Felice Jacka Defends Boundaries of Allowable Dietary Thought

Felice Jacka is an Australian professor of epidemiology. In her official capacity as an expert, she made a public health warning from her Twitter account: “If your/an MD is advocating an extreme diet of any type, please understand that they may NOT be the best person to listen to.” In her other tweets that followed, it was made clear that doctors had no right to recommend any diet other than whatever is officially declared healthy by the appropriate government and medical institutions.

She made this statement after watching a video of Dr. Shawn Baker informally discuss the carnivore diet, as if in doing so he was a public threat and an immoral actor who must be publicly called out and shamed. Her professional assessment was that he wasn’t being scientific enough. Fine. If she wanted a more scientific analysis of the evidence, she could have turned to talks given by Georgia Ede, Zoe Harcombe, Amber L. O’Hearn, and Paul Saladino. Her damning indictment of the carnivore diet was rather strong after watching a single Youtube video of a casual talk. That doesn’t seem like a scientific response.

Or she could have checked out the informal survey that Dr. Baker himself recently did in exploring people’s experience with the carnivore diet. Her complaint was that his experience was merely anecdotal. Sure. But he isn’t alone, which was the purpose of the survey he did. Look at the carnivore groups on social media, some of which have hundreds of thousands of members.

Carnivore is not a minor diet. She calls it “extreme”. It’s no more extreme than veganism and certainly far less extreme than the modern industrial standard American diet (SAD). I’d also go so far as to say, in terms of history and evolution, carnivore is also not nearly as extreme as the diet advocated by the AHA and USDA, the diet that the data shows Americans have been mostly following and that has led to a disease epidemic.

It’s not only the carnivore diet Jacka targets. In her book Brain Changer, she has a small section on the ketogenic diet in relationship to schizophrenia. She writes that, “Until we have the evidence from such studies, however, we would definitely not recommend such a diet, as it’s extremely strict and demanding and requires close medical supervision.” There she goes again: “extremely” — as if she were talking about potentially violent political activists. Her language is consistent in talking about any diet that dares to cross the line.

Let me set one thing straight. No, the ketogenic diet isn’t extremely strict or particularly demanding. Those who go on it often find it to be the easiest diet they ever tried, as hunger and cravings tend to decrease. It still allows for a wide variety of animal and plant foods. If ketosis is all you care about, you don’t even have to worry about the quality of the food, as long as it is low enough in carbs. Go out to fast food and eat the hamburger but without the bun. And if you want snack foods, have a bag of pork rinds instead of a bag of potato chips. Plus, there are all kinds of prepared products now marketed as keto, from protein bars to cauliflower pizzas, and nearly all stores carry them.

So, why all this fear-mongering about alternative dietary approaches? In response to Jacka, Dr. Ara Darakjian tweeted, “This seems overly restrictive on a physician’s freedoms. Why should there be a gag rule? If a physician believes differently they have to stick to the party line? I’ve never recommended carnivore but I don’t think it’s wrong for other MD’s to advocate based on anecdotal evidence” That is a good point. Why not allow doctors to use their best judgment based on their own professional experience?

A light went off in my head when I saw that mention of a “gag rule”. The specific doctor she is criticizing, Dr. Shawn Baker, was the target of a witch-hunt that involved a several year legal battle and resulted with the state board temporarily taking away his license to practice. So, it seems like no accident that he still is being targeted. It turns out he was vindicated and his license was reinstated. Still, he was forced out of work during that time and, along with severe disruption in his life and his family, because of legal costs he lost his house.

His sin in that earlier situation, however, wasn’t about the carnivore diet. He was simply recommending lifestyle changes as a prevention for surgery. By the way, he doesn’t only recommend a carnivore diet but also keto and moderate low-carb, even plant-based in some cases. He treats his patients as individuals and seeks the best treatment according to his knowledge. Sometimes that involves a particular dietary approach or another, but according to Felice Jacka that should not be allowed, a powerful message considering the doctor she chose to use as an example.

When I first saw her tweet, I didn’t know she was Australian. It occurred to me to see where she was from. I wondered this because I knew some other major cases of witch-hunts. The moment I saw that she is employed at an Australian university, another light bulb went off in my head. One of the worst witch-hunts against a low-carb advocate sought to destroy the career of the Australian doctor Gary Fettke. I don’t know if she was involved in that witch-hunt or supported it in any way, but it seems likely she wouldn’t been on the side defending Dr. Fettke’s rights.

I also left some tweets in that thread she started. I brought up some criticisms of the field of nutrition studies itself. She defended her field of expertise since, after all, her authority rests upon it. She said to me that, “I don’t agree that there is (largely) not consensus among nutrition professionals and researchers. But it’s not the point I’m making. MDs are charged with practising evidence-based medicine. Whether or not you or they dont agree with the evidence for whatever reason.”

Responding back to her, I wrote: “Consensus from evidence-based medicine in a field suffering from one of the worst replication crises in scientific history is precisely part of the problem.” That was a tougher criticism than it might seem, since the main replication failure of nutrition studies has been epidemiology, Jacka’s sole area of expertise. After that simple comment, she blocked me. There was nothing else I said that was mean or trollish. The closest I came to being antagonistic was in saying that I’d rather trust the expertise of those who are world-leading experts in keto and low-carb diets: Benjamin Bikman, Jason Fung, etc; also, Tim Noakes (another victim of a witch-hunt, as shown in the documentary The Magic Pill, in Daryl Ilbury’s book The Quiet Maverick, and in Noakes’ own book Lore of Nutrition). She obviously is not in favor of open scientific debate and inquiry.

There are powerful interests seeking to maintain the status quo. A simple tweet might not seem like anything to be concerned about. Then again, Tim Noakes troubles began with a single innocent tweet that was used as evidence. He fought back, but it also took years and immense amounts of money. If he wasn’t such a brilliant and determined guy, the powers that be might have been successful. Still, the attack did effectively make Noakes into an example. Few people could have stood up to that kind of organized and highly funded onslaught. When someone like Felice Jacka complains about someone like Dr. Shawn Baker, there is always an implied threat. Most doctors probably remain silent and keep their heads down. Otherwise, the consequences might mean the ending of one’s career.

 

Is Ketosis Normal?

Humans are born into ketosis and will remain in ketosis while breastfeeding, whether or not the mother is in ketosis. For hunter-gatherers, breastfeeding commonly lasts for the first couple of years, the most important time for growth and development, especially the brain. So, evolution has created ketosis as a protected state for infancy. But it goes far beyond that.

Unlike other carnivores, evidence indicates humans remain in ketosis even while eating higher amounts of protein. We are capable of gluconeogenesis, a necessary function turning protein into glucose, but we don’t so heavily rely upon it. Under normal evolutionary conditions, humans would spend much, probably most, of their time in ketosis. No other species so easily goes into and remains in ketosis. The human brain, in fact, preferentially uses ketones. And it is probably because of our large, energy-hungry brains that we are so ketosis-prone in the first place. That is likely why babies are born so fat, so that they can have a ready supply of ketones.

It was a trade-off of the human brain growing larger as the gut grew smaller, as it requires a lot of energy to digest plant matter and that energy was needed for the evolutionary development of a larger brain. So, humans turned to eating fat from animals, to replace a digestive system needed to break down fibrous plants to produce fat. Herbivores are forced to spend all day eating vast amounts of plant matter and it is energy intensive work. Ketosis freed humans from this activity and simultaneously freed up immense energy to be used for other purposes, specifically greater neurocognitive functioning and higher thought.

The benefits and advantages of ketosis are amazingly numerous. It protects against or improves epilepsy, along with other neurocognitive disorders and mental illnesses, from bipolar disorder to ADHD, not to mention much more serious diseases such as Alzheimer’s. It also shows benefit for autoimmune disorders, cancer, and trauma. There is no health condition I can think of, besides type 1 diabetes, that would be worsened by ketosis. And if one were on a ketogenic diet in the first place, one would be unlikely to develop type 1 diabetes and so that is moot.

One would be forgiven for thinking that ketosis might be the natural state of the human species. Still, whatever one thinks of evolutionary arguments, no one can deny that ketosis is a far healthier state to be in, or at least there is no evidence to the contrary. That said, one doesn’t have to be in constant ketosis to see many of these benefits. Even in epilepsy, after a period of healing, some patients can stop a ketogenic diet and stay free of seizures. There are many mechanisms for this healing power of ketosis, such as the related autophagy, but the general anti-inflammatory effect might be more important considering inflammation is found in so many diseases.

