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.

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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.

Fiber or Not: Short-Chain Fatty Acids and the Microbiome

A common viewpoint among both conventional and alternative health practitioners is that fiber is good for you. Not only good but necessary. Millie Barnes, as an example, identifies her expertise as a chef and nutrition coach. She apparently comes from a functional medicine approach, common among those advocating traditional foods diet that is plant-based and fiber-heavy (another example is Dr. Terry Wahls).

Barnes wrote a post about fiber and short-chain fatty acids (SCFAs), Why Short-Chain Fatty Acids Are Key To Gut & Overall Health, Plus How To Get More — her position is typical: “SCFAs are produced when bacteria—the good kind—ferment fiber in the gut, thereby providing your body with energy, keeping your metabolism humming, and even thwarting a wide range of digestive disorders.” There is nothing necessarily wrong about this position, although the scientific evidence is severely limited and highly contested. The problem is in treating the science as settled.

I’m not against fiber. I eat some high-fiber vegetables, especially fermented, along with other cultured foods. I used to eat even more fiber and vegetables, back when I was doing a paleo diet. And there was benefits to it, at least in comparison to my prior high-carb diet of processed foods. But I’ve also tried the carnivore diet and felt freaking awesome! I never realized how hard to digest are most plant foods (Like water fasts, meat fasts are good for health.).

I’m much more cautious about the plants and hence plant substances, including toxins and anti-nutrients, I allow into my body. Still, I have nothing against plants on general principle and I’m persuaded by Siim Land’s argument for hormesis and antifragility, that is to say beneficial stress (in case you’re interested, there is an intriguing scientific paper to check out: Hagen, Roulette & Sullivan, Explaining Human Recreational Use of ‘pesticides’). I now think of plants as more medicine than food, but nonetheless quite useful as medicine.

SCFAs are a complex topic, as is the microbiome of which we know little. As aside note, while some SCFAs (acetate and butyrate) are ketogenic, others (propionate) is glycogenic. They play an important role in health. That much we can agree on. What is less understood or at least less acknowledged is that SCFAs can come from other sources besides fiber. Butyrate, for example, is found in dairy fat. The cow eats the fiber and makes the butyrate for us.

So butyrate deficiency shouldn’t be a problem for anyone on a reasonably healthy diet, plant-based or animal-based. That is assuming they are getting plenty of high-fat dairy, pasture-raised all the better, and most Westerners tend to consume tons of dairy. As for myself, I get plenty of ghee (clarified butter) which means I’m probably fine on butyrate levels. By the way, my preferred mode of ghee delivery is through coffee and tea, what has been made famous as Dave Asprey’s Bulletproof Coffee, but he got the idea from a Tibetan woman who served him tea with yak butter. This maybe is not such a foreign practice. My mother recalls her Kentuckiana grandmother regularly pouring coffee over butter, although she also mixed in saltine crackers — that latter part probably less traditional and certainly not low-carb.

To get back to our discussion of SCFAs, I’m not as familiar with acetate, but apparently you can get it from apple cider vinegar (ACV), something I also take on a daily basis. I assume that the microbes in the ACV produced the acetate and so bypasses the need of the microbes in your own gut to do the work. No fiber is required, at least not in the diet. Furthermore, one can get acetate from ketosis as well and ketosis is my preferred state. Acetate/acetoacetate sometimes is what is measured for ketone levels. Some amino acids such as leucine and lysine can be converted into acetoacetate through fatty acid synthesis. Acetoacetate then is reduced to beta-hydroxybutyrate and the latter gets turned into acetone and acetate.

Now on to propionate, even more fascinating. It is a food additive that the modern person is getting overdosed on and appears to be a causal factor behind such conditions as autism (The Agricultural Mind). Those on the autistic level tend to have high levels of the bacteria that produce propionate and tend to crave foods that are high in it. Rodents injected with propionate express autistic-like behaviors. And those on the autistic spectrum show decreased behavioral problems when propionate is removed from their diet or when an antibiotic kills off some of their microbiome. SCFAs are a key part of a health diet, but they are powerful substances not to be taken lightly. They potentially can do harm as well.

As a last comment, no studies have been done on the microbiome of those on a carnivore diet or near-carnivore diet such as the Inuit. Heck, there has been no research even on a more general healthy omnivore diet including meat — the studies on the Standard American Diet (SAD) don’t count. But from what we do know about biology in general, it appears humans have multiple pathways of producing or obtaining SCFAs. The microbiome, in particular, is probably extremely adaptable to a wide variety of diets that were necessary during evolution (e.g., the microbiome of some hunter-gathers completely alters from season to season). Dr. Paul Saladino has talked a lot about this kind of thing — take what he had to say in an interview with Geoffrey Woo (Nose-to-Tail Carnivore Diet: Organ Meat, TMAO Implications, & Reaching Ketosis ft. Dr. Paul Saladino; & video):

“There are many bacteria which can metabolize fat, protein and animal-based collagen. That’s the thing I think that most people are missing. That our gut microbiome can shift. There’s a study where they put people on what I would consider to be a very poor version of a carnivorous diet and they compare it a plant-based diet. What they see is a divergence in the gut flora within a week. The animal-based eater, again, it’s not an ideal diet. The animal-based eaters had more bile acid tolerant organisms and more organisms to ferment fat and protein. They made isobutyrate and they made acetate and they made propionate as short chain fatty acids.

“The plant-based eaters made butyrate as a short chain fatty acid and had different colonic and small intestinal microflora. The investigators in that study jumped to the conclusion. Look, we know what’s going on with the gut because they have this organism. What’s worthy of biophilia or they don’t have this organism. They clearly have an unhealthy gut microbiome and I think that is an extrapolation. We do not know that. Clinically, nobody is assaying anything clinically in that study. They didn’t do inflammatory markers. They didn’t follow those people moving forward. It was almost like a setup. They were just trying to prove that these bile acid tolerant organisms would show up when they gave people a bunch of foods, which promote the formation of bile.”

Dr. Paul Saladino was on the paleo diet before trying carnivore, but Dr. Will Cole went from vegetarian to a more paleo-style diet. Dr. Cole wrote a book, Ketotarian, about how to do a plant-based keto and so he is right in line with the likes of Millie Barnes. That didn’t stop him, in an interview with Vanessa Spina, from pointing to evidence that a high-fiber diet may not be necessary, even going so far as to mention the carnivore diet:

“Because we have an epidemic of gut problems in the United States and around the world and Europe as well that this is going take time. Sometimes some people can have it right out of the gate. Some people can’t. It’s important to know what’s right for your body and what’s not right for your body. But as you heal, what you used to not be able to have the goal is to be able to reintroduce these things as your body heals.

“So the carnivore diet, for example, it’s the ultimate elimination die because it’s removing a lot of these fibers. But the goal isn’t to be carnivorous forever and ever, even though maybe some people would prefer that. But the goal is to use something like that to drive down this inflammatory cascade to bring things back in, as long as it’s nutrient-dense. And there are studies to show like the Hadza tribe in Tanzania they have good bacterial diversity during those months where they are eating less vegetables. But they’re eating more raw meat or getting like drinking blood and doing things that most people that are on the carnivore diet in the West are not doing today.

“So there are other there are other ways to get back to our diversity beyond fiber. I would just say it is the most common, most well researched way to get back to our diversity.”

