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 …

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!

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.

When I attended the big scientific conference on Pre-Diabetes and Metabolic Syndrome in Barcelona in 2007 (I have blogged about my clash with Dr Frank Sacks there previously), the program included a lecture by Dr Jesse Roth, a gentlemanly old professor, who had an impressive resume including significant work at the senior level of the National Institutes of Diabetes and Digestive and Kidney Diseases. He spoke about which came first, insulin resistance or hyperinsulinemia. In the course of his lecture, I thought I detected somebody who might be sympathetic to my interest in LCHF diets so at the end I approached him and asked whether the development of insulin resistance might be the cell’s defence against too much intracellular glucose. He responded, quite unequivocally, that the cell didn’t want to burn glucose but did so only because the body had to get rid of it. As often happens in these settings, somebody else intercepted him with another question before I had a chance to follow-up. Nevertheless, his comment got me thinking about one of the principle arguments that we hear in defence of dietary carbohydrates, that glucose is the preferred fuel of the cells in our body. This idea is often used to justify a diet high in carbs, even among people who have carbohydrate resistance.

It is true, when you present a range of fuels to the cells, glucose, fatty acids, protein, mainly, the cells will burn glucose first. From this we deduce that they do that because they prefer glucose. What if the opposite were true; that they burn it because they don’t like it and must dispose of it as quickly as possible?

Consider that, if you have a normal blood sugar, you have about a teaspoon of glucose in your blood. It’s not that much when you think about it. Your body likes to keep it in that range and will go to extremes to make that happen. If your blood sugar drops too low, you are at risk of impaired brain function, loss of consciousness and possibly death. This is what sometimes happens to type 1 diabetics who take too much insulin for the amount of carbs they have eaten. If you have a normal metabolism, your body has methods available to ensure this does not happen. If your blood sugar drops too low, you will release glucose from your glycogen stores and, if you deprive yourself of dietary sources of glucose, over time your liver will kick in with gluconeogenesis to convert protein to glucose.

On the other hand, if your blood sugar gets too high, your body goes to work to correct this problem, too. Consider that if you have an excess of as little as a half a teaspoon of glucose in your blood, over time that will cause serious harm. This is what happens in uncontrolled diabetes. Think of that for a moment – as little as a half a teaspoon of excess glucose will harm you over time. Does that not suggest that glucose is a toxic substance? Well your body thinks so because it goes to extraordinary lengths to keep your blood sugar in the normal range.

The primary agent that the body uses for this purpose is insulin. I am sure most are familiar with the idea that insulin is needed to let glucose into the cells so it can be burned. This is one way of disposing of excess glucose. It turns out that insulin has other ways to attack this problem, too. In the presence of high blood sugar and high insulin levels, the liver will turn glucose into fat. And, at the surface of the fat cells, when insulin levels are high, the fat that travels in the bloodstream in the form of triglycerides, is pushed into the fat cells and kept there. All this makes sense when you consider that it is done to keep glucose levels down in the normal range. It is pushed into the cells to be burned, it is turned into fat which is pushed into the fat cells where it can be kept out of the way so as not to interfere with the primary goal of burning off the glucose as quickly as possible.

Think again of that normal amount of blood glucose – one teaspoon. And consider what happens when you eat a typical high-carb meal. Let’s say you have a nice pasta dinner like the ones I used to enjoy in an earlier life. A big plate of pasta represents a lot of starch, all of which gets digested and absorbed as glucose. Add a nice foccacia bread which is also a starch. And for dessert, let’s have a big piece of apple pie a la mode (I used to make excellent pies). The crust of the pie and the sugar in the fruit and ice-cream all contribute to the flow of glucose from the gut into your blood stream. Ah, what the heck, let’s finish with a nice cup of coffee sweetened with a couple ounces of Bailey’s. Sounds pretty yummy, right? I used to eat like this all the time, right up to the point where I got type 2 diabetes.

Consider what is going on at the metabolic level when you eat a high-carb meal like that. Think of the amount of starch and sugar you have eaten which is quickly digested and flows into your blood in the form of glucose. There are many teaspoons of glucose in that meal. What you have done is you have created a metabolic emergency. Your body is desperate to keep your blood glucose in the normal range while your bloodstream is being flooded with glucose from that meal. You can imagine the work that insulin must do, and in fairly short order, to control this flood of glucose and to protect you from its toxic effects. It is no wonder that our metabolic systems break down as we continue to eat this way over the course of years, with the development of insulin resistance, hyperinsulinemia and, eventually, for a lot of us, type 2 diabetes.

Now, consider the possibility that we weren’t meant to burn glucose at all as a primary fuel. Consider the possibility that fat was meant to be our primary fuel. In my current state of dietary practice, I am burning fat as my main source of energy. My liver is converting some of it to ketones which are needed to fuel the majority of my brain cells. A small fraction of the brain cells, around 15%, need glucose along with a few other tissues like the renal cortex, the lens of the eye, red blood cells and sperm.Their needs are met by glucose that my liver produces from proteins. The rest of my energy needs are met with fatty acids and these come from the fats I eat.