* * *

By Amber L. O’Hearn:

Babies thrive under a ketogenic metabolism

Optimal Weaning from an Evolutionary Perspective

Ketosis Without Starvation: the human advantage

I’d love to see this question approached systematically, but the survey does at least suggest that protein levels above our minimum needs based on positive nitrogen balance still support ketosis. […]

Obligate carnivores are always on very low carb diets, so you might think they are always in ketosis, but that’s not at all the case. In fact they are specialised at gluconeogenesis, that is, getting all their energy needs met by converting protein into glucose. Protein needs tend to be high.

Cats have much higher protein needs than omnivores and surprisingly, they don’t adapt well to reduced protein or fasting [Cen2002]. They don’t seem to have good mechanisms to compensate for the various amino acid and vitamin deficiencies that develop, so they suffer from ammonia toxicity, methylation problems, and oxidative stress. They do produce ketones fasted, but they don’t seem to use them in a productive way. and they actually accumulate fatty acids in the liver when fasted; the opposite of what humans do, Because they are still producing glucose, they become like human type two diabetics.

Dolphins are particularly interesting because they have really large brains, and they eat a diet that would be expected to be ketogenic if fed to humans. However, they don’t seem to even generate ketone at all, not even when fasting. Instead, they ramp up gluconeogenesis [Rid2013].

They keep their bodies and their brains going by increased glucose.

When faced with this observation that humans use ketosis even when they don’t have to for glucose production, one obviously wonders how this happens from a mechanistic standpoint. I have never seen the question raised in the literature, let alone answered. If I were to take a guess, I’d say it probably happens somewhere in this process.

CPT1A is a kind of gatekeeper, transporting fatty acids into the mitochondria for oxidation. This is normally a necessary step in the creation of ketone bodies. The coenzyme malonyl-CoA inhibits CPT1A [Fos2004]. The functional reason it does that is because malonyl-CoA is a direct result of glucose oxidation and is on the path to de novo lipogenesis. It could be inefficient to be both generating fat and oxidizing it. So this is a convenient signal to slow entry of fat into the mitochondria.

However, its action is not stictly linear. It uses hysteresis. Hysteresis is a way of preventing thrashing back and forth between two states at the threshold of their switch. For example, if you set your thermostat to 20°C, you would not want the heater to be turned on when the temperature drops to 19.999 and turned off again at 20. This would result in constant switching. Instead, a thermostat waits until the temperature drops a little lower before activating the heater, and heats it a little more than required before deactivating it.

Hysteresis is implemented in CPT1A by its becoming insensitive to malonyl-CoA when levels of it are low [Ont1980][Bre1981][Gra1988][Gre2009][Akk2009]. That means that once CPT1A becomes very active in transporting fatty acids, it takes time before the presence of malonyl-CoA will inhibit CPT1A at full strength again. That means that fluxuations in glucose oxidation, or small, transient increases in glucose oxidation don’t disturb the burning of fatty acids or the production of ketones.

It could be the case that humans develop more insensitivity to malonyl-CoA under ketosis than other species do, allowing them to metabolise more protein without disturbing ketosis. Among humans, this is case in populations such as some Inuit with the Artic variant of CPT1A. That mutation slows down CPT1A activity immensely. This was permitted by their diet which was very high in polyunsaturated fats from sea mammals. Polyunsaturated fats upregulate fatty acid oxidation by a large proportion compared to saturated fats [Cun2002][Fra2003][Fue2004], so this mutation would not necessarily have been disruptive of ketosis in that population when eating their natural diet [Lem2012]. But a second effect of the same gene further decreases the sensitivity of CPT1A to inhibition by malonyl-CoA. That means they are less likely to be knocked out of ketosis by high protein intake. […]

But it’s not just epilepsy that ketosis is good for. Epilepsy is just the condition with the most research, and the widest acknowledgment.

Other conditions for which at least some evidence supports improvement via a ketogenic diet include neurological disabilities in cognition and motor control [Sta2012]; the benefit here may have to do with the proper maintenance of brain structures such as myelination (Recall phases: tear down damage, rebuild)

Survival after brain damage, the hypoxia of stroke or blows to the head is improved in animal models [Sta2012]. There is even animal evidence that brain damage due to nerve gas is largely mitigated by being in a state of ketosis during the insult [Lan2011]. Again, this suggests a structural support and resilience provided by a ketogenic metabolism. Resilience comes in part from not being as susceptible to damage in the first place, and that could be from reduced oxidative stress when using ketones for fuel.

Ketogenic diets as a treatment for cancer are controversial, but some of the best evidence in support of it comes from glioblastomas. See e.g. [Zuc2010][Sch2012]. This could be due mostly to the hypoglycemia stalling the rate of tumour development.

And to venture into an area less well studied, but of critical importance given the epidemic that would be more apparent were it less taboo, there is preliminary evidence in the form of case studies that ketogenic diets may be promising treatments for many psychiatric illnesses too, for example, [Kra2009][Phe2012]. Given that anticonvulsants are also used to treat bipolar, and the solid results of ketogenic diets on epilepsy, this may not be surprising. Additionally, the enhanced availability of AA and DHA may play a crucial role Because these fatty acids are critical for the brain, and dysregulation in their flux has been associated with bipolar disorder and schizophrenia. See e.g. [McN2008] and [Pee1996].

I would almost like to call a ketogenic diet a brain-growth mimicking diet.

The question of how and why humans are so ketosis prone may lead to interesting new insights about us as a species. We seem to avoid giving up ketosis as long as possible. only halting it when we take in so much glucose exogenously that we have to store it.

It seems likely that it facilitated the evolution of our brains, that organ that makes us so different from other animals that we sometimes forget we are animals.

The Ketogenic Miracle Cure

Why do we hear so little about the ketogenic diet? At this point, there has probably been thousands of studies done on it going back a century. In the 1920s, it was first demonstrated effective as a medical treatment for epileptic seizures. And since then, it has been studied with numerous other health conditions, especially for weight loss in obesity.

The results are often dramatic. Dr. Terry Wahls, in using a ketogenic diet in a clinical study, was the first to prove that multiple sclerosis could be put into remission. Dr. Dale Bredesen, also through a ketogenic diet in a clinical study, was able to reverse Alzheimer’s which has never before been accomplished, in spite of all the massive funding that has gone into pharmaceuticals.

Dr. Paul Saladino talked with Dr. Chris Palmer about metabolic disorders and psychiatric disorders (Paradigm shiftng treatment of schizophrenia and bipolar with Ketogenic diets. Chris Palmer, MD). Indicating this connection, many antipsychotics and antidepressants affect not only mood but also metabolism, such as weight gain (e.g., see how “a common class of antidepressants works by stimulating activity in the gut and key nerves connected to it rather than the brain as previously believed”; from Michelle McQuigge, New study suggests role of the gut is important in treating depression).

This connection is also seen in how depressives have higher rates of diabetes and diabetics have higher rates of depression, and to emphasize this point those with both conditions tend to have more severe depression. Unsurprisingly, the keto diet has been useful for treating depression.

It likewise has been used to treat other neurocongnitive conditions, including major psychiatric disorders like bipolar disorder and schizophrenia, arguably the same. Lessening of symptoms has been seen with schizophrenics on a keto diet (Chris Palmer, Chronic Schizophrenia Put Into Remission Without Medication). And in one case, 53 years of schizophrenia went entirely into remission and remained in remission for years following. That patient, after doing a keto diet under the care of Dr. Eric Westman in order to lose weight, found she was able to stop taking all psychiatric medications and became independent in no longer needing assistance to do daily tasks.

Now Dr. Stephen Phinney has done the same thing with diabetes, although less surprising as ketogenic research on diabetes goes back several generations. What has been the response from government health officials, non-profit health organizations, and mainstream doctors? A combination of silence and fear-mongering. A revolution in medicine is happening and few seem to be paying attention. But think how many lives could have been saved and improved, if the promising research on the keto diet hadn’t been shut down earlier last century.

* * *

What If They Cured Diabetes and No One Noticed?
If the ketogenic diet can reverse diabetes, why isn’t your doctor recommending it?
by Piper Steele

Keto Diet Puts Diabetics in Remission

After Inkinen’s pre-diabetes diagnosis in 2012, he spent the next few years researching the disease and treatments and ultimately teaming up with Stephen Phinney, MD, Ph.D in 2014 to form Virta Health, a research and virtual medical clinic whose mission is to reverse type 2 diabetes.

Phinney has been researching the keto diet and publishing studies on it for over 40 years. But last month, Virta published the results of what may be the most comprehensive study of the diet yet, a two-year intervention tracking 349 people who were divided into two groups. One followed a keto diet, the other followed their usual care for diabetes.