Vanessa Spina, in that interview, then added an important point, not all prebiotics are fiber or necessarily come from plants at all: “I found this list of prebiotic foods that were non-carbohydrate that included cellulose, cartilage, collagen, fructooligosaccharides, glucosamine, rabbit bone, hair, skin, glucose. There’s a bunch of things that are all — there’s also casein. But these tend to be some of the foods that actually have some of the highest prebiotic content. So it’s interesting, I think, if someone has less tolerance for fiber, they can also explore some of these other product prebiotics.” That is something I never hear anyone talk about.

This might explain why so many people do so well on a carnivore diet. They are still getting prebiotics. And we know those on entirely or mostly meat diets retain functioning microbiomes. But there has been so few scientists looking into this.

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.

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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

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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.

What causes health?

What causes health? It’s such a simple question, but it’s complex. The causes are many and the direction of causality not always clear. There has been a particular challenge to dietary ideology that shifts our way of thinking. It has to do with energy and motivation.

The calorie-in/calorie-out (CICO) theory is obviously false (Caloric Confusion; & Fung, The Evidence for Caloric Restriction). Dr. Jason Fung calls it the CRaP theory (Caloric Reduction as Primary). Studies show there is a metabolic advantage to low-carb diets (Cara B. Ebbeling, Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial), especially ketogenic diets. It alters your entire metabolism and endocrine system. Remember that insulin is a hormone that has much to do with hunger signaling. Many other hormones are involved as well. This also alters how calories are processed and used in the body. More exercise won’t necessarily do any good as long nothing else is changed. The standard American diet is fattening and the standard American lifestyle makes it hard to lose that fat. Even starving yourself won’t help. The body seeks to limit energy use and maintain energy stores, especially when it is under stress (NYU Langone, Researchers Identify Mechanism that May Drive Obesity Epidemic). All that caloric restriction does is to slow down metabolism, the opposite of what happens on carbohydrate restriction.

We associate obesity with disease and rightly so, but that isn’t to say that obesity is the primary cause. It too is a symptom or, in some cases, even a protective measure (Coping Mechanisms of Health). The body isn’t stupid. Everything the body does serves a purpose, even if that purpose is making the best out of a bad situation. Consider depression. One theory proposes that when there is something wrong we seek seclusion in order to avoid further risks and stressors and to figure out the cause of distress — hence the isolation and rumination of depression. It’s similar to why we lay in bed when sick, to let the body heal. And it should be noted that depression is a symptom of numerous health conditions and often indicates inflammation in the brain (an immune response). Insulin resistance related to obesity also can involve inflammation. When the cause of the problem is permanent, the symptoms (depression, obesity, etc) become permanent. The symptoms then become problems in their own right.

This is personal for me. I spent decades in severe depression. And during that time my health was worsening, despite struggling to do what was right. I went to therapists and took antidepressants. I tried to improve my diet and exercised. But it always felt like I was fighting against myself. I was gaining weight over time and my food cravings were persistent. Something was missing. All that changed once I got into ketosis. It’s not merely that I lost weight. More amazingly, my depression and food addictions went away, along with my tendencies toward brooding and compulsive thought (The Agricultural Mind). Also, everything felt easier and more natural. I didn’t have to force myself to exercise for it now felt good to exercise. Physical activity then was an expression of my greater health, in the way a child runs around simply for the joy of it, for no other reason than he has the energy to do so. Something fundamentally changed within my body and mind. Everything felt easier.

This touches on a central theory argued by some low-carb advocates. It’s not how many calories come in versus how many go out, at least not in a simple sense. The question is what is causing calories to be consumed and burned. One thing about ketosis is that it forces the body to burn its own energy (i.e., body fat) while reducing hunger, but it does this without any need of willpower, restraint, or moral superiority. It happens naturally. The body simply starts producing more energy and, even if someone eats a high-calorie diet, the extra energy creates the conditions where, unless some other health condition interferes, increased physical activity naturally follows.

It’s not merely that being in ketosis leads to changed activity that burns more energy. Rather, the increased energy comes first. And that is because ketosis allows better access to all that energy your body already has stored up. Most people feel too tired and drained to exercise, too addicted to food that trying to control it further stresses them. That is the typical experience on a high-carb diet, mood and energy levels go up and down with the inevitable crashes becoming worse over time. But in ketosis, mood and energy is more balanced and constant. Simply put, one feels better. And when one feels better, one is more likely to do other activities that are healthy. Ketosis creates a leverage point where health improvements can be made with far less effort.

In the public mind, diet is associated with struggle and failure. But in its original meaning, the word ‘diet’ referred to lifestyle. Diet shouldn’t be something you do so much as something that changes your way of being in and relating to the world. If you find making health changes hard, it might be because you’re doing it wrong. Obesity and tiredness is not a moral failing or character flaw. You aren’t a sinner to be punished and reformed. Your body doesn’t need to be denied and controlled. There is a natural state of health that we can learn to listen to. When your body hungers and craves, it is trying to tell you something. Feed it with the nutrition it needs. Eat to satiety those foods that contribute to health. Lose excess weight first and only later worry about exercise. Once you begin to feel better, you might find your habits improving of their own accord.

This is a challenge not only to dietary belief systems but an even more radical challenge to society itself. Take prisons as an example. Instead of using prisons to store away the victims of poverty and inequality, we could eliminate the causes and consequences of poverty and inequality. We used to treat the mentally ill in hospitals, but now we put them into prisons. This is seen in concrete ways, such that prisoners have higher rates of lead toxicity. As a society, it would be cheaper, more humane, and less sociopathic to reduce the heavy metal poisoning. Similarly, studies have shown the prison population tends to be extremely malnourished. Prisons that improve the diet of prisoners result in a drastic reduction in aggressive, violent, anti-social, and other problematic behaviors. A similar observation has been made in studies with low-carb diets and children, as behavior improves. That indicates that, if we had increased public health, many and maybe most of these people wouldn’t have ended up in prison in the first place (Physical Health, Mental Health).

We’ve had a half century of unscientific dietary advice. Most Americans have been doing what they’ve been told. Saturated fat, red meat, and salt consumption went down over the past century. In place of those, fruits and vegetables, fish and lean chicken became a larger part of the diet. What has been the results? An ever worsening epidemic of obesity, diabetes, heart disease, autoimmune disorders, mood disorders, and on and on. In fact, these kinds of health problems were seen quite early on, following the fear toward meat that followed Upton Sinclair’s 1906 muckraking journalism on the meatpacking industry in The Jungle. Saturated fat intake had been decreasing and seed oil intake had been increasing in the early 1900s, in the decades leading up to the health epidemic that began most clearly around the 1940s and 1950s. The other thing that had increased over that time period were grains, sugar, and carbs in general. Then the victims who followed this bad advice were blamed by the experts for being gluttonous and slothful, as if diet were a Christian morality play. We collectively took the hard path. And the more we failed, the more the experts doubled down in demanding more of the same.

Do we want better lives for ourselves and others? Or do we simply want to scapegoat individuals for our collective failures? If you think we can’t afford to do the right thing, then we really won’t be able to afford the consequences of trying to avoid responsibility. The increasing costs of sickness, far from being limited to healthcare, will eventually bankrupt our society or else cause so much dysfunction that civil society will break down. Why choose such a dark path when an easier choice is before us? Why is the government and major health institutions still pushing a high-carb diet? We have scientifically proven the health benefits of low-carb diets. The simplest first act would be to change our dietary guidelines and all else would follow from that, from the food system to medical practice. What are we waiting for? We can make life hard, if we choose. But why not make it easy?

