniping back and forth pretty much on a daily basis, from what I can tell. Based on my experiences, which I have already detailed here, my sympathies lie with Eddie and his cohort of true low-carbers. Their main beef with the others appears to be that they pay lip service to a low-carb diet but, in practice, appear not to be doing a true low-carb/high-fat diet and are openly critical of those who do. People often display HbA1c values that are much too high, even when they are taking meds while claiming to be doing low-carb at the same time. In addition, some of the claims in terms of what people are actually eating are preposterous. For instance, some argue that low-carb and low-fat is a sustainable diet when they are weight stable. This is an impossibility, of course, unless you are getting significant calories from alcohol, perhaps. Given the state of mind reflected in some of these posts, one does wonder about that. When the scientific realities are pointed out, defensive comments appear claiming that “everybody is different” as if the rules of nutritional science don’t apply to them and nobody should be forced to do anything they don’t want to do, etc. etc. ad nauseum. Now that I have become mixed up in this, and since Eddie has been posting flattering things about me on his blog, I have started to notice people trying to transport their troublesome nonsense here.

Here is a classic example that just arrived from “carbophile”:

It’s a pity you don’t feel offended by any of Eddie’s posts…but then you are hardly one of his targets are you?

Whilst I have sympathy for your experiences in DCUK, I find it surprising that an MD would suggest any treatment plan without first finding out histories of those he’s trying to treat.

I have nothing against a LCHF diet, but the perception that it is a panacea for diabetes denies our individuality.

OK – I could engage “carbophile” in a debate to explain why those are unsupportable statements but I am not going to allow this kind of rancourousness to infect my blog. If you want to argue with Eddie, do it on his blog. If you have anything to say about my posts on DCUK, reply there. I have zero interest in the childish back and forth nonsense that has made DCUK an inhospitable place for people who have genuine expertise to share and for people with diabetes who should be benefiting but who are put off by a hostile environment.

I am happy to have a civil debate with anyone who has a position different from mine, but, be advised that I will not be allowing posts like this here. If that appears unclear, please give it some further thought as you take a long walk on a short pier!

Since my interesting experience at diabetes.co.uk a few weeks back, it appears that things have changed for the better over there. You may recall that I started posting on their low-carb forum and quickly found myself in a protracted argument with the forum moderator and a group of his supporters. The problems stemmed from the fact that the moderator et al were claiming to be eating a sustainable diet that was very  low in carbs and also low in fat. As you may know, this is possible while one is burning off stored body fat, but once weight has stabilized, those stored calories need to be replaced with dietary calories, preferably from fat. I had patiently laid out the argument with examples of daily menus which showed that the claims of the low-fat/low-carb folks were unsupportable. I persisted because it appeared to me that this important low-carb venue was leading people astray on the benefits of low-carb/high-fat. Many of the posters there were proud of their HbA1c’s on their version of low-carb but were also taking meds. And, not all of them were achieving normal HbA1c levels, even when combining “low-carb” and meds.

When the moderator was not able to refute my arguments he began to delete my posts and eventually labeled me a troll and permanently banned me from the forum. I was then contacted by another fellow who, as it turned out, was one of the original moderators of that forum and a proponent of low-carb/high-fat who had met a similar fate. I found myself caught up in a struggle that had been going on for some time and in which the current moderator and his preposterous dietary claims had, until now, prevailed.

Things got more interesting when I alerted Jimmy Moore to what was happening across the pond. Jimmy contacted the former moderator and interviewed him on his widely read blog, www.livinlavidalowcarb.com. Things began to change quickly after that. I soon received a sincere apology from one of the administrators of diabetes.co.uk and the moderator and his side-kick were suspended. My “permanent ban” was lifted and I was, once more, allowed to post on that forum. There was a slight hiccup when a new moderator took over (someone proud of a HbA1c of 9.7!), who again banned me. The reason was not given but I suspect it was for “promoting a low-carb diet” for which I had been admonished after suggesting that once you have type 2 diabetes you have two choices: very low-carb and no meds or recommended diet and meds. Interesting that one can be banned for “promoting a low-carb diet” on a low-carb diet forum. Once again, however, when he was alerted to the situation, the administrator apologized and re-instated me.

I have been observing and making the occasional post over the past few days and I have to admit that the atmosphere seems to have improved. The original moderators are nowhere to be found; clearly a good thing. Also, their band of sycophants and supporters seem to be much more muted in their non-sensical ranting. I am hopeful that this forum has, once again, become a place where diabetics can benefit from accurate advice on low-carb/high-fat dieting.

Seems like that old saying is true: the best disinfectant is sunshine.

I have had the opportunity to have another look at a very successful diet program recently. I will reflect on what have been the elements of that success, but, first the more important stuff.