The results are impressive. At the end of two years, the keto group saw incredible improvements: 55% were able to reverse their diabetes and stop all medications except Metformin, and 18.5% were able to achieve remission. That is, they were both officially out of the diabetic range and off of all diabetes medications. Plus they maintained that state for at least one year.

The keto dieters were also able to lose weight (an average of 12% of body weight), reduce their dependence on insulin — dosages dropped 81% — and reduce triglycerides, inflammation and other markers for metabolic syndrome.

By contrast, just 10.5% of the participants in the control group were able to reverse their diabetes, and none was able to achieve full remission.

The control group also gained an average of 5% of their body weight, had a 13% increase in insulin dosages, and saw only modest improvements in triglycerides, inflammation and metabolic syndrome markers.

It’s also worth noting that this research is entirely self-funded — Virta receives its funding from venture capital investors.

“Online Revolt” Infuriates Diabetes Establishment
by Christopher James Clark

Last week, we saw the news that the world’s largest diabetes organizations, including the International Diabetes Federation, the American Diabetes Association, the Chinese Diabetes Society, and Diabetes India, are embracing bariatric surgery as a radical new approach to treating type-2 diabetes. According to these experts, surgery should be the standard protocol for many patients.

At the same time, these experts are becoming increasingly dismissive of diet and lifestyle approaches to reversing type-2 diabetes. The crux of the problem is that “the experts” recommend a low-fat, higher-carbohydrate approach, which simply doesn’t cut the mustard when compared to low-carb, higher-fat approaches.

In the information era, however, the truth always comes out.

Today, The Times is reporting on what they are referring to as “an online revolt by patients.” Diabetes.co.uk, a health organization that opposes the official dietary guidelines for diabetes treatment, launched a study, which included over 120,000 participants, the majority of whom suffer from weight related type-2 diabetes.

These people ate low-carb diets for 10 weeks, in defiance of the UK government’s Eatwell Guidelines, which mimic official US guidelines.

Over 70% of participants lost weight and improved their blood glucose levels.

“The results from the low-carb plan have been impressive and this is a solution that is clearly working for people with type 2 diabetes,” said Arjun Panesar, chief executive officer of diabetes.org.uk

* * *

Ketone bodies mimic the life span extending properties of caloric restriction
by Richard L. Veech Patrick C. Bradshaw Kieran Clarke William Curtis Robert Pawlosky M. Todd King

Aging in man is accompanied by deterioration of a number of systems. Most notable are a gradual increase in blood sugar and blood lipids, increased narrowing of blood vessels, an increase in the incidence of malignancies, the deterioration and loss of elasticity in skin, loss of muscular strength and physiological exercise performance, deterioration of memory and cognitive performance, and in males decreases in erectile function. Many aging‐induced changes, such as the incidence of malignancies in mice 82, the increases in blood glucose and insulin caused by insulin resistance 39, 78, and the muscular weakness have been shown to be decreased by the metabolism of ketone bodies 18, 83, a normal metabolite produced from fatty acids by liver during periods of prolonged fasting or caloric restriction 12.

The unique ability of ketone bodies to supply energy to brain during periods of impairment of glucose metabolism make ketosis an effective treatment for a number of neurological conditions which are currently without effective therapies. Impairment of cognitive function has also been shown to be improved by the metabolism of ketone bodies 84. Additionally, Alzheimer’s disease, the major cause of which is aging 20 can be improved clinically by the induction of mild ketosis in a mouse model of the disease 85 and in humans 86. Ketosis also improves function in Parkinson’s disease 87 which is thought to be largely caused by mitochondrial free radical damage 19, 88. Ketone bodies are also useful in ameliorating the symptoms of amyotrophic lateral sclerosis 89. It is also recognized that ketosis could have important therapeutic applications in a wide variety of other diseases 90 including Glut 1 deficiency, type I diabetes 91, obesity 78, 92, and insulin resistance 20, 39, 93, and diseases of diverse etiology 90.

In addition to ameliorating a number of diseases associated with aging, the general deterioration of cellular systems independent of specific disease seems related to ROS toxicity and the inability to combat it. In contrast increases in life span occur across a number of species with a reduction in function of the IIS pathway and/or an activation of the FOXO transcription factors, inducing expression of the enzymes required for free radical detoxification (Figs. 1 and 2). In C. elegans, these results have been accomplished using RNA interference or mutant animals. Similar changes should be able to be achieved in higher animals, including humans, by the administration of d‐βHB itself or its esters.

In summary, decreased signaling through the insulin/IGF‐1 receptor pathway increases life span. Decreased insulin/IGF‐1 receptor activation leads to a decrease in PIP3, a decrease in the phosphorylation and activity of phosphoinositide‐dependent protein kinase (PDPK1), a decrease in the phosphorylation and activity of AKT, and a subsequent decrease in the phosphorylation of FOXO transcription factors, allowing them to continue to reside in the nucleus and to increase the transcription of the enzymes of the antioxidant pathway.

In mammals, many of these changes can be brought about by the metabolism of ketone bodies. The metabolism of ketones lowers the blood glucose and insulin thus decreasing the activity of the IIS and its attendant changes in the pathway described above. However, in addition ketone bodies act as a natural inhibitor of class I HDACs, inducing FOXO gene expression stimulating the synthesis of antioxidant and metabolic enzymes. An added important factor is that the metabolism of ketone bodies in mammals increases the reducing power of the NADP system providing the thermodynamic drive to destroy oxygen free radicals which are a major cause of the aging process.

“Is keto safe for kids?”

“How come no one ever asks if sugary breakfast cereal, grape juice, and white bread w/ margarine is “safe for kids?” We have entered bizarro world when we’re asking if it’s safe for kids to not eat sugar.”
~ Amy Berger

How come no one ever asks if sugary breakfast cereal, grape juice, and white bread with margarine is “safe for kids?” We have entered bizarro world when we’re asking if it’s safe for kids to not eat sugar or carb-load like they’re about to run a marathon. As I explain here, there is nothing — no vitamin, mineral, or other essential nutrient — that you can get from high-carb foods that you cannot get from LOW-carb foods.

This reminds me of the case brought against Tim Noakes. He recommended a low-carb diet to a pregnant woman. Public officials considered it to be a crime against humanity that must be harshly punished. After the first attack on him failed, he was forced to endure a second trial. The government spent millions of dollars persecuting him and he not only proved his innocence but proved that the low-carb diet was scientifically valid. It was the greatest boost for the low-carb diet since Ancel Keys led his crusade against it.

Tweet that landed Noakes in hot water ‘scientifically correct’ – lawyer
by Alex Mitchley

Tim Noakes Found Not Guilty Of Misconduct Over Advising Mother To Get Her Baby Onto The Banting Diet
from Huffington Post

Professor Noakes Found Innocent (Again)!
from Nutrition Coalition

Lore of Nutrition
by Tim Noakes & Marika Sboros
pp. 32-34, Introduction by Marika Sboros
(see more at: The Creed of Ancel Keys)

This is the story of a remarkable scientific journey. Just as remarkable is the genesis of that journey: a single, innocuous tweet.

In February 2014 , a Twitter user asked a distinguished and world-renowned scientist a simple question: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’

Always willing to engage with an inquiring mind, Professor Tim Noakes tweeted back: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [ si c ] baby onto LCHF.’

With those few words, Noakes set off a chain of events that would eventually see him charged with unprofessional conduct, caught up in a case that would drag on for more than three years and cost many millions of rands. More difficult, if not impossible, to quantify is the devastating emotional toll that the whole ordeal has taken on him and his family, as critics attacked his character and scientific reputation at every turn.

At the time, it was open season on Tim Noakes. Doctors, dietitians and assorted academics from South Africa’s top universities had been hard at work for years trying to discredit him. They did not like his scientific views on low-carbohydrate, high-fat foods, which he had been promoting since 2011 . His opinions contrasted sharply with conventional, orthodox dietary ‘wisdom’, and the tweet provided the perfect pretext to amp up their attacks and hopefully silence him once and for all.

Within 24 hours of his tweet, a dietitian had reported him to the Health Professions Council of South Africa for giving what she considered ‘incorrect’, ‘dangerous’ and ‘potentially life-threatening’ advice. To Noakes’s surprise, the HPCSA took her complaint seriously.

Noakes is one of the few scientists in the world with an A 1 rating from the South African National Research Foundation (NRF) for both sports science and nutrition. In his home country, he has no equal in terms of expertise in and research into LCHF. Few can match his large academic footprint – quantified by an H-index of over 70 . The H- or Hirsch index is a measure of the impact of a scientist’s work. Noakes’s impact is significant. He has published more than 500 scientific papers, many of them in peer-reviewed journals, and over 40 of which deal exclusively with nutrition. He has been cited more than 17 000 times in the scientific literature.