* * *

I’ve long wondered why we humans make life unnecessarily hard. We artificially construct struggle and suffering out of fear of what would happen if people were genuinely free from threat, punishment, and social control. We think humans are inherently bad and must be controlled. This seeps into every aspect of life, far from being limited to demented dietary ideology.

We are even willing to punish others at great costs to ourselves, even to the point of being highly destructive to all of society. We’d rather harm, imprison, kill, etc millions of innocents in order to ensure one guilty person gets what we think they deserve. And we constantly need an endless parade of scapegoats to quench our vengeful natures. Innocence becomes irrelevant, as it ultimately is about control and not justice.

All of it is driven by fear. The authoritarians, social dominators, and reactionaries — they prey upon our fear. And in fear, people do horrific things or else submit to others doing them. Most importantly, it shuts down our ability to imagine and envision. We go to great effort to make our lives difficult. Struggle leads to ever more struggle. Suffering cascades onto suffering. Worse upon worse, ad infinitum. As such, dietary ideology or whatever else pushed by the ruling elite isn’t about public good. It’s social control, pure and simple.

But let all of that go. Let the fear go. We know from science itself that it doesn’t have to be this hard. There are proven ways to do things that are far simpler and far easier and with far better results. We aren’t bad people who need to be punished into doing the right thing. Our bodies aren’t fallen forms that will lead us into sin. What if, instead, we looked to the better angels of our nature, to what is inherently good within us?

Here is some of what I’ve written before about the easy versus the hard, about freedom versus social control:
Public Health, Public Good
Freedom From Want, Freedom to Imagine
Rationalizing the Rat Race, Imagining the Rat Park
Costs Must Be Paid: Social Darwinism As Public Good
Denying the Agency of the Subordinate Class
Capitalism as Social Control
Substance Control is Social Control
Reckoning With Violence
Morality-Punishment Link
Unspoken Connection: Fundamentalism and Punishment
What If Our Economic System Conflicts With Our Human Nature?
An Invisible Debt Made Visible

About imagining alternatives, I’ve been reading Edward Bellamy’s Looking Backward. It’s a utopian novel, but in many ways it isn’t all that extreme. The future portrayed basically is a Nordic-style social democracy taken to the next level. That basic model of governance has already proven itself one of the best in the world, not only for public good but also wealth and innovation.

In reading about this fictionalized world, one thing stood out to me. The protagonist, Julian West, was put into trance to aid his sleep. He was in a sealed room underground and apparently the house burned down, leaving behind an empty lot. As a leap of imagination for both author and reader, this trance state put him into hibernation for more than a century. His underground bedchamber is discovered by the Leete family who, in the future world, lives on his old property although there house was built on a different location.

The father is Doctor Leete who takes particular interest in Julian. They have many conversations about the differences between the late 19th and early 21st centuries. Julian struggles to understand the enormous changes that have taken place. The world he fell asleep in is no longer recognizable by the world he woke up in. When he questions something that seems remarkable to him, Doctor Leete often responds that it’s more simple than it seems to Julian. The contrast shows how unnecessarily difficult, wasteful, and cruel was that earlier society.

The basic notion is that simple changes in social conditions can result in drastic changes in public good. The costs are miniscule in comparison to the gains. That is to say that this alternative future humanity chose the easy path, instead of continually enforcing costly punishment and social control. It’s quite amazing that the argument I make now was being made all the way back in 1888 when Bellamy began writing it. From the novel, one example of this other way of thinking is the description of the future education system in how it relates to health:

I shall not describe in detail what I saw in the schools that day. Having taken but slight interest in educational matters in my former life, I could offer few comparisons of interest. Next to the fact of the universality of the higher as well as the lower education, I was much struck with the prominence given to physical culture, and the fact that proficiency in athletic feats and games as well as in scholarship had a place in the rating of the youth.

“The faculty of education,” Dr. Leete explained, “is held to the same responsibility for the bodies as for the minds of its charges. The highest possible physical, as well as mental, development of everyone is the double object of a curriculum which lasts from the age of six to that of twenty- one.”

The magnificent health of the young people in the schools impressed me strongly. My previous observations, not only of the notable personal endowments of the family of my host, but of the people I had seen in my walks abroad, had already suggested the idea that there must have been something like a general improvement in the physical standard of the race since my day ; and now, as I compared these stalwart young men and fresh, vigorous maidens, with the young people I had seen in the schools of the nineteenth century, I was moved to impart my thought to Dr. Leete. He listened with great interest to what I said.

“Your testimony on this point,” he declared, “is invaluable. We believe that there has been such an improvement as you speak of, but of course it could only be a matter of theory with us. It is an incident of your unique position that you alone in the world of to-day can speak with authority on this point. Your opinion, when you state it publicly, will, I assure you, make a profound sensation. For the rest it would be strange, certainly, if the race did not show an improvement. In your day, riches debauched one class with idleness of mind and body, while poverty sapped the vitality of the masses by overwork, bad food, and pestilent homes. The labour required of children, and the burdens laid on women, enfeebled the very springs of life. Instead of the these maleficent circumstances, all now enjoy the most favourable conditions of physical life ; the young are care fully nurtured and studiously cared for ; the labour which is required.of all is limited to the period of greatest bodily vigour, and is never excessive ; care for one’s self and one’s family, anxiety as to livelihood, the strain of a ceaseless battle of life, all these influences, which once did so much to wreck the minds and bodies of men and women, are known no more. Certainly, an improvement of the species ought to follow such a change, In certain specific respects we know, indeed, that the improvement has taken place. Insanity, for instance, which in the nineteenth century was so terribly common a product of your insane mode of life, has almost dis appeared, with its alternative, suicide.”

* * *

Bonus Article:
Here’s What Weight-Loss Advice Looked Like Nearly 100 Years Ago
by Morgan Cutolo, Reader’s Digest

I’m throwing this in for a number of reasons. It is showing how low-carb views are basically the same as dietary advice from earlier last century. Heck, one can find advice like that going back to the 1800s and even 1700s. Low-carb diets were well known and mainstream until the changes at the AHA and FDA over the past 50 years or so.

The return of low-carb popularity is what inspires such articles from the corporate media. Reader’s Digest would’t likely have published something like that 10, 20, or 30 years ago. Attitudes are changing, even if institutions are resistant. Profits are also changing as low-carb products become big biz. Corporate media, if nothing else, will follow the profits.

Here is what really stood out to me. In the article, two major dietary experts are quoted: Dr. Jason Fung and Dr. Robert Lustig. Both of them are leading advocates of low-carb diets with Dr. Lustig being the most influential critic of sugar. But neither of them is presented as such. They are simply used as authorities on the topic, which they are. That means that low-carb has become so acceptable as, in some cases, to go without saying. They aren’t labeled as low-carb gurus, much less dismissed as food faddists. No qualifications or warnings are given about low-carb. The article simply quotes these experts about what the science shows.

This is a major advance in news reporting. It’s a positive sign of changes being embraced. Maybe we are finally turning off the hard path and trying out the easier path instead. Some early signs are indicating this. The growing incidence of diabetes might be finally leveling out and even reversing for the first time in generations.

Diabetic Confusion
Low-Carb Diets On The Rise
American Diabetes Association Changes Its Tune
Slow, Quiet, and Reluctant Changes to Official Dietary Guidelines
Official Guidelines For Low-Carb Diet
Obese Military?
Weight Watchers’ Paleo Diet

“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.