Isabelle is thriving. She is all of 22 months now and still eating little in the way of carbs and virtually zero sugar. There are times that she might eat a strawberry or chew on a piece of apple but her food preferences are for protein and fat. We don’t limit fruit, it is just her preference. She has always been a chatterbox but recently she has begun to speak english. And, even at this early stage of language development, she is starting to tease her dad. We had a little incident a few weeks ago where a large latte was left on the roof of my freshly washed white car. Of course, as I began to drive it splashed all down the side leaving a mess not unlike that of a seagull in gastric distress. Everyone had a laugh at Dad’s expense, including Isabelle. From that point on she started to tease me with “car so bad”. From first thing in the morning to when I arrive home from work, her first words for me are “car so bad”, to which I reply, “nooo, daddy’s car is good”. She is a delightful little girl and cute as all get out, too. She brings a huge amount of joy into all our lives. And, she still has not had a fever or a rash. I am more convinced than ever that the absence of sugar has a huge positive impact on her immune system function. There has been scientific work in this area. Here are some references that I got from Barry Grove’s website (www.second-opinions.co.uk ) that make the case for increased starch and sugar consumption causing a significant reduction in the ability of immune system cells to neutralize bacteria:

Kijak E, Foust G, Steinman R.R. Relationship of Blood Sugar Level and Leukocytic Phagacytosis. South Calif Dent Assn 1964; 32: 349-351

Sanchez A, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973; 26: 1180-84.

Ringsdorf WM jr, Cheraskin E and Ramsey RR jr. Sucrose, Neutrophilic Phagocytosis, and Resistance to Disease. Dent Surv 1976; 52: 46-48

I have just returned from a visit to two small towns in southern British Columbia, Midway and Grand Forks. Firstly,  I have to say that this is a beautiful part of the country and is well worth a visit just for the surroundings. However, my time there was not for tourism but related to, what else, diet.

Something interesting is happening. You will recall that I was recently in Valemount, BC where Dr Stefan DuToit has been running a highly successful diet program for the local population (see my earlier post: Village(s) on a Diet). Although the diet he is using is more restrictive than what I would recommend in terms of calories and fat, and although it is not as low in carbs, his dieters routinely achieve significant weight loss and usually correct their metabolic problems while getting off their meds. I recall one gentlemen telling me he is saving $500 per month on meds. Another woman showed me her before photos and told me she had lost half her body weight. One of the most remarkable aspects of Dr. DuToit’s approach is that he gets very high rates of compliance on a diet that I think is not that easy to follow. In my discussions with other physicians and public health types about this, the common observations are that this is a flash in the pan, that it will prove to be unsustainable and that the initial success is likely due to Dr Du Toit’s charisma and is therefore not reproducible.

Well, it turns out that this may not be true at all. The longest running Valemount dieters are now at about 18 months. There has been some attrition but the majority appear to be sticking with it. We have been helping Dr DuToit manage the transition to a diet that will be sustainable for the long-term by adding fat back in once maximum weight loss has been achieved. He thinks this will be the key to long-term success. We will continue to monitor the data from his groups and, hopefully, will have something he can publish so that others can benefit, too.

In the meantime, however, some other sites have started using Dr DuToit’s diet and are also demonstrating excellent results. A group has started in McBride, BC, a small town about an hour’s drive from Valemount. The physician there tried the diet, lost weight and has now recruited a bunch of local people who are losing weight and getting off their meds just like their neighbours in Valemount. And, since then, another project has sprung up in Midway, BC, a southern town smaller than Valemount. In that case, a local public health nurse who learned about Dr DuToit from the CBC news coverage a few months ago, travelled up to Valemount to join one of his groups. Both she and her husband did very well on the diet and now she has started a group in Midway. This is not led by a physician but the local doc is open-minded and supportive. Again, the results are startlingly good.

What does all this mean? For starters, it means that there is some validity to the approach that goes beyond the effect of a charismatic doctor (not to suggest the doctors mentioned here are not charismatic; they are). It also means that the results are reproducible. Not only is this a model that can be implemented in a family practice setting by a doctor, it can also succeed when it is led by a non-physician. This is pretty exciting.

Until now, my physician colleagues have not had a stellar track record in terms of getting their patients to lose weight. I think this is largely because we haven’t developed a quick and ready approach that is amenable to the real-life realities of general practice medicine. If it were as simple as writing a prescription, they would be all over it. Since it is not, and since the failure rate of the currently accepted approach (eat less, exercise more) is so abysmal, I think it is completely understandable that my colleagues have, for the most part, abandoned the field. And this is why I think it is so fascinating to figure out what is the secret of the huge success of Dr DuToit’s approach.

We are hard at work analyzing the data but I don’t think that is where the answer necessarily lies. I think the initial diet is so significantly lower in carbohydrates that the subjects do benefit from de facto carb restriction more than the calorie restriction. And, you can restrict fat early on as you are burning off your stored body fat. So the diet he has been using, in the early stages, makes sense from a low-carb diet perspective even if it is not quite as low as I would recommend. In addition, however, I am very impressed with the effect of the group dynamics. He has his dieters meet together once a week for an hour. I have attended a couple of these sessions and they remind me a little of what an AA meeting might be like (I have never attended one of those). There appears to be something compelling to be part of, and accountable to, a group of others who are engaging in the same struggle. There has been research that supports this idea and certainly there are examples in the commercial diet industry that incorporate the concept of group support.

Having said that, there are other elements of this success that need to be considered. For instance, is there something unique about a small community that contributes to better compliance? As someone pointed out to me, “everybody knows your business”. Perhaps one is more determined to succeed if there is the perception that everyone is watching. If this is the case, the anonymity of a large city would make it easier to relapse. It would be interesting to test that idea (not that I need any more research questions at the moment).

I will continue to study Dr DuToit’s diet and perhaps we will eventually publish something. If he has solved the problem of what a physician in a general practice setting can do about reversing obesity, he will have done everyone a huge service. I will keep you posted as I find out more.