Yet, remarkably, the HPCSA chose to back the opinion of a dietitian in private practice over an internationally renowned nutrition research scientist. They charged him with ‘unprofessional conduct’ for providing ‘unconventional advice on breastfeeding babies on social networks’ and hauled him through the humiliating process of a disciplinary hearing.

The public quickly dubbed it ‘the Nutrition Trial of the 21 st Century’. I’ve called it Kafkaesque. The HPCSA insisted that it was a hearing, not a trial, but the statutory body’s own conduct belied the claim.

At the time of Noakes’s tweet, I wanted to give up journalism. After more than 30 years of researching and writing about medicine and nutrition science, I was frustrated and bored. People were growing fatter and sicker, and the medical and dietetic specialists I wrote about weren’t making much difference to patients’ lives. Neither was my reporting.

Then I started investigating and writing about the HPCSA’s case against Noakes. The more questions I asked, the more walls of silence came up around me, and from the most unexpected sources. There’s an old saying that silence isn’t empty, it is full of answers. I found that the silence was loudest from those with the most to hide. I could not have foreseen the labyrinthine extent of vested inter ests ranged against Noakes, or the role played by shadowy proxy organisations for multinational sugar and soft-drink companies in suppressing and discrediting nutrition evidence.

It took a US investigative journalist to join many of the dots I had identified. Russ Greene’s research led to the International Life Sciences Institute (ILSI), a Coca-Cola front organisation. In an explosive exposé in January 2017 , Greene showed how the ILSI has worked to support the nutrition status quo in South Africa, as well as the health professionals and food and drug industries that benefit from it. It has opened a branch in South Africa and has funded nutrition congresses throughout the country. It has also paid for dietitians and academics opposed to Noakes and LCHF to address conferences abroad . *

Of course, it might be coincidence that so many doctors, dietitians and academics with links to the ILSI became involved, directly and indirectly, in the HPCSA’s prosecution of Noakes. Then again, maybe not.

The HPCSA’s conduct throughout the hearing and since its conclusion has been revelatory. To a large extent, it confirms the premise of this book: that those in positions of power and influence in medicine and academia were using the case to pursue a vendetta against Noakes. The trial highlighted the inherent perils facing those brave enough to go against orthodoxy.

Tim Noakes: The Quiet Maverick
by Daryl Ilbury
pp. 166-172

Into this turgid culture of food and identity stepped Tim Noakes on 5 February 2014, when he replied to a question posted two days earlier on Twitter, addressed to him and Sally-Ann Creed, a nutritional therapist (and co-author with Noakes of The Real Meal Revolution ). It was from a breastfeeding mother, Pippa Leenstra: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’ Noakes’s reply was the following: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [ sic ] baby onto LCHF.’

It’s neither an offensive tweet by any stretch of the imagination, nor does it fall foul of any media law – it’s not libellous and there’s no encouragement of harm to others. People could disagree with him and had a voice to do so; that’s the point of social media: it is a platform for public discussion. And people did disagree, quite vocally, and there were others who supported his advice, equally vocally. Importantly, the question demanded a public, not private, response, which the person asking the question was free to accept or reject. And, as a medical doctor, Noakes didn’t cross any ethical boundaries in replying on a public platform. He didn’t publish any confidential patient information or dispense a diagnosis for a specific patient without seeing that patient; he simply provided generalised nutritional advice based on scientific evidence. Breast milk is high in fat, and there is scientific evidence to support the benefits of an LCHF diet. There is also evidence to the contrary, but, as we’ve realised, that’s science for you. The secret in making sense of science is context, and this is where it clashes with social media.

The character limitation of Twitter is one of its selling points; it demands concise expression, a sub-editor’s dream. It also means that tweets can be short on context, unless accompanied by click-through links to supporting evidence. Therefore tweets can be open to interpretation. However, this misses the main point of the brevity of Twitter messages: they are designed to encourage debate. Whether Noakes should have said ‘Key is to wean a baby …’ as opposed to ‘Key is to wean baby …’ is a matter for retrospective semantic debate. The fact is he provided a broad opinion on a public platform as a scientist and researcher of human nutrition.

Importantly, in her original tweet, to which Noakes replied, Pippa Leenstra never referred to herself or her baby. She spoke of ‘breastfeeding mums’. She was doing the media equivalent of asking a question in a town hall where the discussion was around LCHF. At that moment, Leenstra was a media consumer of medical or health information.

Not everyone saw it that way. One of those was Claire Julsing-Strydom, who at that time was president of the Association for Dietetics in South Africa (ADSA), the professional organisation for the country’s registered dietitians. Julsing-Strydom’s reaction was to register a complaint with the Health Professions Council of South Africa. It was a decision that would effectively threaten to destroy Noakes’s career, and make Julsing-Strydom the focus of a social media witch-hunt.

According to its website, the HPCSA provides the public with the right to request an investigation of any registered health practitioner whom they believe has acted unethically or caused harm. The site includes a downloadable form and an email address for Legal Med, the department within the HPCSA that handles complaints. To make sure that no health professional is a victim of a truculent member of the public with a hefty doctor’s bill in one hand and an axe to grind in the other, there is a due process of investigation and assessment before any measure of disciplinary action is followed. Only the most serious cases demand a professional-conduct committee hearing, which is what Tim Noakes would be called before.

As I said at the beginning of this book, I am not going to go into the trial in detail; instead, I will focus on the following: the complaint, the charge that resulted, two key components in the case against Noakes, and the unexpected outcome of the hearing. The main focus will be on how this was all covered in the media.

By now you know that whereas content is king, context is King Kong, and in this case the context behind the complaint makes for interesting reading, for two reasons: firstly, it shows that Noakes’s tweet was judged in isolation, and, secondly, it suggests that the complaint may not have been thought through.

What most people may not know is that directly after Noakes’s reply on Twitter to Pippa Leenstra, someone else entered the discussion: Marlene Ellmer, a paediatric dietitian and someone well known to Julsing-Strydom. Ellmer tweeted the following: ‘Pippa, as a paeds dietician I strongly advise against LCHF for breastfeeding mothers.’ Leenstra replied by posing the following question to both Noakes and Ellmer: ‘Okay, but what I eat comes through into my milk. Is that not problematic for baby and their winds at newborn stage?’ Ellmer responded by tweeting another message with her email address, encouraging Leenstra to contact her directly. Noakes didn’t do this, which is important to note, as we shall soon see. Leenstra tweeted to Ellmer that she would contact her, and after the discussion played out further with various people providing input, Leenstra tweeted: ‘Thanks, but I will go with the dietician’s recommendation.’ This she did, rejecting Noakes’s LCHF suggestion.

Let’s summarise: at that point Leenstra had posted a question on a public forum, received different opinions, including from two health professionals – one of them a registered dietitian – and been provided with the contact details of one of those professionals with an invite to get hold of her. Leenstra was free to choose which one to follow up with, and she agreed, publicly, to contact the registered dietitian. Theoretically, things could have stopped there.

However, the day after Ellmer’s invite for Leenstra to contact her, Julsing-Strydom entered the discussion and reacted with a tweet directed to Noakes, written thus: ‘I AM HORRIFIED!! HOW CAN YOU GIVE ADVICE LIKE THIS??’ For those unfamiliar with the idiosyncrasies of social media, the use of uppercase letters is normally reserved to express a strong feeling of annoyance, displeasure or hostility. On its own, Julsing-Strydom’s use of uppercase in a tweet is perfectly acceptable; it shows how she must have felt reading Noakes’s tweet, and there are possible reasons for that. Firstly, she had a four-month-old daughter she was breastfeeding, so she had a personal as well as a professional interest in the topic under discussion. Secondly, as she would later testify, she had had a strongly worded engagement the previous month with Noakes over what she saw as his dispensing nutritional advice to breastfeeding mothers during a talk. It’s easy to imagine that for Julsing-Strydom the tweet was the last straw, and so she submitted her complaint, including screenshots of Noakes’s tweet, to Legal Med. The accompanying email read:

‘To whom it may concern. I would like to file a report against Prof Tim Noakes. He is giving incorrect medical [nutrition therapy] on Twitter that is not evidence based. I have attached the Tweet where Prof Noakes advises a breastfeeding mother to wean her baby on to a low carbohydrate high fat diet. I urge the HPCSA to please take urgent action against this type of misconduct as Prof Noakes is a celebrity in South Africa and the public does not have the knowledge to understand that the information he is advocating is not evidence based. It is specifically dangerous to give this advice for infants and can potentially be life-threatening. I await your response. Claire Julsing-Strydom.’