If you have seen my earlier posts on physical stamina, you will know that I believe my exercise capacity is certainly much better now than it ever was when I was eating a high-carb diet and depending on glucose for my fuel. There is evidence that the brain, when burning ketones, is more efficient than when it is burning glucose. Less oxygen is needed to produce ATP, the energy molecule, when burning ketones. It also appears that when burning fats and ketones, the problem of excess oxidative stress is resolved. Oxidative stress is being implicated in a host of pathological conditions and may very well be the common factor that explains why serious diseases like cancer, heart disease and diabetes are linked. I also know that my inflammatory markers are very low on a low-carb high-fat diet. We know that there is an inflammatory underpinning to chronic diseases of all types. The inflammation and oxidative stress problems are linked and there is a bit of a chicken and egg issue there in terms of which causes which. It is somewhat moot, however, when it comes to a LCHF diet since both are profoundly reduced.

Another way to look at the question of whether fat is the preferred fuel is to ask yourself, in what form does the body store fuel? We store some glucose in the muscle and liver in the form of glycogen. This is available in times of acute stress as a fast source of emergency fuel but it doesn’t last very long. Our glycogen stores are quickly depleted. The long term storage form of fuel is fat. We store both the fats we eat and the carbs that our liver converts to fat in our adipose tissue. When we need to access that fuel, we release it as fatty acids and burn it as such. We don’t convert it into glucose. This implies to me that the body prefers fat over glucose.

If you accept that we were meant to eat primarily fat rather than carbs, then the question arises as to whether different types of fat are better than others. We have long been admonished about the dangers of saturated fat because of the purported causal link to heart disease. Saturated fats are those that tend to remain solid at room temperature. Butter, coconut oil, bacon fat, lard and the fats on meat are examples of fats that have high proportions of saturated fatty acids. Recently, however, the evidence that supported this idea has been under attack and there is newer  and more convincing research showing that, not only does dietary saturated fat not cause heart disease in general, certainly in the context of a low-carb diet it may actually improve your cardio-metabolic risk profile. At the same time, meta-analyses of research on fat consumption and obesity rates are confirming that fat in the diet is not the cause of excess body fat.

On the other hand, the vegetable oils that we have been encouraged to eat in place of saturated fats, are being implicated in the rise in chronic disease. Remember that inflammation is an important underpinning of chronic diseases of all types. It turns out that the vegetable oils that have become ubiquitous are very rich in omega-6 fatty acids and these are implicated in the promotion of inflammation (this is why you are advised to avoid most vegetable oils with the exception of olive oil and canola which are relatively low in omega-6). So, it is important to consider which fats and oils you are eating after all but not in the way most people think.

One last piece of this puzzle fell into place for me when I collaborated with my friend and colleague, Dr Steve Phinney , to study a popular west coast traditional food, oolichan grease. The west coast First Nations people ate a traditional diet that was high in fat and low in carbs. An important part of this diet was a unique marine oil. They have been harvesting the oolichan fish and rendering and eating its fat for centuries, if not millennia. It is a big deal. In modern times there is a lot of work involved so in the old days, before there were powered boats, modern nets and other technologies, the oolichan harvest represented a huge undertaking. Whole villages moved to the oolichan camps along the rivers in which the fish would spawn and they would stay there for months catching and processing the fish. When the oil was extracted it was stored in water-tight bent-wood cedar boxes and was remarkably durable. It was highly valued as a staple food and was traded inland to populations who didn’t have access to the fishery. “Grease trails” were established through the coastal mountains for this purpose and there are accounts from early explorers who reported seeing whole villages trekking inland with everyone carrying boxes of grease to trade.

The question that intrigued us was why did they go to all that effort to render the fat from that particular fish when there were other abundant sources of fat available in this environment? There were sea mammals like whales, seals and sea lions. There were land mammals like moose, deer, elk and mountain goat. There were other fatty fish like salmon, herring and halibut. Yet, for some reason, going back into ancient times these people went to great lengths to extract the oil from that one particular little fish.

We think we got the answer when we had the grease analyzed in the Minnesota lab of our friend and colleague Dr Doug Bibus.  It turns out that the fatty acid profile of the oolichan grease is remarkably similar to that of human fat. That is at once a startling and revelatory discovery. If the body’s preferred fuel is fat, then it stands to reason that when the body stores fat it would do so with the fatty acid profile it prefers to burn. It follows then, that if you are burning fat from your diet, the preferred dietary fat would be the one that has a similar fatty acid profile to the one you store. These ancient people figured out that the fat from the oolichan fish was the most preferred fat from all the choices they had in their environment. And, they did this without the use of a gas chromatograph! This is a wonderful story of ancient dietary wisdom that helps advance our understanding of current dietary science. The coastal people figured out that their low-carb traditional diet was highly sustainable when they ate the fat that most resembled their body fat. This strikes me as an important clue to the puzzle of how to sustain a modern LCHF diet.

After we completed our study of oolichan grease which resulted in the publication of a scientific paper, Dr Phinney concocted a faux oolichan grease for his own use. He mixes one part butter, two parts olive oil and one part canola oil to approximate the fatty acid profile of the real oolichan grease. He stores this in his fridge and uses it for all his cooking needs.

The key to sustaining a LCHF diet is in the fats. You need to get comfortable with fat consumption in general and saturated fats in particular and you need to avoid the high omega-6 oils.

We were meant to burn diesel, not gas.

Phinney SD, Wortman JA, Bibus D. Oolichan grease: a unique marine lipid and dietary staple of the north Pacific coast. Lipids. 2009 Jan;44(1):47-51