Getting Into Ketosis

Here is some information about ketones, ketosis, and ketogenic diets. The focus is on treating Alzheimer’s, although the topic applies to many other conditions as well. Let me begin by explaining the basics.

Ketosis is the primary burning of fat, dietary fat or body fat, to produce ketones that the body uses. A ketogenic diet is sometimes called nutritional ketosis, as opposed to ketosis through other means such as fasting. When ketone levels are high enough, it is called ketosis — the term being used more strictly for medical purposes. The body has two main options for fuel, glucose and ketones. With Alzheimer’s as type 3 diabetes, insulin resistance in the brain decreases the ability to use glucose and so the brain slowly starves. Ketones can mostly replace glucose, especially for brain cells. Some argue they’re the preferred source of energy, since for most of human evolution there were limited amounts of carbohydrates in the diet. This is shown in how, when both glucose and ketones are available, the brain prioritizes the latter. Ketones are a more efficient and steady source of energy because few people have to worry about running out of dietary or body fat to make ketones.

Ketones are a superfuel that allows the brain function at a higher level. In ketosis, not only does metabolism change but so does brain functioning. This is why ketogenic diets have been medically used to treat diverse neurocognitive conditions: epileptic seizures, autism, ADHD, depression, multiple sclerosis, Alzheimer’s, etc. Part of this has to do with inflammation, as ketosis is anti-inflammatory. This is important because inflammation is often involved in problems with brain health and many other problems as well (arthritis, autoimmune disorders, etc). I can vouch for this in my own experience when my depression disappeared after going low-carb. Partly that is because my glucose, insulin and serotonin levels would have stabilized, but cutting back my carbs further to go into ketosis definitely made a difference. I generally feel better.

Immediately below is a chart comparing ketogenic strategies and the resultant increase in ketones. If multiple strategies are combined, ketone levels can be higher still. Ketoacidosis is thrown in the chart below for comparison, but it only happens to diabetics and it is harmful — it’s an entirely separate condition from ketosis, although both involve ketones. People sometimes confuse ketoacidosis with ketosis, but what causes each is separate. As you can see below, ketoacidosis raises ketone levels to a degree that nothing else does. Unless one is diabetic, that isn’t a concern.

Ketogenic Strategy                             —>               Ketone Levels (mmol/L)

Caffeine                                                    —>               0.2 to 0.3

Coconut Oil                                              —>               0.3 to 0.5

Vigorous Exercise                                  —>              0.3 to 0.5

Overnight Fast                                        —>              0.3 to 0.5

MCT Oil                                                      —>             0.3 to 1.0

Branched Chain Amino Acids            —>             0.3 to 1.0

Ketone Mineral Salts                            —>             0.5 to 1.0

Classic Ketogenic Diet                          —>             2 to 6

Starvation/Long-Term Fasting       —>             2 to 7

Ketone Esters (Oral or IV)                   —>             2 to 7 or higher

Diabetic Ketoacidosis                           —>            10 to 25

This chart and most of the other info I share here comes from Mary T. Newport’s book, The Complete Book of Ketones. There is also good info available in Dale E. Bredesen’s The End of Alzheimer’s, Amy Berger’s The Alzheimer’s Antidote, and Bruce Fife’s Stop Alzheimer’s Now. All I’m discussing below is the most basic info. For a more in-depth approach, I’d recommend checking out Dr. Bredesen, the author mentioned above, who is an Alzheimer’s researcher and clinician at UCLA. He has a complex protocol, going beyond ketosis, that requires working with a doctor trained in it. The clinical trial he did is the only confirmed reversal of Alzheimer’s. But back to increasing ketones and suppressing mental loss.

How to get into ketosis:

The most dependable method of entering into ketosis and maintaining it is through diet. Put in the simplest terms, there needs to be strict limits on starchy carbs and sugar (bread, crackers, noodles beans, potatoes, fruit, fruit juice, pop, candy, most processed foods, etc) combined with moderate amounts of protein and lots of fat/oil. Specific details can be found below. It is not necessarily easy, since those are some of the foods we enjoy most. Even so, it still allows a fair amount of diversity. Many foods are low in carbs: non-starchy vegetables, fruits like olives and avocados, most nuts and seeds, etc. The difficult part is that many convenience foods aren’t allowable other than as occasional foods eaten in limited amounts.

Of course, there are simpler methods of increasing ketones. Here are three:

(1) Exogenous ketones can be taken directly and will give a quick mental boost that doesn’t last long, but it is easy for the body to use since it is already in the needed form. A single dose peaks out in 30-60 minutes with the body fully eliminating them in a few hours. Exogenous ketones would need to be regularly taken in smaller amounts throughout the day to maintain higher ketone levels. One thing to keep in mind is that as ketone levels go up blood sugar and insulin levels drop. This can be an issue for people with diabetes or pre-diabetes. There are two options of exogenous ketones: ketone esters and ketone salts. The former are more easily used by the body, but the latter are more available on the market. I haven’t found ketone esters in any local store. They can be obtained online, though. I’d probably stick to the ketone salts, as there is much more research done showing their safety. Exogenous ketones are of more limited use since most people can’t safely handle more than one or two servings a day.

(2) Or one can use MCTs (medium chain triglycerides) which turn into ketones without much effort. MCT oils and powders can be added throughout the day and the body uses them fairly quickly. There are also MCTs in coconut oil and Mary T. Newport found that, in treating her husband’s Alzheimer’s, that coconut oil had a longer lasting effect. She used a combination of all three: exogenous ketones, MCT oil, and coconut oil. This gave a more steady level of ketones throughout the day. Her husband showed improvement despite her not doing anything else initially, not otherwise changing his diet. As a side note, Newport says to use cold-pressed coconut oil for reasons of general health. The main advantage is that greater amounts of MCTs and coconut oil allow the body to produce ketones even when carbs aren’t as restricted, not that one can eat carbs unlimited.

(3) An even simpler way is fasting, although easier still if one is already in ketosis (trying to go from a high-carb diet to fasting can be a challenge). A person is guaranteed to go into ketosis by not eating. Even a full night of sleep is enough to begin increasing ketone levels. Skip a meal or an entire day of eating and ketone levels will keep going up to a much more noticeable degree. If you break your fast with a ketogenic meal of low-carb and high-fat, that will extend ketosis into the rest of the day. Starting your day with fat in your coffee can be even better, as caffeine will also boost ketones (I add ghee and MCT oil to my coffee and mix it up with a battery-powered frother). In fasting for ketogenic purposes, one can do a fat fast by eating only fat, such as drinking fat-filled coffee all day. Without starches and sugar, the body is forced to burn fat and produce ketones. There isn’t anything easier than a fat fast nor as satiating.

The only potential downside is not everyone digests and metabolizes fat equally well. MCT oils, in particular, can require some adaptation. Too much can cause diarrhea for those sensitive to it. It’s best to start off with small amounts (1/2 to 1 tsp or less at a time, once or twice a day) and build up a tolerance (upwards of 1 to 2 tbsp or possibly higher, two to four times a day). If sensitive, take MCT oils with other foods, such as mixing it into cottage cheese or Greek yogurt. Coconut oil is easier for the body to handle, as it is a mix of other fats such as lauric acid that has some of the traits of MCTs. There is evidence that lauric acid works as a ketogenic fat directly in the brain. Coconut oil also helps with the thyroid and Alzheimer’s patients often develop thyroid problems.