The wording is a little breathless, and the reason for that would emerge in the hearing.

The complaint contains many factors that Legal Med would have considered, but five pertain to focus points covered so far in this book: the limits to the public’s understanding of science, in this case that of human nutrition; the complexity and unreliability of academic research behind that science; the media profile of Tim Noakes, and the idea that he is a ‘celebrity’; that the complaint related to something said within a disrupted media environment; and the suggestion that nutritional advice is a clear-cut case of right or wrong.

What the legal department would have known when they received the complaint was that the complainant was another health professional; this wasn’t just someone with a beef about their proctologist having cold hands. This meant that the complainant would have understood the potential outcomes of submitting her complaint, especially one claiming that an act by a fellow health professional was ‘life-threatening’. The fact of the matter is that Legal Med saw sufficient seriousness in the complaint to investigate.

However, inconsistencies in Julsing-Strydom’s complaint soon came to light. She supposedly submitted it on behalf of ADSA, and yet didn’t make that clear in the complaint. When questioned in the HPCSA hearing that her complaint triggered, she replied that it was the first time she had registered a complaint, saying, ‘I was not aware that this email would actually be, you know, used at this level.’

Now, after 30 years of interviewing people for the media, if there’s something I’ve learnt it’s that the most honest comments are usually unconsidered – made as an aside, when thoughts are wandering, or if a little flustered. Perhaps, I thought, Julsing-Strydom hadn’t really thought through what was going to happen once she submitted the complaint.

Furthermore, a forensic analysis of Twitter timelines and the submission date and time of the complaint shows that Julsing-Strydom publicly expressed her horror on Twitter on 6 February 2014 at 07:48, and sent her email to Legal Med less than an hour later, at 08:47. It’s fair to say that Julsing-Strydom was upset when she wrote that email.

Based on the findings of a preliminary committee of inquiry, the legal department of the HPCSA sent a letter to Noakes on 28 January 2015, saying that he was to be summoned before the Professional Conduct Committee of the Medical and Dental Professions Board. The charge against him was attached to the letter, and it makes for puzzling reading: ‘That you are guilty of unprofessional conduct, or conduct which, when regard is had to your profession is unprofessional, in that during February 2014, you acted in a manner that is not in accordance with the norms and standards of your profession in that you provided unconventional advice on breastfeeding babies on social networks (tweet).’

It is so badly written that it would send any sub-editor reaching for a stiff shot of whisky, so it was invariably presented in the media thus: ‘charged with providing unconventional advice on social media to breastfeeding mothers’.

When I first read the charge, that part about ‘social networks’ intrigued me the most. Providing advice on a public social media platform is an ethical catch-22 for any clinician: if they provide generalised information, they can be accused of not taking into consideration the specifics of the patient; yet if they ask for specifics, they risk encouraging the sharing of confidential information on a public platform. There’s also the ethical conundrum that if they open a consultative dialogue with someone other than a patient, they can be charged with supersession, essentially ‘stealing’ a patient; and for the HPCSA, that is grounds for discipline. How is that for irony?

I sensed confusion in the poorly worded charge. On a hunch I contacted the HPCSA and asked for a copy of their guidelines for how registered health practitioners should engage with the public on social media – if the HPCSA were charging Noakes because of his use of social media, they’d obviously have the necessary guidelines in place. I received the following reply: ‘Kindly note that the HPCSA doesn’t have guidelines around how registered health practitioners should engage with the public on social media.’ The HPCSA was clearly in unfamiliar territory. I thought it didn’t bode well for a speedy, clear-cut course for the hearing; and I was right.

What started on 4 June 2015, and was supposed to be wrapped up in little over a week, would drag on for almost two years, and if its aim was to deliver a swift, unsparing and public reprimand of a dissident scientist, it failed.

Low-Carb Diets On The Rise

I’ve been paying close attention to diet this past year. It’s something I’ve had some focus on for decades now, but new info has recently changed the public debate going on. For example, a few years back, the research data from Ancel Keys was reanalyzed and an entirely different conclusion was found to be more plausible — instead of blaming saturated fat, the stronger correlation was to sugar. So much of what mainstream dietitians and nutritionists asserted as fact was based on Keys’ work, but it has since come under a dark cloud of doubt. Simply put, it was horrible science and even worse public health policy.

My own recent interest, though, was piqued in watching the documentary The Magic Pill. It came out in 2017 and several other great documentaries have come out in the last few years, with Nina Teicholz’s documentary in the works. In playing around with diet in the broad sense, I didn’t find much that helped, beyond limiting added sugar and throwing in a few healthy traditional foods (e.g., cultured dairy). It’s not that I ever was much interested in formal diets — some combination of laziness, apathy, and being too independent-minded, hence figuring something out for myself or else failing on my own terms, no doubt plenty of failure was involved and long periods of depressive despair and frustration. I’ve always been more about experimenting and finding what works or doesn’t work for me, if for no other reason than being stubborn in going my own way.

The problem was that nothing fundamentally had worked for my depression that plagued me my whole life nor for the weight gain that hit me as I approached my 40s. It is damn hard struggling to be healthy while depressed, but I did try such things as exercising regularly for it had some immediate palpable effect. Still, it was strange to exercise and yet not lose weight, even if aerobics did lift my mood ever so slightly. I was literally running to stay in place.

That is where The Magic Pill came in. I randomly came across it and watched it out of passing curiosity. Something about the case made was compelling to me, a blend of science and personal experience that rang true to my decades of reading and experimentation. It brought many pieces together: the whole foods emphasis on quality, the vegetarian emphasis on plant foods, the traditional food emphasis on nutrient-density, the low-carb emphasis on avoiding grains, legumes and sugar, the ketogenic emphasis on shifting metabolism, mood and much else, the alternative health emphasis on eliminating processed foods and additives, and the holistic/functional medicine emphasis on seeing the body as a system and part of larger systems.

So, what miraculous diet brings all of this diversity of views together under the umbrella of a coherent understanding? It’s the paleo diet, although some prefer to call it a lifestyle or a philosophy as it isn’t a singular dietary regimen or protocol. It’s about learning how to be healthy by following the examples of traditional societies in combination with the best science available, not only research in diet and nutrition as narrow fields but also research from dentistry, anthropology, archaeology, etc — any and all info that helps us understand the evolution of human health, specifically in explaining what has gone so terribly wrong in industrialized societies with the diseases of civilization. Diet is important, but only one part. Through an alliance with functional medicine, there is a greater focus on what makes for a healthy lifestyle: exercise, stress reduction, toxicity elimination, forest bathing, sun exposure, learning new things, etc… and don’t forget about play, something lost to so many modern adults.

Despite that greater focus of concern, it is the dietary angle that draws people in. Simply put, a lot of people feel better on the paleo diet, often in healing numerous conditions or at least reversing some of the worst symptoms, from conditions like obesity and diabetes to autism and depression to Alzheimer’s and multiple sclerosis, and much else. The paleo diet, as with traditional foods (both inspired by the work of Weston A. Price), is a good introduction to an alternative way of thinking not only about diet but health in general. It seems to be a gateway diet for many who go on to try related diets: primal (paleo plus dairy), Whole30, ketogenic, ketotarian, pegan, pescatarian, carnivore, etc. Primal, as one common example, demonstrates how paleolists have a tendency of drifting toward the similar traditional foods. Paleo is more of a framework than anything else, to the extent that it requires or promotes a paradigm change in one’s attitude.

The greater issue at hand is a potential paradigm change of society. That is the battle going on right now, those promoting that shift and those defending the status quo. Most figures and institutions of authority attack diets like paleo and keto because they are threatening. And the reason they are threatening is because of their growing popularity which in turn comes from their being highly effective for their intended purposes, while also being followed and sometimes promoted by many famous people, from media figures to politicians, including plenty of athletes (according to various sources, and in no particular order):

Bill Clinton, Madonna, Drew Carey, Renee Zellweger, Katie Couric, Al Roker, Halle Berry, Kim Kardashian, Kourtney Kardashian, Vinny Guadagnino, Jordan Peterson, Vanessa Hudgens, Megan Fox, Adriana Lima, Jessica Biel, Blake Lively, Channing Tatum, Eva La Rue, Phil Mickelson, Aisha Tyler, Matthew McConaughey, Edgar Ramirez, Jeb Bush, Kanye West, Christina Aguilera, Jack Osbourne, Kelly Osbourne, Sharon Osbourne, Miley Cyrus, Ursula Grobler, Becca Borawski, Aaron Rodgers, Andrew Flintoff, Jenna Jameson, Savannah Guthrie, Chris Scott, Tamra Judge, Grant Hill, Uma Thurman, Kobe Bryant, Gwyneth Paltrow, LeBron James, Alicia Vikander, Tim McGraw, Kristin Cavallari, Tom Jones, Grant Hill, Mick Jagger, Melissa McCarthy, Jennifer Lopez, Robin Wright, Cindy Crawford, Jennifer Aniston, Guy Sebastian, Elle Macpherson, Courteney Cox, Catherine Zeta Jones, Geri Halliwell, Ben Affleck, Joe Rogan, Brendan Schaub, Shane Watson, Tim Ferris, Jessica Simpson, Rosie O’Donnell, Lindsey Vonn, Alyssa Milano, Kendra Wilkinson, Christina Aguilera, Britney Spears, Joe Manganiello, Tom Kerridge, Jessica Alba, Mariah Carey, Tobey McGuire, Jennifer Hudson, Shania Twain, etc.

These low-carb diets work. People feel better, lose weight, go off their meds, have a lot of energy, and on and on. It’s a paradigm change with a real kick and so the change is largely coming from below, from probably hundreds of thousands of individuals experimenting similar to what I’ve done, including individual doctors who decide to buck the system and sometimes are punished for it (a few key examples are: John Yudkin, Tim Noakes, and Gary Fettke). And every individual this works for ends up being an inspiration to numerous others, even if only to the people they personally know such as family members, friends, neighbors, and coworkers. Other people see it works and so they try it themselves. This is how it went from a minor diet to its present growing momentum and did so in a fairly short period of time.

As I was saying at the beginning of this piece, I’ve been observing this shift. And I’ve come to realize it might be a seismic change going on. Every now and then, I see hints of the impact in the world around me. These alternative views are taking hold and won’t remain alternative for long. They are forcing their way into mainstream awareness, often for practical reasons such as bakeries taking a hit in sales (Amy-Clare Martin, Bakers notice decline in dough – as more Brits ditch bread for low-carb diets). Unsurprisingly, there is backlash.

There is the corporate media, of course, with their typical attack pieces on “fad diets”, ignoring the fact that the keto diet has been medically researched since the early 1900s, the low-carb diet having been the first popular diet starting back in the 1800s, the traditional foods diet based on hundreds of thousands of years of shared human experience, and the paleo diet as the diet hominids have thrived on for millions of years. The corporate media prefers to ignore what is threatening, until the point it no longer can be ignored, and so we are in that second phase right now, maybe a bit beyond since the mainstream authorities have already adopted some of the alternative views without acknowledging it (e.g., AHA quietly lowering its recommendations of carb intake after pushing a high-carb diet for a half century, as if hoping no one would notice this implicit admission to having been wrong, and wrong in a way that harmed so many; also see here and here). Local media is sometimes more open to new views, though.

The whole EAT-Lancet issue demonstrates the sense of conflict in the air. The authors of the report frame the situation as a crisis for all of humanity and the earth. And they use that as a cudgel to bash the new low-carb challengers, to nip them in the bud, even to the extreme of pushing for international regulations that would force conformity with the high-carb approach of conventional diets that have risen to prominence these past decades — mainstream versions of: vegetarianism, veganism, and Mediterranean (the modern Mediterranean diet as studied after World War II, not the traditional one with high levels of animal foods that existed for millennia before 20th century industrialization of the food system, no noodles or tomatoes prior to modern colonial trade, and surprisingly not much if any olive oil since according to ancient texts it was mainly used for lamp fuel, with animal fat being preferred for cooking). We’ve seen this push with such things as “Veganuary”.

It has become an overtly ideological fight, but maybe it always was. The politicization of diet goes back to the early formalized food laws that became widespread in the Axial Age and regained centrality in the Middle Ages, which for Europeans meant a revival of ancient Greek thought, specifically that of Galen. And it is utterly fascinating that pre-scientific Galenic dietary philosophy has since taken on scientific garb and gets peddled to this day, as a main current in conventional dietary thought (see Food and Faith in Christian Culture ed. by Ken Albala and Trudy Eden with an excerpt to be read here; I made this connection in realizing that Stephen Le, a biological anthropologist, was without awareness parroting Galenic thought in his book 100 Million Years of Food).

But the top-down approach to pushing dietary regimens hasn’t been all that successful in more recent years, maybe because of growing cynicism about past failures. Even with it being heavily promoted by well-funded organizations and government agencies, the high-carb plant-based diets are beginning to find it hard to maintain their footing in the tides of change. According to various data, it’s easy to get people to try veganism for a short period, but few maintain it (only 20% who try veganism continue on the diet long-term). Vegetarianism is less restrictive, of course, but consistent adherence is still rare. The vast majority who start veganism or vegetarianism either occasionally eat meat or fish or else eventually give up on the diet (less than 3.2% of Americans are vegan or vegetarian and few of them consistently adhering to the diet). There is big money, including corporate money, behind the campaigns promoting it (most processed foods, including junk food, are technically vegan and big food has come to realize this is an effective way of marketing unhealthy food as healthy). Still, it doesn’t seem to be catching on with the general public, not that I doubt there will be those who continue their games of propaganda, persuasion, and perception management.

People have gotten the message that a plant-based diet is good. That part of the official messaging machine has been successful. Indeed, for decades, most Americans have been increasing their intake of fruits and vegetables and that might or might not be a good thing (the science is contested), but as far as that goes the paleo diet and many related diets also tend to recommend high levels of fruits and vegetables. The main advantage the low-carb diets have is that it’s easier to give up bread than to give up all animal foods (including eggs and dairy), though vegetarianism is a decent compromise since it allows some animal foods and that increases availability of the key fat-soluble vitamins. It’s not that low-carb, keto, or paleo vegetarianism is hard to do — so it isn’t an either/or scenario, but many pushing a so-called “plant-based” diet for some reason want to portray it in such dualistic terms, maybe as a way of falsely portraying low-carb as an anti-plant caricature in order to make it seem ridiculous and extremist.

Despite the ideological reaction, there is the growing realization that maybe there is some profit to be had in this emerging trend, as most businesses ultimately don’t care about dietary ideology and will go where the wind blows. New products cater to these alternative diets (paleo creamer, keto supplements, etc) or else old products are repackaged (“Keto Friendly!”). This is why it gets called a “fad diet”. But if being heavily marketed makes a diet a fad, then the same label applies to conventional diets (e.g., low-fat) as well that are more heavily marketed than any alternative diet. I’ve also begun seeing paleo and keto magazines, guides, and recipe booklets in grocery stores. Even when dismissed by experts such as in rankings of recommended diets, these “fad diets” nonetheless get mentioned, albeit usually tossed to the bottom of the list. As all this demonstrates, we are long past the silent treatment.

Furthermore, it goes beyond the products specifically marketed as paleo or keto or whatever. Demand has been increasing for organ meats, coconut products (from coconut milk to coconut oil), cauliflower, etc; consumption of eggs is likewise on the rise — all favorites on the paleo diet, in particular, but also favorites for similar diets. Prices have been going up on these items and, because demand sometimes exceeds supply, they can go out of stock at stores. Why are they so sought after? Organ meats are nutrient-dense, coconut milk is a good replacement for dairy and coconut oil for unhealthy vegetable/seed oils, and cauliflower can be used as a replacement for rice, mashed potatoes, tater tots and pizza crust (“The weird thing about cauliflower, though, is that while it has allies, it doesn’t really have adversaries.” ~Rachel Sugar); as for eggs, their popularity needs no explanation now that the cholesterol and saturated fat myths are evaporating.

Even Oprah Winfrey, though financially invested in the conventional Weight Watchers diet (in owning 8% of the company) and a self-declared lover of bread (actual quote: “I love bread!”), has put out a line of products that includes a low-carb pizza with cauliflower crust. This is interesting since, as low-carb diets have gained popularity, the stock of Weight Watchers has plunged 60% and Oprah lost at least 58 million dollars in one night and a loss of 500 million over all, putting Oprah’s star power to a serious test — maybe Oprah decided it is wise to not put all her eggs in one basket, in case Weight Watchers totally tanks. The company is finding it difficult to gain and retain subscribers. Those profiting from established dietary ideology are feeling the pinch.

It’s amusing how Weight Watchers CEO Cindy Grossman responded to the low-carb threat: “We have a keto surge,” she said. “It’s a meme, it’s not like a company, it’s people have keto donuts, and everybody on the diet side look for the quick fix. We’ve been through this before, and we know that we are the program that works.” And that, “We’ve lived through this [competition from fad diets] for 57 years and we’re not going to play a game and we never have.” Good luck with that! Maybe in reassuring stockholders, she also stated that, “We’re going to be science informed and we’re sustainable for the long term.” That is great. Everyone should be science informed. The problem for those trying to hold onto old views is that the science has changed and so has the public’s knowledge of that science.