By the way, here is what Mary T. Newport writes: “When Steve [her husband with Alzheimer’s took just coconut oil in the morning, his ketone levels peaked at about three hours but had returned to nearly normal after eight to nine hours, just before dinner time. With just MCT oil, Steve’s ketone levels went higher, peaked at about ninety minutes, but were gone within three hours.” So, she used both in a 4:3 ratio (MCT to coconut oil) to maintain stable ketone levels throughout the day. Newport suggests gradually increasing coconut oil (and MCT) intake up to 4-6 tablespoons a day or even as high 8 tablespoons, but gradually is the key part.

If one wants to ensure ketosis, there are ways to measure ketone levels. I’ve never done this, but I keep my carbs so low that there is no way for me to avoid ketosis. Without a ketogenic diet, it will be more difficult keeping ketone levels elevated and stable. Still, any greater amount of ketones is better than nothing when it comes to how the brain is starving for fuel in Alzheimer’s or in relation to many other conditions. If you want to try a ketogenic diet, here are some variations explained in detail and with good visuals about what the macronutrient (carb, protein, & fat) ratios should look like as a plate of food: Diet Plans – Charlie Foundation. Also, keep in mind protein levels, which can be an issue for with diabetes, pre-diabetes, etc: Too Much Protein?

Eating in such a way that ketosis is frequent is not always easy, although it can be the easiest diet in the world. It is not easy for many people because such diets reduce the foods they ‘love’ (sugar and carbs), reduce the foods they know how to prepare, and reduce the food options found in most restaurants. Further, these diets run contrary to the traditional food pyramid that we have been trained on for years. They seem downright unhealthy, when in fact, current research is showing they have been healthier all along. It requires changing how one thinks about food. In short, one must be very intentional. One cannot coast along and provide optimal brain nutrition. The first step for most people is breaking their food addiction, but it’s worth the effort.

Too Much Protein?

A ketogenic diet is any diet that puts you into ketosis. The issue isn’t only what raises your ketone levels but also what lowers them. It is glucose that keeps you out of ketosis and that generally means restricting carbohydrates. But glucose can come from other sources. This is where protein come in. It has been a common view that too much protein would keep you out of ketosis. The theory was that gluconeogenesis, the process that turns proteins into glucose, could interfere with ketosis. So, some have worried that too much protein was basically no different than too many starches and sugar.

That view has been challenged by more recent research. The newer understanding is that gluconeogenesis is mostly demand-driven, not supply driven. That said, it’s more complicated than that. There are conditions that can alter demand or else signaling. Benjamin Bikman, an insulin researcher, advocates a higher protein ketogenic diet. He says that initially it might matter when someone first goes onto a ketogenic diet, if they have hyperglycemia and hyperinsulinemia, a problem for far too many Americans. But as insulin levels are normalized, which can happen quickly, gluconeogenesis is not a problem.

So, it depends on how healthy you are. With insulin resistance, high protein intake might spike insulin and cause the insulin glucagon/ratio to become imbalanced. Yet for a person with a healthy metabolism, the glucose/insulin ratio might not change at all. As Ben Wagenmaker explains it, “Studies do show that GNG affects obese people and diabetics, in that excess protein produces measurable spikes in blood glucose levels, although this same effect has not been observed and quantified in non-diabetics that are not obese” (Gluconeogenesis, Chocolate Cake, and the Straw Man Fallacy).

Considering that most Americans are obese, diabetic, pre-diabetic or insulin resistant, it might be advisable to limit protein until one has become fat-adapted and metabolically flexible. It’s easy to figure out for yourself, though. You can simply measure such things and see how it is affecting you. Or you can go by an even simpler method. Once your body is regularly in ketosis, fasting should become easy. If you can skip meals or go a day without eating at all and not be particularly bothered by it, then you know you’re body has fully adjusted to ketosis. At that point, protein should no longer be a concern.

This is good to keep in mind, considering most people turn to specific diets later in life. Bikman points out that, as people age, the body requires more protein for health. That is because the body becomes less effective at using protein. And if you don’t get enough protein on a keto diet, the body will cannibalize muscle.  A lack of protein, in general, can be problematic — look at how lacking in musculature are many vegans with limited protein and lower quality protein. Muscle loss is a major health hazard for senior citizens, but muscle loss can begin much earlier in life.

* * *

Dietary Proteins Contribute Little to Glucose Production, Even Under Optimal Gluconeogenic Conditions in Healthy Humans
by Claire Fromentin et al

Dietary Protein and the Blood Glucose Concentration
by Frank Q. Nuttall & Mary C. Gannon

The relationship between gluconeogenic substrate supply and glucose production in humans
by F. Jahoor, E. J. Peters & R. R. Wolfe

More Than You Ever Wanted to Know About Protein & Gluconeogenesis
by Amy Berger

If You Eat Excess Protein, Does It Turn Into Excess Glucose?
by L. Amber O’Hearn

Protein, Gluconeogenesis, and Blood Sugar
by L. Amber O’Hearn

Ketosis Without Starvation: the human advantage
by L. Amber and Zooko Wilcox-O’Hearn

The Ultimate Guide to the Carnivore Diet:
How can carnivore diets be ketogenic when they have so much protein?
by L. Amber O’Hearn and Raphael Sirtoli

What is gluconeogenesis? How does does it control blood sugars?
by Raphael Sirtoli

the blood glucose, glucagon and insulin response to protein
by Marty Kendall

why do my blood sugars rise after a high protein meal?
by Marty Kendall

Gluconeogenesis – The worst name for a rock band ever
by Tyler Cartwright

Protein Over-consumption in Ketogenic Diets Explained
by Ken Adkins

Will This Kick Me Out Of Ketosis?
by Dustin Sikstrom

Keto Problems: Too Much Protein?
by Keto Sister

Dietary protein does not negatively impact blood glucose control.
by Bill Lagakos

 

The Fad of Warning About Fad Diets

Over at the Hurn Publications blog, the author warns against “fad diets”, specifically ketotarian diet, snake diet, and peganism. Let me clear up a few misconceptions. First off, none of these diets are exactly a fad. Various populations have been following diets like these for as long as humans have been around. There are many anthropological and historical examples that can be pointed to.

One-meal-a-day (OMAD) diets like the snake diet were practiced by the Spartans and Romans, but OMAD is common among hunter-gatherers as well. It is the three-meals-a-day-with-multiple-snacks-between diet that is bizarre by the standards of history and evolution. OMAD is one way to dispose the body to ketosis, especially if the diet is at least somewhat low-carb as were most diets in the past. Many populations would be ketogenic for long periods of time, such as during winter when starchy and sugary plant foods were scarce. Mongol warriors under Genghis Khan did extended fasts before military campaigns that would’ve put them into ketosis and then following that typically only ate meat, blood, and milk paste; although they might eat any food available in a city once conquered.

It’s not unusual for hunter-Gatherers like the Piraha to eat all the food they can take in at a time, sometimes until their stomachs are distended, as food can’t easily be stored, and then sometimes not eat for days. This is the standard feast and fast style of eating that was common throughout human evolution and remained far from uncommon around the world until the agricultural surpluses of past century or two. Fasting was a typical and regular practice among Europeans into the Middle Ages. On a related note, most Europeans and Americans didn’t start fattening up their cattle and themselves with grains until the 1800s. By the way, the Piraha’s fasting, intermittent and extended, would have left them in ketosis fairly often. There wasn’t much that would kick them out of ketosis since starchy plant foods are limited in their diet, such as occasional tubers. Ninety percent of their calories come from animal foods, mostly fish.

I might add that nothing equivalent to a baked potato, french fries, or potato chips were a part of the human diet until agriculture. the few wild tubers hunter-gatherers had access to were extremely tough and fibrous, hard to obtain, prepare, and eat (with chewing each bite being a slow process followed by spitting out a big wad of indigestible fiber)— and not nutrient or energy dense for all the work that went into using them in the diet. Most wild plants are extremely fibrous which is why hunter-gatherers got so much fiber in their diet, even when they didn’t eat a lot of plants. Modern plant foods have far less fiber and far more starch and sugar, not to mention nutrient-depleted.

Peganism would be the closest to a fad diet. But it really is rather moderate. It’s mostly about balancing foods for optimal nutrient content and bioavailability while eliminating the foods most often problematic for people. If followed carefully, there is no nutrient one would lack. It fits well within the evolutionary boundaries of human eating. The diet emphasizes food quality including large amounts of nutrient-dense plant foods and does allow moderate amounts of meat, fish, and eggs; but like paleo diet, it restricts foods not eaten for most of human evolution: grains, dairy, and legumes. I should point out that peganism is far from being the only paleo-style diet that heavily emphasizes a plant-based approach. There is Dr. Terry Wahl’s protocol and Dr. Will Cole’s ketotarian diet, both former vegetarians who now recommend ketosis. Like Mark Hyman with his peganism, Wahl’s protocol and ketotarianism allow moderate amounts of animal foods and Wahl’s protocol only recommends ketosis for some people.

Consider that all of these diets fit the profile of what we know of hunter-gatherer and other traditional diets from historical accounts, the anthropological record, and from archaeological evidence. There have even been dietary studies that have measured the macronutrients and micronutrients of hunter-gatherers. We still need to know a lot more, but we are far from merely speculating in ignorance. We do know, for example, that after everywhere agricultural foods were introduced there was a deterioration in height, cranial size, and general health. The vast majority of humans survived and thrived for hundreds of millennia without agricultural foods, without nutritional deficiencies, and without diseases of civilization. Sometimes people point to the high infectious rates of hunter-gatherers, but the infectious rates of agriculturalists was much higher and, besides, many of the infectious diseases harming hunter-gatherers were introduced by agriculturalists (e.g., malaria). Excluding high death rates from infections in childhood, the average lifespan of hunter-gatherers is about the same as a modern Westerner.

Ketosis has always been a normal state and, until quite recently, a state that humans entered into on a regular basis — since constant and unlimited access to carbs was unusual in the past. Ketosis doesn’t trick the body into a pseudo-fasted state. It is its own physiological state, one of the ways of fueling the body, what some argue as being the original preferred fuel in how the body uses it so well. So many diseases are related to glucose and insulin resistance, in a way not seen with ketones and ketosis. Quite the opposite in fact, since ketosis has been used to treat numerous diseases: epileptic seizures, diabetes, multiple sclerosis, Alzheimer’s, autism, ADHD, etc. In particular, a ketogenic diet is one of the best options in the world for blood sugar conditions and one would be insane to not advise cutting out carbohydrates. And there isn’t necessarily a reason to worry about problems with eating disorders, as ketosis is well known to make cravings disappear and improve diverse psychiatric disorders, but it would have to be decided on an individual basis in working with a doctor. Since the Hurn Publications article appears to be written for or promoted by the Cancer Wellness Center, I’m surprised the author didn’t bring up the contentious debate over cancer’s relationship to glucose, specifically in relationship to diet — there are recent books that discuss the science. No matter which side of the debate one falls on, the debate should at least be mentioned.

There is a lot of research out there right now and it is accumulating quickly (including that of Dr. Terry Wahls and Dr. Dale Bredesen, both with books out). It’s been studied for almost a century at this point and it is well understood. I might suggest not worrying about being in ketosis in the scientific sense, unless you have a serious medical condition. The scientific measurement for the amount of ketones to be called ‘ketosis’ is somewhat arbitrary. Even at lower levels of ketones, many of the same benefits are seen. And any significant level of carb restriction will produce more ketones. It doesn’t matter if one occasionally slips out of ketosis. But if one is concerned about this, there are multiple ways of measuring ketones at home.

Even millennia ago, physicians would use ketosis to treat some conditions, although they didn’t have the knowledge of what ketosis was and they were mostly limited to using fasting to induce it. The Chinese observed how the Mongols on their ketogenic diet could ride and fight for days without stopping to eat. That is the power of beta-hydroxybutyrate, the human superfuel. It’s the reason humans were able to cross deserts and oceans with little food or else go without while tracking down, sometimes over days, the next meal. You can’t do that with carbohydrates. Even more awesome is that ketosis creates the conditions for autophagy, which is how your body heals from damage and, by activating stem cells, building new cells, including in the brain. Both ketosis and autophagy reduce inflammation, a major reason for the health benefits, but reversing insulin resistance and bringing diabetes under control is no small feat.

More broadly, low-carb diets are even less of a fad. They’ve been discussed by medical professionals and scientific experts going back to the 1700s and have been well known and widely used since the 1800s. Compare that to fad diets like that of the high-carb/low-fat that has been recommended in the mainstream only for about a half century now. If you are worried about “essential vitamins, minerals, fiber, as well as anti-oxidants and phytochemicals in a healthy diet to support wellness”, then these supposed “fad diets” can be a major part of it. Most people focusing on these kinds of diets tend to be highly informed about potential nutritional deficiencies and about the sources and bioavailability of nutrients. Their obsession with nutrient-density might turn some people away. Peganism explicitly is about nutrient-density as are other forms of the paleo diet, but the ketogenic and snake diets are easily adapted to nutrient-density (e.g., ketotarian). This sector of the diet community is one of the last places one would expect to find malnourishment.

As for the fear-mongering about side effects, there is far less to worry about health-wise on any of these diets than what you are likely to experience from what is recommended in the mainstream. Few people experience side effects and most people experience dramatic improvements, unlike seen on conventional diets. And these dramatic improvements tend to be permanent, not transitory. Ketosis, OMAD, peganism, etc are about changing your dietary lifestyle and fundamentally changing how your body functions. Opposite of what the Hurn Publications article warns, you are less likely to feel “hangry” (hungry and angry) on the snake diet, as you’d be spending most of your time in ketosis. It’s on a diet of constant carbs that people tend to get hangry. These kinds of diets aren’t merely or primarily about losing weight. They can transform the way you feel and even the way your brain operates. There are plenty of people who explain the science behind why this happens, if you’re motivated enough to dig into the details.

The author is right about focusing on nutrient-density, but that is an irrelevant point in terms of criticizing these diets, as I already explained. Even less relevant is the continued focus on calories. If you are eating satisfying and satiating nutrient-dense foods while avoiding carbs that cause cravings, you probably won’t need to worry about calorie counting and portion control. There is a good chance you’ll naturally find yourself only eating the amount of food your body needs. These “fad diets” readjust your taste and hunger. There is nothing simpler and easier than that.

* * *

This post is critical of what I perceived as unfair criticism. But it wasn’t intended to be mean-spirited. As for many people, diets touch upon the personal for food is central to life. And as with others, I’ve used diets in seeking health.

The reason I started following the Hurn Publications blog is because of a piece on the EAT-Lancet that I appreciated. I think I linked to it in my own writing about the topic. That brings me to a concern. We were both critical of EAT-Lancet and so there was some basic agreement. But this latest post of mine is about disagreement.

So what exactly bothered me? One thing is that the attack on fad diets is precisely what turns people toward such things as EAT-Lancet that, in the end, is simply a repackaging of status quo dietary ideology. The advice given in the recent Hurn Publications post fits perfectly in with the EAT-Lancet diet, despite their earlier post rightly discrediting EAT-Lancet.

There is an inconsistency there. But also it puts the two posts at the same blog at cross-purposes. No one can serve two masters. Challenging and defending the status quo are separate positions. Speaking of fad diets is to use the language of the status quo, which is simultaneously misleading since the closest to a fad diet is the status quo.

Obese Military?

I came across some articles on obesity and the military (see below). Metabolic syndrome, obesity being one part of it, is on the rise in the military and in the population in general, along with much else such as autoimmune and mood disorders.

Weight issues are not an issue of mere exercise, as I discovered in aging. The weight began accruing in my thirties and continued into my forties. I’ve always been active and so, in response, I became even more active. I had long done aerobic exercise multiple times a week, often long jogs and sometimes carrying extra weight. Weightlifting was added to my regimen these past few years. Still, the body fat wouldn’t budge. Besides, the worst rates of obesity are found among the young and so aging is not the issue, as further demonstrated by age-related diseases (e.g., what was once called adult onset diabetes) hitting hard at younger and younger ages.

Why is that? Some of it is basic biological changes in aging, of course — still, that couldn’t explain it all since it is happening in all age groups. I had improved my diet over time, but admittedly I was still eating a fair amount of carbs and sugar, even if no where near the amount the average American gets. In the wider population, the consumption of carbohydrates and added sugars has drastically increased over time, specifically as dietary percentage of red meat and saturated fat has gone down while dietary percentage of vegetables and vegetable oils has been on the rise. There are other complex factors that could be mentioned, but I’ll keep it simple.

The point is that the American population, in and outside of the military, are in compliance with official dietary recommendations. The military is even able to enforce a high-carb, low-fat diet on military personnel since they have few other choices when food is prepared for them, and it is specifically during deployment that military personnel have the worst diet-related health decline. There is no greater opportunity than the military for gathering highly-controlled dietary data, as the only other segment with more controlled diets are those locked away in institutions. Also, the military enforces a rigid exercise program, and those who join are those who self-selected for this lifestyle and then had to meet high standards to be accepted. Yet military personnel apparently are getting fatter and fatter.

The amount of carbohydrates we’re talking about here is not insignificant. The USDA recommends 50-60% of the diet to consist of carbohydrates with an emphasis on grains, most of those simple starchy carbs. Even adding some fiber back into processed foods doesn’t really make them any healthier. Grains alone brings up a whole mess of other issues besides gluten (e.g., grains block absorption of certain key nutrients) — it’s long been known that the best way of fattening animals is with grains.

To put in context how distorted is our diet, a recent study compared a high-carb and a low-carb diet where the latter consisted of 40% carbs. If that is what goes for low-carb these days, no wonder we are such a sickly population. Most traditional societies rarely get such high levels of carbs and what they do get usually comes from sources that are fibrous and nutrient-dense. Look at hunter-gatherers — 40% carbs would be at the extreme high end with many groups only getting 22% carbs. As a concrete example, compared to potato chips or a baked potato, chewing on a fibrous wild tuber is a laborious process because of how tough it is, only gaining slightly more calories than you’d be expending for all the effort.

For further perspective, a study published this month implemented a ketogenic diet (Richard A. LaFountain et al, Extended Ketogenic Diet and Physical Training Intervention in Military Personnel). That by itself isn’t noteworthy, as ketosis has been scientifically studied for about a century. What is significant is that it was the first time that such a diet done was done with military personnel. If you’re familiar with this area of research, the results were predictable which is to say they were typical. Military personnel aren’t essentially any different than other demographics. We all evolved from the same ancestors with the same metabolic system.

The results were positive as expected. Health improved in all ways measured. Body fat, in particular, was lost — relevant because the subjects were overweight. Benefits were seen in other aspects of what is called metabolic syndrome, such as better insulin sensitivity. All of this was accomplished while physical fitness was maintained, an important factor for the military. Going by what we know, if anything, physical fitness would improve over time; but that would require a longer term study to determine.

Ketosis is how I and millions of others have lost weight, even among those who don’t know what ketosis is. Anyone who has ever restricted their diet in any way, including fasting, likely has experienced extended periods of ketosis with no conscious intention being required — ketosis simply happens when carbs and sugar are restricted, and even commercial diets like Weight Watchers are quite restrictive along these lines. Other ketogenic gains often are experienced in relation to hunger, cravings, mood, energy, stamina, alertness, and focus. The point here, though, was weight loss and once again it was a glorious success.

That such studies are finally being done involving the military indicates that, after a century of research, government officials are maybe finally coming around to taking ketosis seriously. It’s understandable why drug companies and doctors have been resistant, since there is no profit in a healthy sustainable diet, but profit isn’t a concern for the military or shouldn’t be, although military contractors who provide the food might disagree (high-carb food is cheaper to provide because of high-yield crops subsidized for a half century by the government). If the USDA won’t change its guidelines, maybe the military should develop its own. A military filled with those of less than optimal health is a national security threat.

As for the rest of us, maybe it’s time we look to the studies and make informed decisions for ourselves. Not many doctors know about this kind of research. And if anything, doctors have a misinformed fear about ketosis because of confusion with diabetic ketoacidosis. Doctors aren’t exactly the most knowledgeable group when it comes to nutrition, as many have noted. And the government is too tied up with agricultural and food corporations. Any positive changes will have to come from the bottom up. These changes are already happening in a growing movement in support of alternative diets such as ketogenic low-carb, which is maybe what brought it to the attention of some military officials.

Government will eventually come around out of necessity. A global superpower can’t maintain itself in the long run with a malnourished and obese population. The healthcare costs and lost sick days alone could cripple society — even now most of the healthcare costs go to a few preventable diseases like diabetes. I’m willing to bet that when the next world war is fought the soldiers will be eating low-carb, high-fat rations made with nutrient-dense ingredients. Not doing so would risk having an inferior military. For-profit ideology only goes so far when the stakes are high.

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Is U.S. Nutrition Policy Making the Military (and Recruits) too Fat to Fight?
from Nutrition Coalition

This year, for the first time since 2005, the Army fell short of its recruitment goal, according to the recent report, “Unhealthy and Unprepared,” by The Council for a Strong America, a group of retired generals and admirals. Obesity was largely to blame. Some 71% of young people between the ages of 17 and 24 fail to qualify for military service, says the report. These alarming numbers raise the disturbing question of whether the U.S. will be able to continue the luxury of maintaining an all-volunteer army in the future.

Another recent study, this one by the Rand Corporation found that some two-thirds of the nation’s active military personnel are overweight or obese. Topping the scale is the Army, with 69.4% of its personnel overweight or obese. But even the trimmest military branch – the Marine Corps – isn’t much better, at 60.9%. These numbers may be misleading, since “obesity” is defined by BMI (body mass index), which does not distinguish between whether extra pounds come fat or muscle—the latter being more likely to be the case in the military. Still, rates of 60-69% are disturbingly high. Since these folks are following the military’s exercise program, we certainly can’t blame them for shirking on physical activity.

It seems, in fact, that the U.S. military diet actually worsens health, according to an Army publication six years ago. Chanel S. Weaver of the U.S. Army Public Health Command wrote, “Even those Soldiers who are actually fit enough to deploy can face challenges in maintaining a healthy weight while serving in the deployed environment.”

In the article, Dr. Theresa Jackson, a public health scientist at the U.S. Army Public Health Command, states, “Literature suggests that fitness decreases and fat mass increases during deployments.” This is an astonishing fact: fitness declines in the military, despite mandated regular exercise.

This paradox could be explained by the growing understanding that exercise plays a relatively minor role in weight loss. “You can’t exercise your way out of a bad diet,” is the new common catchphrase among experts. Instead, the principal factor driving obesity, as the data increasingly show, is poor nutrition.

A look at the Army’s nutrition guidelines shows that they emphasize low-fat, high-carbohydrate foods. The Army recommends eating “…high protein, low-fat items such as: fish, beans, whole wheat pasta, egg whites, skim or 1 percent milk, and low-fat yogurt” while avoiding “items such as: fried items, high fat meats, egg yolks, and whole milk.” This guidance comes from the U.S. Dietary Guidelines for Americans (DGA), a policy that has been co-issued by USDA and US-HHS since 1980. The military essentially downloads these guidelines and serves food in mess halls to reflect DGA recommendations.

Ironically, this reliance on the U.S. Guidelines could well be the very reason for the military’s obesity problems. This diet tells the entire U.S. population to eat 50-60% of their calories as carbohydrates, principally grains, and just as a high-grain diet fattens cattle, a large body of government-funded science shows that a high-carbohydrate diet, for most people, is inimical to sustainable weight loss.

The argument that Americans don’t follow the guidelines is not supported by the best available government data on this subject—which demonstrates widespread adherence to the Dietary Guidelines.

New military study: “Remarkable” results among soldiers on a ketogenic diet
by Anne Mullens and Bret Scher

Those on the ketogenic diet lost an average of 17 pounds (7.5 kg), 5 percent of their overall body fat, 44 percent of their visceral fat, and had their insulin sensitivity improve by 48 per cent. There was no change in the participants on the mixed diet. Training results in physical strength, agility, and endurance in both groups were similar.

The researchers noted:

The most striking result was consistent loss of body mass, fat mass, visceral fat, and enhanced insulin sensitivity in virtually all the ketogenic diet subjects despite no limitations on caloric intake. Physical performance was maintained…. These results are highly relevant considering the obesity problem affecting all branches of the military.

[…] Although neither group counted calories, the ketogenic diet group naturally reduced their caloric intake while eating to satiety.

The most noteworthy response was a spontaneous reduction in energy intake, resulting in a uniformly greater weight loss for all ketogenic diet participants.

The military should lead the U.S. fight against obesity
by Steve Barrons

That advice, driven by the government’s Dietary Guidelines for Americans, has largely stuck to the familiar low-fat, high-carbohydrate diet that calls on us to cut meat, butter and cheese. Yet in recent years, the science has evolved, and it has become increasingly clear to people like me that fats aren’t the enemy. Indeed, as I ate more fat and reduced my intake of sugars and other carbohydrates like grains, I lost weight and became healthier.

Experiences like mine are now backed by a fast-growing body of science, showing carbohydrate restriction to be effective for fighting obesity and diabetes while improving most heart-disease risk factors.

For many, it’s hard to get past the basic assumption that the fat on your plate becomes the fat in your body. But the truth is that it’s excessive carbohydrates that turn into body fat — completely contrary to what Americans have long been told.

So why hasn’t the government’s dietary advice caught up to the science? According to a rigorous investigation in The BMJ on the dietary guidelines, the experts appointed to review the scientific evidence relied on weak scientific standards in their report and failed to review the most recent science on a number of topics, including optimal intakes for carbohydrates, saturated fat and salt. Most critically, the report relied heavily on observational studies in which researchers follow test groups over long periods of time. But even the best epidemiological studies, according to the BMJ, “suffer from a fundamental limitation. At best they can show only association, not causation. Epidemiological data can be used to suggest hypotheses but not to prove them.” This is science 101.

The U.S. military serves more than 150 million meals per year to its personnel, and when those meals are based on a government-advised, high-carbohydrate diet, our troops have a harder time staying trim and healthy. The Army’s own website warns people to stay away from high-fat meats, egg yolks and whole milk and advises “eating less fatty food for better overall health,” while encouraging a diet that includes pasta and bread. Making matters worse, service members usually have fewer options for avoiding these nutritional mistakes, especially on deployments when they often can’t cook their own meals.

Pentagon eyes controversial diet in bid to build more lethal warriors
by Ben Wolfgang

Ditching carbs may be the key to military success in America’s future wars.

Top Pentagon officials say research has shown that human bodies in ketosis — the goal of the popular and controversial ketogenic diet — can stay underwater for longer periods, making the fat- and protein-heavy eating plan a potential benefit to military divers. It is one example of a rapidly growing trend as military researchers zero in on how nutrition and certain drugs can enhance how fighting men and women perform in battle. […]

But industries that specialize in the link between diet and performance are eager to engage in complex conversations about using cutting-edge science to optimize the human body while preserving basic elements of choice and individuality. The example of how ketosis — a biological process in which the body burns fat for fuel — could produce more capable military divers is one of the clearest examples of the 21st-century debate that now confronts the Pentagon.

“One of the effects of truly being in ketosis is that it changes the way your body handles oxygen deprivation, so you can actually stay underwater at [deeper] depths for longer periods of time and not go into oxygen seizures,” Lisa Sanders, director of science and technology at U.S. Special Operations Command, said at a high-level defense industry conference in Tampa late last month.

“That kind of technology is available today,” she said. “We can tell whether you are or are not in ketosis. We have really good indications of how to put you in ketosis. And we know statistically what that does to your ability to sustain oxygen.

“The problem,” she said, “is I don’t have the authority to tell people — swimmers, submariners, etc. — that they’re going to get themselves in ketosis so they can stay in the water longer. That’s an authority question, not a technology question.”

Defense Department to ban beer and pizza? Mandatory keto diet may enhance military performance
by Kristine Froeba

The controversial ketogenic or “keto” diet may be the future of the military, some defense officials say.

Service members, and Navy SEALS especially, may have to forgo beer and burritos for skinny cocktails and avocado salad (forget the tortilla chips) if a proposal from Special Operations Command gains momentum.

While a nutritionally enhanced future could eventually be put into effect for all branches, the SEALS and other underwater dive-mission specialists might be the first groups targeted for the change in nutritional guidelines. […]

Discussion of new dietary guidelines for service members comes at a time of growing concern about obesity in the military and its potential threat to readiness. […]

For the diet to be implemented laterally across the military, produce choices and meat quality at military dining facilities across the world would have to change significantly, not to mention the high-carb and sugar content of MRE’s. The popular pepperoni pizza MRE would be a thing of the past. Although one benefit of formulating a new high-fat ration is that it would be lighter weight to carry.

“You can carry even more calories because fats weigh less, which is an advantage,” said Kinesiologist Jeff Volek, a professor at Ohio State University’s Department of Human Sciences and author of the study.

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