Most people these days aren’t looking for complicated diets with eating plans and paid services, much less pre-prepared meals to be bought. A subscription model is becoming less appealing, as so much info and other resources are now available online. Besides, the DYI approach (Do It Yourself) is preferred these days. Diets like paleo and keto are simple and straightforward, and they can be easily modified for individual needs or affordability. But even for those looking for a ready-made system like Weight Watchers, there are other options out there that are looking attractive: “Wall Street is clearly nervous, too. JPMorgan analyst Christina Brathwaite downgraded the [Weight Watchers] stock to “underperform” last week and slashed her price target. One of the reasons? She was worried about competition from rival weight-loss service Diet Doctor, which is a proponent of keto.”

In whatever form, like it or not, low-carb diets are on the rise. Even among vegans and vegetarianism, the low-carb approach will probably become more common. Maybe that is why we’ve suddenly seen new low-carb, plant-based diets like Dena Harris’ paleo vegetarianism (2015), Will Coles’s ketotarianism (2018), and Mark Hyman’s peganism (2018). Do a web search about any of this and you’ll find numerous vegans and vegetarians asking about, discussing, or else praising low-carb diets. The same is true in how one sees broad interest in thousands of websites, blogs, and articles. Hundreds upon hundreds of organizations, discussion forums, Reddit groups, Facebook groups, Twitter alliances, etc have sprouted up like mushrooms. More and more are jumping on the low-carb bandwagon, as apparently that is what a large and growing part of the public is demanding. Whether or not it ever was a fad, it is now a movement and it isn’t slowing down.

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New Survey Shows Changes in American Diet Trends
from Nutrition Coalition

Many Americans appear to be ditching low-fat diets for higher-fat foods in hopes of improving heart health and losing weight — according to a recent survey by the International Food Information Council (IFIC) Foundation on more than 1,000 Americans, ages 18 to 80.

Roughly 36 percent of respondents reported following a specific diet, according to the survey. Of those on a diet, nearly 25 percent chose plans with more fat or protein. Some seven percent followed a paleo diet, six percent low-carb, five percent Whole30, four percent high-protein, and three percent ketogenic.

Ten percent of respondents reported following a regime of intermittent fasting, or cycling between periods of fasting and eating, during a defined period of time.

The report did not include data on the other 64 percent of survey respondents who elected not to share specific dietary preferences.

Overall, the survey suggests that Americans are increasingly trading carbohydrates for fats. Twenty-five percent of survey respondents blamed carbohydrates for their growing waistlines — up from 20 percent last year, while 33 percent blamed sugar. These numbers are both at “the highest since 2011,” according to the report. Only 16 percent blamed fats for weight gain, and just three percent fingered protein.

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Why are these changes happening now? Here is one answer. The wisdom of crowds.

 

Spartan Diet

There are a number well known low-carb diets. The most widely cited is that of the Inuit, but the Masai are often mentioned as well. I came across another example in Jack Weatherford’s Genghis Khan and the Making of the Modern World (see here for earlier discussion).

Mongols lived off of meat, blood, and milk paste. This diet, as the Chinese observed, allowed the Mongol warriors to ride and fight for days on end without needing to stop for meals. Part of this is because they could eat while riding, but there is a more key factor. This diet is so low-carb as to be ketogenic. And long-term ketosis leads to fat-adaptation which allows for high energy and stamina, even without meals as long as one has enough fat reserves (i.e., body fat). The feast and fast style of eating is common among non-agriculturalists.

There are other historical examples I haven’t previously researched. Ori Hofmekler in The Warrior Diet, claims that Spartans and Romans ate in a brief period each day, about a four hour window — because of the practice of having a communal meal once a day. This basically meant fasting for lengthy periods, although today it is often described as time-restricted eating. As I recall, Sikh monks have a similar practice of only eating one meal a day during which they are free to eat as much as they want. The trick to this diet is that it decreases overall food intake and keeps the body in ketosis more often — if starchy foods are restricted enough and the body is fat-adapted, this lessens hunger and cravings.

The Mongols may have been doing something similar. The thing about ketosis is your desire to snack all the time simply goes away. You don’t have to force yourself into food deprivation and it isn’t starvation, even if going without food for several days. As long as there is plenty of body fat and you are fat-adapted, the body maintains health, energy and mood just fine until the next big meal. Even non-warrior societies do this. The meat-loving and blubber-gluttonous Inuit don’t tolerate aggression in the slightest, and they certainly aren’t known for amassing large armies and going on military campaigns. Or consider the Piraha who are largely pacifists, banishing their own members if they kill another person, even someone from another tribe. The Piraha get about 70% of their diet from fish and other meat, that is to say a ketogenic diet. Plus, even though surrounded by lush forests filled with a wide variety of food, plants and animals, the Piraha regularly choose not to eat — sometimes for no particular reason but also sometimes when doing communal dances over multiple days.

So, I wouldn’t be surprised if Spartan and Roman warriors had similar practices, especially the Spartans who didn’t farm much (the grains that were grown by the Spartans’ slaves likely were most often fed to the slaves, not as much to the ruling Spartans). As for Romans, their diet probably became more carb-centric as Rome grew into an agricultural empire. But early on in the days of the Roman Republic, Romans probably were like Spartans in the heavy focus they would have put on raising cattle and hunting game. Still, a diet doesn’t have to be heavy in fatty meat to be ketogenic, as long as it involves some combination of calorie restriction, portion control, narrow periods of meals, intermittent fasting, etc — all being other ways of lessening the total intake of starchy foods.

One of the most common meals for Spartans was a blood and bone broth using boiled pork mixed with salt and vinegar, the consistency being thick and the color black. That would have included a lot of fat, fat-soluble vitamins, minerals, collagen, electrolytes, and much else. It was a nutrient-dense elixir of health, however horrible it may seem to the modern palate. And it probably was low-carb, depending on what else might’ve been added to it. Even the wine Spartans drink was watered down, as drunkenness was frowned upon. The purpose was probably more to kill unhealthy microbes in the water, as was watered down beer millennia later for early Americans, and so it would have added little sugar to the diet. Like the Mongols, they also enjoyed dairy. And they did have some grains such as bread, but apparently it was never a staple of their diet.

One thing they probably ate little of was olive oil, assuming it was used at all, as it was rarely mentioned in ancient texts and only became popular among Greeks in recent history, specifically the past century (discussed by Nina Teicholz in The Big Fat Surprise). Instead, Spartans as with most other early Greeks would have preferred animal fat, mostly lard in the case of the Spartans, whereas many other less landlocked Greeks preferred fish. Other foods the ancient Greeks, Spartans and otherwise, lacked was tomatoes later introduced from the New World and noodles later introduced from China, both during the colonial era of recent centuries. So, a traditional Greek diet would have looked far different than what we think of as the modern ‘Mediterranean diet’.

On top of that, Spartans were proud of eating very little and proud of their ability to fast. Plutarch (2nd century AD) writes in Parallel Lives “For the meals allowed them are scanty, in order that they may take into their own hands the fight against hunger, and so be forced into boldness and cunning”. Also, Xenophon who was alive whilst Sparta existed, writes in Spartan Society 2, “furnish for the common meal just the right amount for [the boys in their charge] never to become sluggish through being too full, while also giving them a taste of what it is not to have enough.” (from The Ancient Warrior Diet: Spartans) It’s hard to see how this wouldn’t have been ketogenic. Spartans were known for being great warriors achieving feats of military prowess that would’ve been impossible from lesser men. On their fatty meat diet of pork and game, they were taller and leaner than other Greeks. They didn’t have large meals and fasted for most of the day, but when they did eat it was food dense in fat, calories, and nutrition.

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Ancient Spartan Food and Diet
from Legend & Chronicles

The Secrets of Spartan Cuisine
by Helena P. Schrader

Ketogenic Diet and Neurocognitive Health

Below is a passage from Ketotarian by Will Cole. It can be read in Chapter 1, titled “the ketogenic diet (for better and worse)”. The specific passage is to be found on pp. 34-38 in printed book (first edition) or pp. 28-31 in the Google ebook. I share it here because it is a great up-to-date summary of the value of the ketogenic diet. It is the low-carb diet pushed to its furthest extent where you burn fat instead of sugar, that is to say the body prioritizes and more efficiently uses ketones in place of glucose.

The brain, in particular, prefers ketones. That is why I decided to share a passage specifically on neurological health, as diet and nutrition isn’t the first thing most people think of in terms of what often gets framed as mental health, typically treated with psychiatric medications. But considering the severely limited efficacy of entire classes of such drugs (e.g., antidepressives), maybe it’s time for a new paradigm for treatment.

The basic advantage to ketosis is that, until modernity, most humans for most of human evolution (and going back into hominid evolution) were largely dependent on a high-fat diet for normal functioning. This is indicated by how the body more efficiently uses ketones than glucose. What the body does with carbs and sugar, though, is to either to use it right away or store it as fat. This is why hunter-gatherers would, when possible, carb-load right before winter in order to fatten themselves up. We have taken this knowledge in using carbs to fatten up animals before the slaughter.

Besides fattening up for winter in northern climes, hunter-gatherers focus most of their diet on fats and oils, in that when available they choose to eat far more fats and oils than they eat meat or vegetables. They do most of their hunting during the season when animals are the fattest and, if they aren’t simply doing a mass slaughter, they specifically target the fattest individual animals. After the kill, they often throw the lean meat to the dogs or mix it with fat for later use (e.g., pemmican).

This is why, prior to agriculture, ketosis was the biological and dietary norm. Even farmers until recent history were largely dependent in supplementing their diet with hunting and gathering. Up until the 20th century, most Americans ate more meat than bread, while intake of vegetables and fruits was minor and mostly seasonal. The meat most Americans, including city-dwellers, were eating was wild game because of the abundance in nearby wilderness areas; and, going by cookbooks of the time, fats and oils were at the center of the diet.

Anyway, simply in reading the following passage, you will not only become more well informed on this topic than average American but, sadly, also the average American doctor. This isn’t the kind of info that is emphasized in medical schools, despite it being fairly well researched at this point (see appended section of the author’s notes). “A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of eighteen questions correctly,” as referenced by Dr. Cole. He concluded that, “In short, most mainstream doctors would fail nutrition” (see previous post).

Knowledge is a good thing. And so here is some knowledge.

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NEUROLOGICAL IMPROVEMENTS

Around 25 percent of your body’s cholesterol is found in your brain, (19) and remember, your brain is composed of 60 percent fat. (20) Think about that. Over half of your brain is fat! What we have been traditionally taught when it comes to “low-fat is best” ends up depriving your brain of the very thing it is made of. It’s not a coincidence that many of the potential side effects associated with statins—cholesterol-lowering drugs—are brain problems and memory loss. (21)

Your gut and brain actually form from the same fetal tissue in the womb and continue their special bond throughout your entire life through the gut-brain axis and the vagus nerve. Ninety-five percent of your happy neurotransmitter serotonin is produced and stored in your gut, so you can’t argue that your gut doesn’t influence the health of your brain. (22) The gut is known as the “second brain” in the medical literature, and a whole area of research known as the cytokine model of cognitive function is dedicated to examining how chronic inflammation and poor gut health can directly influence brain health. (23)

Chronic inflammation leads to not only increased gut permeability but blood-brain barrier destruction as well. When this protection is compromised, your immune system ends up working in overdrive, leading to brain inflammation. (24) Inflammation can decrease the firing rate of neurons in the frontal lobe of the brain in people with depression. (25) Because of this, antidepressants can be ineffective since they aren’t addressing the problem. And this same inflammatory oxidative stress in the hypothalamic cells of the brain is one potential factor of brain fog. (26)

Exciting emerging science is showing that a ketogenic diet can be more powerful than some of the strongest medications for brain-related problems such as autism, attention deficit/hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, anxiety, and depression. (27) Through a ketogenic diet, we can not only calm brain-gut inflammation but also improve the gut microbiome. (28)

Ketones are also extremely beneficial because they can cross the blood-brain barrier and provide powerful fuel to your brain, providing mental clarity and improved mood. Their ability to cross the blood-brain barrier paired with their natural anti-inflammatory qualities provides incredible healing properties when it comes to improving traumatic brain injury (TBI) as well as neurodegenerative diseases. (29)

Medium-chain triglycerides (MCTs), found in coconuts (a healthy fat option in the Ketotarian diet), increase beta-hydroxybutyrate and are proven to enhance memory function in people with Alzheimer’s disease (30) as well as protect against neurodegeneration in people with Parkinson’s disease. (31) Diets rich in polyunsaturated fats, wild-caught fish specifically, are associated with a 60 percent decrease in Alzheimer’s disease. (32) Another study of people with Parkinson’s disease also found that the severity of their condition improved 43 percent after just one month of eating a ketogenic diet. (33) Studies have also shown that a ketogenic diet improves autism symptoms. (34) Contrast that with high-carb diets, which have been shown to increase the risk of Alzheimer’s disease and other neurodegenerative conditions. (35)

TBI or traumatic brain injury is another neurological area that can be helped through a ketogenic diet. When a person sustains a TBI, it can result in impaired glucose metabolism and inflammation, both of which are stabilized through a healthy high-fat ketogenic diet. (36)

Ketosis also increases the brain-derived-neurotrophic factor (BDNF), which protects existing neurons and encourages the growth of new neurons—another neurological benefit. (37)

In its earliest phases, modern ketogenic diet research was focused on treating epilepsy. (38) Children with epilepsy who ate this way were more alert, were more well behaved, and had more enhanced cognitive function than those who were treated with medication. (39) This is due to increased mitochondrial function, reduced oxidative stress, and increased gamma-aminobutyric acid (GABA) levels, which in turn helps reduce seizures. These mechanisms can also provide benefits for people with brain fog, anxiety, and depression. (40)

METABOLIC HEALTH

Burning ketones rather than glucose helps maintain balanced blood sugar levels, making the ketogenic way of eating particularly beneficial for people with metabolic disorders, diabetes, and weight-loss resistance.

Insulin resistance, the negative hormonal shift in metabolism that we mentioned earlier, is at the core of blood sugar problems and ends up wreaking havoc on the body, eventually leading to heart disease, weight gain, and diabetes. As we have seen, healthy fats are a stronger form of energy than glucose. The ketogenic diet lowers insulin levels and reduces inflammation as well as improving insulin receptor site sensitivity, which helps the body function the way it was designed. Early trial reports have shown that type 2 diabetes symptoms can be reversed in just ten weeks on the ketogenic diet! (41)

Fascinating research has been done correlating blood sugar levels and Alzheimer’s disease. In fact, so much so that the condition is now being referred to by some experts as type 3 diabetes . With higher blood sugar and increased insulin resistance comes more degeneration in the hippocampus, your brain’s memory center. (42) It’s because of this that people with type 1 and 2 diabetes have a higher risk of developing Alzheimer’s disease. This is another reason to get blood sugar levels balanced and have our brain burn ketones instead.

Notes:

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I came across something interesting on the Ketogenic Forum, a discussion of a video. It’s about reporting on the ketogenic diet from Dateline almost a quarter century ago, back when I was a senior in high school. So, not only has the ketogenic diet been known in the medical literature for about a century but has even shown up in mainstream reporting for decades. Yet, ketogenic-oriented and related low-carb diets such as the paleo diet get called fad diets, and the low-carb diet has been well known for even longer, going back to the 19th century.

The Dateline show was about the ketosis used as treatment for serious medical conditions. But even though it was a well known treatment for epilepsy, doctors apparently still weren’t commonly recommending it. In fact, the keto diet wasn’t even mentioned as an option by a national expert, instead focusing on endless drugs and even surgery. After doing his own research for his son’s seizures, the father discovered the keto diet in the medical literature. The doctor was asked why he didn’t recommend it for the child’s seizures when it was known to have the highest efficacy rate. The doctor essentially had no answer other than to say that there were more drugs he could try, even as he admitted that no drug comes close in comparison.

As one commenter put it, “Seems like even back then the Dr’s knew drugs would always trump diet even though the success rate of the keto diet was 50-70%. No drugs at the time could even come close to that. And the one doctor still insisted they should try even more drugs to help Charlie even after Keto. Ugh!” Everyone knows the diet works. It’s been proven beyond all doubt. But there is a simple problem. There is no profit to be made from an easy and effective non-pharmaceutical solution.

This doctor knew there was a better possibility to offer the family and chose not to mention it. The consequences to his medical malfeasance is the kid may have ended up with permanent brain damage from seizures and from the side effects of medications. The father was shocked and angry. You’d think cases like this would have woken up the medical community, right? Well, you’d be wrong if you thought so. Yet quarter of a century later, most doctors continue to act clueless that these kinds of diets can help numerous health conditions. It’s not a lack of information being available, as many of these doctors knew about it even back then. But it simply doesn’t fit into the conventional medicine nor within the big drug and big insurance framework.

Here is the video: