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.

A Fun Experiment

I’ve written a lot about diet lately, but let me get personal about it. I’ve had lifelong issues with diet, not that I thought about it that way when younger. I ate a crappy diet and it was the only diet I knew, as everyone else around me was likewise eating the same basic crappy diet. Even my childhood sugar addiction didn’t stand out as all that unique. Though I didn’t know it at the time, looking back at it now, I’m sure an unhealthy diet with nutrient-deficiencies and food additives (maybe along with environmental toxins or other external factors) was likely contributing factors to my learning disability and word finding difficulties (WFD) — see previous posts: Aspergers and Chunking; and Specific Language Impairment. As early as elementary school, there were also signs of what would later be diagnosed as depression. I knew something was wrong with me, but felt at a loss in that there was no way to explain it. I was just broken, inferior and inadequate. I didn’t even understand that I was depressed during my youth, although my high school art teacher once asked me if I was depressed and, in my ignorance, I said I wasn’t. Being depressed was all I knew and so it just felt normal.

I didn’t have the insight to connect my neurocognitive and psychological struggles to physical health. The crappiness of my diet only became apparent to me in adulthood, although I’m not sure when I started thinking about it. I grew up in churches where people were more health-conscious and my mother tried to do what she thought was healthy, even as good info was lacking back then. Still, a basic mentality of healthfulness was instilled in me, not that it initially did me much good. It took a while for it to lead to anything more concrete than doing what was the height of “healthy eating” in those day, which was skim milk poured over bran cereal and an occasional salad with low-fat dressing. That simply would’ve made my depression and learning disabilities worse as it surely was fucking up my neurocognition precisely as my brain was developing, but mainstream advice asserted that this USDA-approved way of eating would cure all that ails you. Fat was the enemy and fiber was a health tonic. Few at the time realized that fat-soluble vitamins were key to health nor that a high-fiber diet can block nutrient absorption.

Everything fell apart after high school. I despised life and wanted to escape the world. I dropped out of college and seriously considered becoming a hermit, but the prospect was too lonely and after moving out to Arizona I felt homesick. Then in going back to college, I attempted suicide. I failed at that as well and earned myself a vacation in a psychiatric ward. I was bad off, but having been raised in New Thought Christianity I was always looking for answers in self-help books and similar things. It would’ve been maybe in my early to mid 20s when I first read books that were explicitly about diet, nutrition, and health. I do recall, for instance, a book I picked up on low-carb diets and it wasn’t about the Atkins diet — it might have been an old copy of Vilhjalmur Stefansson’s Not By Bread Alone or it could have been something else entirely. Around that time, there was a minor incident that comes to mind. I told my friend that fast food was unhealthy and he didn’t believe me. It sounds odd now, but this was back in the 1990s. His mother was a nurse and regularly bought him fast food as a child. So how could it be bad? Many people at the time didn’t have much sense of what made food healthy or not, but obviously something had got me thinking about it. I knew that some foods were not healthy, even as what a healthy diet should look like was a bit hazy in my mind, beyond the nostrum of eating more fruits and veggies.

I lacked knowledge and there weren’t many sources of knowledge prior to my getting internet. Still, based on what limited info I could glean, I did start experimenting during that period. I began trying supplements to deal with my depression with the related low energy and low motivation, as therapy and medications had failed to put a dent in it. Around 1998, four years after graduating high school and a couple years after the suicide attempt, I tried vegetarianism for a time, maybe for a year or so, but it mainly involved eating as a regular meal a mix of Ramen noodles, eggs, and frozen vegetables cooked in the microwave — it was a poverty diet as I was living in poverty. I probably also was eating plenty of junk food as well, considering most cheap processed foods are vegetarian. Avoiding meat certainly doesn’t guarantee health — it didn’t fill me with joy and vitality. A bit later on I did finally try a low-carb diet, but it mainly consisted of eating processed meat because I was too depressed to cook. Even then, I might not have been getting many fat-soluble vitamins, as I didn’t understand nutrient-density. I wasn’t procuring pasture-raised meat, much less emphasizing organ meats, bone broth, wild-caught fish, etc.

My experiments weren’t well-informed and so weren’t done under optimal conditions. There was no one around to offer me guidance and so it didn’t work out all that well. I don’t give up easy, though. I went looking for guidance from dozens of psychiatrists, therapists, energy healers, body workers, and even a shaman. In my desperation, I’d try anything. Then I went to massage school where I learned Shiatsu massage and traditional Chinese theory, along with some other modalities. Even that didn’t change anything. My massage teachers were alternative health practitioners, one being a naturopath, but it seemed like no one understood what was wrong with me and so nothing could make a difference. My depression was an incomprehensible mystery. Rather than something being wrong with me, I was the problem in being inherently defective, so it seemed in my lingering dark mood.

The only thing that made much of a difference was exercise. I found that I could keep the worst symptoms of depression at bay through jogging, if only temporarily. At some point, I learned to jog before eating anything in the morning and I found that my hunger and cravings were less for the rest of the day. I had accidentally discovered ketosis and didn’t know what it was. It didn’t make sense that physical exertion minus food would lead to such results — rather counterintuitive. I was also occasionally fasting around then which also would’ve contributed to ketosis. That isn’t to say ketosis while in nutrient deficiency is a good thing. I’d have been better off in having avoided ketosis entirely and, instead, having filled up on nutrient-dense fatty animal foods. I needed healing and only high dosage of nutrition was going to accomplish that. I had been too malnourished for far too long at that point. Ketosis would’ve been great after a period of deep nourishment, but I didn’t understand either the significance of key nutrients nor how to implement ketosis in a more beneficial way.

At some point, I read Sally Fallon Morrell’s Nourishing Traditions (1995) where I was introduced to nutrient-density and fat-soluble viatmins along with traditional food preparation, but I was too depressed and too isolated to fully and successfully implement what I was learning. Depression is a real kick in the ass. Still, I was slowly accruing basic knowledge and making small changes when and where I felt able. I was limiting some of the worst problematic foods. In particular, I began cutting back on junk food, especially candy. And I replaced sugar with such things as stevia. Simultaneously, I increased healthier foods like probiotics and Ezekiel bread, although I’m not sure that the latter really is all that healthy (it has vital gluten added to it and it mostly starchy carbs). I tried to limit my sugar intake to foods that were relatively better, such as yogurt and kefir. I still was experimenting a bit with supplements, but wasn’t getting any clear results. My depression persisted and I see now that, even with these changes, I continued to lack nutrient-density. It just wasn’t clicking together for me. Maybe my depression had moderated ever so slightly, to the degree that I was a functional depressive and not in the total gloom and doom of my late teens to early twenties. I figured that was as good as it was going to get. I had survived that far and figured I’d be depressed for the rest of my life. Let me put this in perspective. This slightly lessened depression was, nonetheless, chronic and severe. For example, suicidal ideation persisted — maybe more as a background noise to my thoughts, but there, always there. I had this suspicion that eventually depression would catch up with me and then that would be the end of me. Suicide remained a real possibility in my mind, a persistent thought. It was hard for me imagine myself surviving into old age.

I carried on like this. I managed my life at a bare minimal level. I held down a job, I sort of kept my apartment clean, I fed my cats and sometimes changed their litter, and I more or less paid my bills on time. But depression had kept me working minimal hours and barely staying above poverty. There wasn’t only the depression for, over the decades, a crippling sense of shame had accumulated. I felt worthless, a failure. I wasn’t taking care of myself or at least wasn’t doing it well. Everything felt like a struggle while nothing I did seemed to make a difference. It was shitty and I knew life was just going to get worse as I aged and thinking about that made me feel more hopeless. To add to that general anxiety and despair, as I drifted through my thirties, I began gaining weight. I had always thought of myself as athletic. I played soccer from 1st grade to 11th grade and was always slim and trim, although I remember at one point after high school having been so inactive for a number of years that I felt winded just by walking up a hill — that was a strange experience for me because I had never been out of shape before that time. That was why I came to focus so much on exercise. Yet with age, mere exercise wouldn’t stop the weight gain, much less help with weight loss… nor any of the other symptoms of declining health. I was jogging multiple times a week for long periods, sometimes while wearing a heavy backpack as I hoofed it out to my parent’s place on the far edge of town. Still, the excess fat remained. That was rather dispiriting. Yet from a conventional viewpoint, my diet was balanced and my lifestyle was generally healthy, at least by American standards. I was doing everything right, as I understood it. Just the expected results of aging, most doctors would likely have told me.

I realize now that insulin resistance probably had set in quite a while back. I was probably prediabetic at that point, maybe even in the early stages of diabetes (I sweated a lot, in the way my grandmother did before her diabetes was managed with insulin shots). I know that I no longer handled sugar well, which helped keep my sugar addiction in check. About a decade ago, my friend and I visited a nearby donut shop and I got several fine specimens. Upon eating them, I felt sick with a slight headache. No more donuts for me. Sugar or not, my diet was still fairly high-carb, but I wasn’t yet fully aware of how starches and sugars sneak into everything. Then last year I randomly came across the paleo documentary The Magic Pill and watched it without any expectation. I suppose it was just basic curiosity, as is my habit. Something about it resonated with me. I showed it to my parents and they too found it inspiring. So, we all set about changing our diets — having mutual support from family was surely an important factor for motivation. The diet portrayed is standard paleo with a combination of low-carb and nutrient-density. What made the documentary compelling was how a wide variety of people were followed as they tried the paleo diet: a woman living alone with various health problems, a family with a young daughter with severe autism, and an Australian Aboriginal community that had lost their traditional way of life. It demonstrated the significant changes that could occur through diet. The transformation of the autistic girl was particularly impressive. The entire documentary was motivational. After that, I looked for some other documentaries to watch with my parents: The Perfect Human Diet, Carb Loaded, etc. Learning more reinforced this new view and brought together all that I had learned over the decades. I finally had a broader framework of understanding.

It was this low-carb paleo diet that was the starting point for me, although my mother never was quite on board with it. After looking online, she was drawn to the FODMAP diet in hoping it could help with her gut issues, specifically GERD and belching, but also osteoporosis (and indeed it did seem to work for her, as her former high-fiber diet apparently was the source of her problems), although her diet had some overlap with paleo. Going into my typical obsessive-compulsive mode, I gathered dozens of books on the subject, voraciously took in all the info I could find online, and began following various people on social media. I quickly figured out the basics and what was most essential while determining the points of disagreement and uncertainty. What I liked about the paleo and low-carb community was the attitude of curiosity, of exploration and experimentation. Try something and see what happens. And if it doesn’t work, try something else. There was no failure, a much more positive attitude about health. Within three months of implementing the paleo diet, I had lost 60 pounds of fat and I did it without starving myself. I simply figured out how to tap into the body’s natural mechanisms for fat-burning and hunger signalling. As I switched from general low-carb to ketogenic, my experience improved even further. It finally dawned on me that my depression had gone away, simply and utterly disappeared, decades of depression along with a lifetime of sugar addiction no longer an issue. I didn’t need to struggle against it. I wasn’t even trying to cure my depression, not that I realized this even was a possibility. It was a complete surprise.

It’s been a little over a year now. I’m still coming to terms with this new state of being. It’s strange. Depression had become part of my identity, as had sugar addiction and the roller coaster hangriness of insulin resistance. I now simply wake up in the morning feeling perfectly fine. It’s not that I go around feeling ecstatic, but the extreme low moods and funks no longer happen. I feel more balanced and relaxed. I used to fall into long periods of apathy and despair where all I could do was isolate myself until it passed, sometimes requiring days or weeks before I could rejoin humanity. How I functioned at all in such a state is kind of amazing, but not nearly as amazing as the miracle of its drama-free disappearance. Depression was there and then it wasn’t. I didn’t really notice it going away, until after it was gone. This leaves me in a strange position, as the decades of depressive thought and behavioral patterns remain. It’s hard for me to know how to not be a depressed person. I can’t quite wrap my mind around it. I don’t remember the last time I had any suicidal tendencies or fantasies. Yet the decades of damage to my body also remains as a reminder.

That hasn’t stopped me from getting back in shape and beyond. In fact, I’m in better shape now as I move toward middle age than ever before in my life. It’s not simply that I’ve been working out but that I enjoy working out. It feels good to me and I enjoy doing physical activity, pushing myself to the point of exhaustion. Unsurprisingly, I’m looking better. People notice and tell me. This sometimes makes me uncomfortable, as I’m not used to getting compliments. Just today I went to a picnic with a large crowd, some people I knew and some I didn’t. I met a friendly young woman and she was obviously flirting with me as we talked. It was a nice day and, having been out in a kayak, I had my shirt off. She told me that I looked “gorgeous” — the exact word she chose.* I’ll be blunt about this. No one has ever said anything like that to me in my entire life. I had never been a buff guy before and now I actually have muscles. It changes how I carry myself, how I feel.

It makes me realize why some fat people, after losing a bunch of weight, will sometimes gain their weight back just to feel normal again. The person I am now is not the person I’ve known myself for as long as I can remember. And I don’t know what to do with people relating to me differently. I’m sure people treat me differently not only because I look different but probably because I’m putting off a different vibe. I’m less sullen and dissociated than I used to be. An easygoing friendliness comes more naturally to me now. I don’t feel so crappy in no longer being on a crappy diet, but I’m not sure what it might mean to be healthy and happy. That is an odd concept to my mind. What if I could really be different? I take this seriously. In the past, I didn’t feel capable of being different, but all of that has changed. I don’t feel so irritable, frustrated, and angry. In place of that, I find myself wanting to be kinder and more forgiving. I want to be a good person. I realize that, in the past, how I could be an asshole and I was often open in admitting this basic fact of my former state, sometimes apologizing for my antagonistic moods. My life didn’t always feel like a net gain for the world and I’m sure some people might have agreed with that assessment. I could be harshly critical at times and that doesn’t make others feel better — I seriously harmed a number of relationships.

Now here I am. It’s a bit late in my life, but I have a second chance to try to do things differently. It will take some further experimentation beyond diet to find better ways of relating to others and to myself. That said, I’ll go on tinkering with my diet and lifestyle. It’s an ongoing experiment, all of it. Most importantly, it’s a fun experiment. The idea that I can try various things and discover what works is new to me. I’m more used to failure, but now I’m starting to see ‘failure’ as simply part of the experiment. There is no failure. Life doesn’t have to be hard. And I’m realizing that I’m not alone in this, as I’ve come across hundreds of stories just like mine. Sometimes simple changes can have profound effects.


* I must admit that it was a disconcerting experience. A young beautiful woman telling me in no uncertain words that I’m attractive. That is not the kind of thing I’ve grown accustomed to. I handled the situation as well as I could. It was kind of an amusing scenario. She was with her family. Along with her parents, she was visiting from Tunisia in order to see her sister who now works at the local university.

So, this young woman wasn’t going to be around long. Developing a romantic relationship didn’t seem to be in the cards, even if I had wanted it, but I feel ambivalent about romantic relationships these days. I’ve become comfortable in my bachelorhood with its lack of complications. Even so, I played along with the flirtation. As I sat near her with her family at the picnic table, she kept wanting to feed me. And how I could I decline food offered by a beautiful woman, even when she offered me carbs. That is my new plan for carb cycling — I’ll eat carbs every time a beautiful woman feeds them directly to me.

Anyway, combined with introversion and shyness, the lifetime of depression has made me reticent. I’m not confident around the opposite sex, but I’ve had long years of training in hiding any anxieties. Still, I didn’t know what purpose there was in flirting with this nice-looking person who would soon be gone. She said she might be back to visit again in a few years and that seems like a long time when you just met someone. I convinced myself there was no point and didn’t give her my contact info or ask for hers. But now I feel some regret.

I was acting according to my old self, the one who was ruled by his depression. Maybe it was irrelevant that I might not see her again. I should have left the door open for the possibility. These are the kinds of habits I need to learn.

Coffee and Cream, Ketosis and Autophagy

On Twitter, Jerry Teixeira (JT) declared his love of cream in coffee. It led to a long thread where the joys and benefits of creamy vs black coffee were argued.

An interesting side discussion formed over the issue of fasting, ketosis, and autophagy. I must admit that my understanding was always a big hazy about the relationship between the latter two, both of which can be results of fasting. Despite common factors involved in both processes, I didn’t think there was a causal link.

I guess there is a connection, after all (Camberos-Luna et al, The Ketone Body, β-Hydroxybutyrate Stimulates the Autophagic Flux and Prevents Neuronal Death Induced by Glucose Deprivation in Cortical Cultured Neurons.). Even so, that still leaves other benefits of fasting, such as downregulating mTOR (vitamin D3 and Autophagy).

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Patrice Bäumel
My number one reason for drinking black coffee in the morning is to not interfere with IF, which cream does.

Rob W. James
The benefits of IF are overstated in my opinion. Most of the benefits come from calorie restriction, which a splash of milk isn’t going to make much difference too

Patrice Bäumel
The main benefit is clearing out damaged cells. It’s an anti-aging hack. You lose that benefit by breaking fast.

JT
Coffee is still a xenobiotic, you are breaking a fast by drinking coffee and you are breaking a fast by drinking 2 tbsp cream. Regardless, autophagy is stimulated via ketogenesis, neither coffee nor cream Inhibit ketogenesis.
https://www.ncbi.nlm.nih.gov/m/pubmed/26303508/

Tell
Autophagy doesn’t really hit significant levels until 48hrs though. So benefits are mininal if any during IF

Tell
This is not to say autphagy isn’t present until 48hrs, rather it hits full scale around 48hrs.
And if autophagy is why you “fast” an extended fast.. past a normal IF, is necessary to achieve what you’re after.

JT
Autophagy happens downstream via BHB regardless, when you are on a ketogenic diet you have these elevated BHB levels at that point for long periods, where fasting takes 48 hours to get you where a Keto diet keeps you

JT
So if you are IF and eating plenty of carbs I totally agree. It takes longer to get to the higher BHB levels because BHB and carbohydrate are inversely proportional

Tell 
This is such an important point I don’t see anyone talking about.
That’s why I was talking about fasting a few weeks ago.
No one is talking about needing to be in ketosis to be fasted. So most of these guys doing IF are basically just TRE.. Which is a good enough reason to IF

Tell 
The contents creators aren’t talking about this though and selling false promises of autophagy and fountain of youth.

Dave
I read an article about IF that showed signs of arteriole smoothing with a 16:8 diet. If this is true then autophagy at 48 hours isn’t necessary for sole benefit and daily fasting does have vasculature anti-aging properties.

JT
There are benefits for every hour you fast according to Salk institute researchers . What we will need to see is calorie matched studies between TRE/ IF and CR. But to say there is zero additional benefit if you are healthy is wrong. The amount of benefit is arguable

JT
Beta hydroxy butyrate is an HDAC inhibitor and downstream via that action increases autophagy. Cream doesn’t matter. The longer you fast for the higher the bhb. Or a ketogenic diet can increase the bhb. Ketogenic diet mimics fasting and vice Versa.

JT
They are not synonymous. Of course, however elevated BHB levels are a common thread and a little cream in your coffee is not going to matter at all in that regard.

JT
Myriads research over the last two years and mixing more underway showing the mechanisms by which you still see these benefits from BHB weather or not you fast. I am compiling all the links and will sends them over when done if you would like

Erik
Hell, coffee alone (even decaf) induces autophagy.
https://t.co/2KcTpGZur0?amp=1

JT
Yeah, I saw some research that it increases ketogenisis

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.

Dietary Dogma: Tested and Failed

There were two recent studies that looked at diets. One compared the 2010 Dietary Guidelines against the typical American diet. The other compared multiple dietary interventions: Mediterranean diet, low-fat diet, and low-salt diet. This covers the main diets advocated most often by doctors, nutritionists, dieticians, and health officials. Yet neither study found a significant overall benefit to any of the recommended diets. That is shocking, when one considers how official experts and major institutions have pushed these diets for decades. The low-fat diet has been a favorite among dietary technocrats for about a half century (The Creed of Ancel Keys).

What these studies didn’t bother to consider is the benefits of traditional foods diet (Weston A. Price & Sally Fallon Morrell), paleo/hunter-gatherer diet, low-carb high-fat diet, ketogenic diet, carnivore diet, etc. Nor any of the related but less well known diets like ketotarian, pegan, etc. Nor related dietary strategies such as fasting, either intermittent or extended, along with calorie restriction. With a narrow focus, the comparisons were limited. Still, it is a powerful judgment that none of the diets that were tested stood out as being all that impressive. What is being brought under doubt represents the key message of authoritative opinion on diet and nutrition. These diets tested (official Dietary Recommendations, Mediterranean diet, low-fat diet, and low-salt diet) are among the best that the collective wisdom of mainstream thought has to offer.

Here is an intriguing point. The first study looked at the 2010 Dietary Guidelines as separate from weight loss, to determine what were the results of the diet itself (besides, even including weight loss, the low-fat diet is one of the worst, as studies show few people drop body fat when adhering to it — see meta-analysis by UK Public Health Collaboration, Eat Fat, Cut The Carbs and Avoid Snacking To Reverse Obesity and Type 2 Diabetes). This officially trumpeted dietary regime, a fad diet that hasn’t been around long by the way, had no noticeable affect on glucose homeostasis, fasting lipids, or type 2 diabetes. Let’s consider another study, as a comparison and to clarify a point (Parker N. Hyde et al, Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss). As with the above mentioned study, body weight was carefully maintained so as to control for that potentially confounding factor. What were the results?

“Despite maintaining body mass, low-carbohydrate (LC) intake enhanced fat oxidation and was more effective in reversing MetS [metabolic syndrome, including type 2 diabetes], especially high triglycerides, low HDL-C, and the small LDL subclass phenotype. Carbohydrate restriction also improved abnormal fatty acid composition, an emerging MetS feature. Despite containing 2.5 times more saturated fat than the high-carbohydrate diet, an LC diet decreased plasma total saturated fat and palmitoleate and increased arachidonate.”

Interestingly, these particular two studies demonstrate that obesity by itself is not necessarily the problem. Rather, it is a symptom of the problem. Obesity can even be an attempt by the body to compensate in preventing something even worse (Coping Mechanisms of Health). The fundamental problem is the metabolic syndrome itself and the insulin resistance behind it, and any diet that doesn’t directly deal with that will be ineffective. Only some variation of a low-carb diet can accomplish that end.

It’s time to rethink dietary recommendations and guidelines. There are signs this is already happening. The public is already turning toward low-carb diets (Low-Carb Diets On The Rise). And slowly but surely the official position is shifting in this direction (Obese Military?, Weight Watchers’ Paleo Diet, American Diabetes Association Changes Its Tune, Official Guidelines For Low-Carb Diet, & Slow, Quiet, and Reluctant Changes to Official Dietary Guidelines). The evidence keeps accumulating. These recent two studies add to the growing pile. It’s getting harder and harder to ignore the obvious.

* * *

A randomized controlled-feeding trial based on the Dietary Guidelines for Americans on cardiometabolic health indexes
by Sridevi Krishnan et al

To our knowledge, this is the first controlled-feeding trial to test the effect of a food-based dietary pattern following recommendations of the DGA [2010 Dietary Guidelines for Americans]. We measured cardiometabolic disease risk factors in an at-risk female cohort, while maintaining body weight, with the use of foods that are accessible and acceptable to the consumer. The higher quality of the DGA diet relative to the TAD [typical American diet] was confirmed by HEI scores of 98 and 62, respectively. We found that, in the absence of weight loss, consuming a diet based on recommendations of the DGA did not change glucose homeostasis or fasting lipids in our cohort. The 2015 DGA Advisory Committee report concluded that there was moderate evidence for reduction in type 2 diabetes risk associated with nutrient-dense diets (2); however, the results from our short-term intervention trial did not align with this evidence. By design, the intervention did not lead to significant weight loss, and because changes in body weight and body fat can play a role in the pathogenesis of type 2 diabetes (31), this may also explain why improvements in blood sugar control were not observed despite the improvement in diet quality.

Supplements and Diets for Heart Health Show Limited Proof of Benefit
by Anahad O’Connor

When Dr. Khan and his co-authors looked at various diets recommended for cardiovascular prevention, they found a similar lack of solid evidence.

That was certainly the case for low-fat diets, which health authorities have recommended for decades as a way to lower cholesterol and heart disease risk. Dr. Khan and his colleagues found that the most rigorous randomized trials provided no evidence that eating less fat, including saturated fat, had an impact on mortality or cardiovascular outcomes. Low-fat diets have largely fallen out of favor among health authorities in recent years, though the federal government’s dietary guidelines still encourage people to limit their intake of foods rich in saturated fat, such as butter, meat and cheese.

One diet that remains highly touted by health authorities is the Mediterranean diet, with its abundance of whole grains, beans, nuts, fruits and vegetables and olive oil. While clinical trials have found that it reduces cardiovascular risk, some of the major ones have been flawed, and experts who have scrutinized the evidence for the diet have urged caution.

One of the largest and most publicized Mediterranean diet trials, called Predimed and published in 2013, found that it reduced heart attacks and strokes. But last year it was retracted because of methodological problems. The Predimed authors published a new analysis of their data, claiming their conclusions had not changed. But other Mediterranean diet trials have been embroiled in similar controversies. After analyzing data from all the relevant trials, Dr. Khan and his colleagues found that “the totality of evidence did not favor the Mediterranean diet for cardiovascular outcomes.”

“It’s not favorable or harmful,” he added. “It’s just a neutral diet from a cardiovascular perspective.”

The one dietary intervention that seemed to have the most support from randomized trials was lowering salt intake, though the researchers graded the evidence only as having “moderate certainty.” And there was nuance. Low-salt diets reduced mortality from all causes only in people with normal blood pressure. Among people with hypertension, lowering salt intake reduced deaths from heart disease but not from other causes.

Dr. Topol said that in his own clinic he sees a wide range of responses to salt intake. Some people are very sensitive to salt: A small increase in salty foods can have a pronounced effect on their blood pressure. But others can eat salt-laden meals and their blood pressure will hardly budge.

Dr. Topol said he finds diet studies hard to interpret because they rarely take into account the unique way that different people can have markedly different responses to dietary changes, whether it is cutting back on salt or avoiding fat or carbohydrates.

“The problem we have here is that all these studies essentially treat all people as one,” he said. “I think that all these things are going to turn out to be quite heterogeneous. Maybe salt restriction really is beneficial for some, but we haven’t defined the people yet that would drive that.”

Low-Carb Diet Is Healthy Even Without Fat Loss

Studies have shown that a low-carb, high-fat diet improves health. But it wasn’t clear if this is caused directly by the diet or caused instead by the fat loss that is a common result of the diet. In a new 3-year study, researchers controlled for fat loss and many of the same health benefits were still seen.

The researchers did this by providing prepared meals. They had to make sure that the subjects were getting enough calories so as to lose no weight. This meant increasing fat intake, sometimes by extraordinary amounts. Despite this including an increased in saturated fat, there was no increase of saturated fat in the bloodstream. This is yet more evidence against the scapegoating of saturated fat. The diets also would have been high in cholesterol and, unsurprisingly, all the health markers for cholesterol were positive.

On the other hand, there are confounding factors. Subjects were given prepared meals. This would naturally decrease the consumption of processed foods. To really understand what was going on, we would have to look at the precise ingredients.  For example, did these prepared meals have less industrial vegetable oils that are known to cause all kinds of health problems, including affecting metabolic syndrome?

The fact that there was greater amount of saturated fat in the diet indicates that the kind of fat one eats does matter. So, simply replacing sources of PUFAs with healthy fats, including saturated fats, will lead to massive improvements, whether it is caused by what is being eliminated or by what is being added in. Still, from what we know about the harm caused by excess starches and sugar, it’s hard to conclude that this study merely showed the positive effects of changes in the amounts and kinds of fats.

Whatever the cause, it is well-established at this point that a low-carb, high-fat diet is healthy. This is true, whether or not there is fat loss. Yet considering fat loss is a definitely health benefit typical of this diet, it demonstrates how the advantages are multiple. If you need to lose weight, it’s the best diet around. But if you don’t need to lose weight, it’s still great. There is no way for you not to come out ahead.

* * *

Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss
by Parker N. Hyde et al

Low-carb diets could reduce diabetes, heart disease and stroke risk even if people DON’T lose weight by cutting down on bread, potatoes and pasta
by Sam Blanchard

Silence on the US Front–News Flash of US Research from the UK!
by Angela A. Stanton

Low-Carb Diet Could Reduce Risk of These Diseases
by Kashmira Gander

Low-carb diet may reduce diabetes risk independent of weight loss
by Misti Crane

“Simply, we were dumb.”

Dr. Richard David Feinman*: “Whatever else we know or don’t know about Paleo, we know that our ancestors did not get three squares a day, and evolution must have invested far more in ketogenic metabolism than was reflected in our research interests.

“Simply, we were dumb. We’re trying to fix that now.”

Dr. Robert Lustig**: “The thing is I’m a practicing physician and a scientist and for every one patient I took care of and got better ten more would show up in my door. There was no way I was ever going to fix this.

“And the thing that really really bothered me was I learned virtually everything I know about nutrition in college because I majored in nutrition and food science at MIT. And then I went to medical school and they beat it out of me and told me that everything I’d learned was the irrelevant, it had no place in patient care, it wasn’t necessary, and that really all I had to do was focus on calories. I figured these are the clinicians. I’m gonna be closer. I better listen to them and so I practiced that way for like 20 years.

“And then I started doing research because my patients weren’t getting better and I started doing research to try to figure out what’s going on and it like all came rushing back to me, kind of like post-traumatic stress disorder. It’s like, oh my, I knew this stuff back in 1975. So I got pissed off. So I think part of the passion actually is sort of the the being dumbfounded and the anger of what I see going on in medicine today. So I’m glad it translates in a positive way and that people appreciate the passion but I’m just like really ticked off.”

* * *

*”[Dr.] Richard David Feinman is Professor of Cell Biology (Biochemistry) at the State University of New York (SUNY) Downstate Medical Center  in Brooklyn, New York. Dr. Feinman’s original area of research was in protein chemistry and enzyme mechanism, particularly in blood coagulation and related processes.

“Dr. Feinman has worked in several scientific areas including animal behavior and he has had a previous life in the visual arts. His friends consider him a Renaissance Man but he has made peace with the term dilettante.

“His current interest is in nutrition and metabolism, specifically in the area of diet composition and energy balance. Work in this area is stimulated by, and continues to influence, his teaching in the Medical School where he has been a pioneer in incorporating nutrition into the biochemistry curriculum. Dr. Feinman is the founder and former co-Editor-In-Chief (2004-2009) of the journal, Nutrition&Metabolism. Dr. Feinman received his BA from the University of Rochester and he holds a PhD in chemistry from the University of Oregon.” (from bio on his blog)

Dr. Feinman is quoted by Kathryn Goulding in a Paleo Magazine interview for an article on his book Nutrition in Crisis (June/July 20019).

**Dr. Robert Lustig is a Professor of Pediatrics in the Division of Endocrinology at the University of California, San Francisco. He specializes in neuroendocrinology and childhood obesity. He is a leading expert on the obesity, diabetes, and metabolic syndrome epidemics.

His career has included working as a physician, involvement in research (authored 125 peer-reviewed articles and 73 reviews), public speaking (videos of his talks have received millions of views), and authoring books (Fat Chance, Hacking the American Mind, Sugar Has 56 Names, and Obesity Before Birth; also the introduction to John Yudkin’s classic Pure, White and Deadly). He has also been a co-founder, president, director, chairman, member, and consultant of numerous public and private medical, health and dietary task forces, committees, board of directors, institutes, and other organizations.

His focus has been primarily on sugar, not carbohydrates in general. Dr. Feinman has been critical of him on this account. But it appears that he is moving toward the low-carb diet, along with a convergence of his views with those of Gary Taubes. See the discussion on the Ketogenic Forums: Has Lustig moved toward us?

Dr. Lustig is quoted from the below video:

 

Does a Healthy LCHF Diet Protect Against Sunburns?

As I’ve written about lately, there is something unique about a low-carb, high-fat diet. People feel better and have more energy. Diverse symptoms disappear, including from serious conditions that for some people are reversed, from autoimmune disorders to mood disorders. That is particularly true in the context of exercise, calorie restriction, fasting, OMAD, ketosis, autophagy, etc and when combined with traditional foods, paleo, carnivore, etc. Many have experimented with this area of dietary changes and have observed major improvements, but it isn’t always clear exactly what is causing any given improvement.

We do understand certain things well. I’ve already discussed in detail ketosis and related factors. And there has been more info coming out about autophagy, an even more fascinating topic. There is the signaling in relation to mTOR, IGF1, and AMPK. And there are the hormones that deal with hunger, satiety, and fullness. Everything is context-dependent. For example, the carnitine in red meat can be turned into carcinogenic TMOA by the Prevotella gut bacteria, but that is a non-issue as long as you aren’t eating the grains that feed Prevotella in the first place. Or consider how vitamin C deficiency that leads to scurvy is rare on carnivore diets, even though vitamin C is found in such small amounts in animal foods, since on a low-carb diet the body needs less vitamin C. Issues with gut health, inflammation, and neurocognition are also more clear in explanation as they’ve received much scientific attention.

Other results are more anecdotal, though. This is largely because the research on low-carb, high-fat diets has been limited and in many cases, such as with zero-carb, scientific evidence is even more sparse. But what thousands of people have observed remains interesting, if yet not entirely explained. Many LCHF dieters have noted that their thoughts are less obsessive and compulsive, something I’ve argued has to do with eliminating addictive foods from the diet, especially added sugar and grains. An example of this is decrease of intrusive sexual thoughts reported by some (and less distraction in general), although at the same time some also state decrease in erectile dysfunction (the latter being unsurprising as the LCHF diet are causally linked to hormonal functioning and cardiovascular health). Sexuality definitely is changed in various ways, as demonstrated in how early puberty becomes common when populations switch to agriculture with high amounts of carbohydrates, in particular grains, and maybe dairy has something to do with it as well since dairy triggers growth hormone — maybe why agricultural societies were able to outbreed hunter-gatherers, overwhelming them with a continually growing supply of cheap labor and cheap lives to send off to war.

There are some confounding factors, of course. Along with more nutrient-dense foods with an emphasis on fat-soluble vitamins, people going on various kinds of low-carb diets also tend to increase cholesterol, saturated fat, and omega-3s while decreasing omega-6s. Cholesterol is one of the most important substances for brain health and it helps your body to process vitamin D from sunlight. Saturated fat is a complicated issue and no one fully knows the significance, beyond our knowing the fear-mongering about it appears to be no longer valid. As for omega-3s, they are essential to so much. The main problem is that omega-6s are at such a high level in the modern diet that they are inflammatory. In using healthier oils and fats, most low-carbers eliminate vegetable oils in junk food and in cooking with vegetable oils being the main source of omega-6s.

This could explain why some think sunburns are less common on a low-carb diet (read down through the Twitter comments). It may or may not have anything specifically to do with carbohydrates themselves and, instead, be more about the general eating pattern common among low-carb dieters. This might have to do with oxidation and free-radicals in relation to omega-6s. Or it could have something to do with fat-soluble vitamins or dietary cholesterol that is typically greater in low-carb, high-fat diets. There are similar patterns in multiple areas of dietary changes and health, and they indicate something that can’t be explained by mainstream health ideology. Consider how Americans have experienced worsening health as they have followed expert opinion in eating more vegetables, fruits, whole grains, and vegetable oils while decreasing red meat and saturated fat. Americans have been following expert advice from mainstream institutions and from their doctors. The same kind of thing has happened with people protecting themselves against sun damage. Americans have increased their use of sunscreen while spending less time in the sun, as they were told to do. What has been the results? The skin cancer rate is going up and those avoiding the sun are less healthy. Is it a mere coincidence that the intake of omega-6s was also increasing during the same period? Maybe not.

When the actual causes are determined, we can isolate them and re-create the appropriate conditions or mimic them. This is biohacking — Siim Land is great in explaining how to get particular results based on the scientific evidence. If omega-6s or whatever is the problem behind sunburns, then it’s far from being knowledge of value limited to the low-carb community. Omega-6s haven’t been as clearly on the radar of many other diets, but health issues with omega-6s are already well known in the scientific literature. So, the advantages in this case might be attained without restricting carbs, although we don’t know that as of yet, assuming the anecdotal observations are proven valid. The interaction between omega-6s and carbohydrates might be a total package, in terms of pushing the body more fully into an inflammatory state where sunlight sensitivity becomes an issue. All we can do at the moment is offer hypotheses to be tested in personal experience and hopefully soon in scientific studies.

There are other arguments for why a specifically low-carb diet could offer sunburn protection, as explored by Keir Watson in Animal Products That Protect You From UV Damage. This is particularly true when we are talking about a paleo or similar diet with plenty of fatty animal foods. Along with omega-3s, saturated fat might play a role: “A higher saturation index should be protective against free-radical damage, suggesting that more saturated fat in the diet might be good, but the evidence I found was not very strong.” More research will need to be done on that possibility. Even if saturated fats simply replace omega-6s, they will be beneficial in this area of health. Another thing to consider is creatine, plentifully found in meat and fish, that “has marked protective effects against oxidative stress and UV-induced damage in the skin, including protecting mitochondrial DNA.” The last thing brought up by Watson are antioxidants, although typically associated with plants, are also found in animal products: “Lutein and zeaxanthin (from egg yolk),” “Astaxanthin found in wild salmon, krill, lobster and crab,” “retinol (vitamin A from animal source, e.g. liver),” and vitamin D from “oily fish – salmon, mackerel, herrings and sardines – the very same fish that give you the protective omega-3 fats!”

The body is a complex system. Change even a single factor and it can have cascading effects. But change multiple factors and the entire functioning can shift into a different state, altering numerous areas of health. Many of the results will be unpredictable based on present science because most research up to this point has had a narrow focus in the population being studied, almost entirely those on the Standard American diet and variations of it. What is true for most people following the past half century of health advice won’t always apply to those following entirely different diets and lifestyles. It’s not that LCHF is going to heal all that ails you, but we find ourselves at a rather fascinating point in the views on diet, lifestyle, and health. We are coming to realize how profoundly affected is the body and mind by even some minor changes. We have more hypotheses at present than knowledge, and that isn’t a new situation. So much of what we thought we knew in the past, the basis of mainstream ideology of health experts, were largely untested hypotheses when first advocated and much of it remains unproven.

Now it’s time to get serious about exploring these other glimpses of entirely different possibilities of understanding. That is the point of hypotheses that often begin as observations and anecdotal evidence.

* * *

Effect of Dietary Lipid on UV Light Carcinogenesis in the Hairless Mouse
by Vivienne E. Reeve, Melissa Matheson, Gavin E. Greenoak, Paul J. Canfield, Christa Boehm‐Wilcox, and Clifford H. Gallagher

Isocaloric feeding of diets varying in lipid content to albino hairless mice has shown that their susceptibility to skin tumorigenesis induced by simulated solar UV light was not affected by the level of polyunsaturated fat, 5% or 20%. However a qualitative effect of dietary lipid was demonstrated. Mice fed 20% saturated fat were almost completely protected from UV tumorigenesis when compared with mice fed 20% polyunsaturated fat. Multiple latent tumours were detected in the saturated fat‐fed mice by subsequent dietary replenishment, suggesting that a requirement for dietary unsaturated fat exists for the promotion stage of UV‐induced skin carcinogenesis.

Effects of high-fat diets rich in either omega-3 or omega-6 fatty acids on UVB-induced skin carcinogenesis in SKH-1 mice
by You-Rong Lou et al

Is Sunscreen the New Margarine?
by Rowan Jacobsen

Don’t Drink (oil) and Fry (in the sun) – the link between polyunsaturated vegetable oil and skin cancer
by George Henderson

N=Many on Omega-6 and Sunburn: Can Sunburn be Reduced?
by Tucker Goodrich

Don’t Blame it on the Sun!
by Dawn Waldron

Why I Don’t Use (Or Need) Sunscreen
by Tom Naughton

American Diabetes Association Changes Its Tune

Over the past decade, ever more mainstream health organizations and government agencies have been slowly reversing their official positions on the dietary intake of carbohydrates, sugar, fat, cholesterol, and salt. This was seen in how the American Heart Association, without acknowledgment, backed off its once strong position about fats that it defended since I think 1961, with the federal government adopting the same position as official policy in 1980. Here we are in 2019, more than a half century later.

Now we see the American Diabetes Association finally coming around as well. And its been a long time coming. When my grandmother was in an assisted living home, the doctors and nurses at the time were following the official ADA position of what were called “consistent carbs”. Basically, this meant diabetics were given a high-carb diet and that was considered perfectly fine, as long as it was consistent so as to manage diabetes with consistent high levels of insulin use. It was freaking insanity in defying common sense.

While my grandmother was still living with my parents, my mother kept her blood sugar under control through diet, until she went to this healthcare facility. After that, her blood sugar was all over the place. The nurses had no comprehension that not all carbohydrates are equal since the glycemic index might be equivalent between a cookie and a carrot, irrespective of glycemic load and ignoring that maybe diabetics should simply be cutting out carbs in general. Instead, they argued that old people should be allowed to enjoy carbs, even if it meant that these nurses were slowly killing their patients and profiting the insulin companies at the same time. My mother was not happy about this callous attitude by these medical ‘professionals’.

Yet here we are. The ADA now says low-carb, high-fat (LCHF) diets aren’t a fad and aren’t dangerous. They go so far as to say they are beneficial for type 2 diabetes. Those not completely ignorant have been saying this for generations. And the research has been accumulating for just as long. The shift in official recommendations that happened in the decades following the 1960s never made sense even according to the research at the time. Many academics and researchers pointed out the lack of evidence in blaming saturated fat and cholesterol. But they were ignored and dismissed, then later attacked, discredited, and silenced by influential and, in some cases, downright charismatic figures (e.g., Ancel Keys) in powerful organizations that became aligned with leading politicians and bureaucrats in key positions. Many careers were destroyed and debate was shut down.

Now those victims of dietary authoritarianism are vindicated, not that this helps all the average folk harmed. There was many decades of bad dietary advice was force onto the American public. This determined official policies and practices of government healthcare programs, school lunch programs, and healthcare providers. Because of the central position of the United States as a geopolitical power during the Cold War, countries all over the world adopted this unhealthy dietary ideology as part of their own official policies.

This also influenced the food system with the government subsidizing high yields of corn and grains to meet the recommendations of these nutritional guidelines. Big ag and big food changed their business models accordingly and put out products that were high in carbs and sugar while low in saturated fat, replacing the latter with unhealthy hydrogenated oils. At least hundreds of millions, if not billions of people, worldwide over multiple generations have suffered a horrible diet, increased sickness, bad medical care, and premature mortality as a result.

Without admitting they were wrong all this time, without apologizing for all the harm they caused, these leading experts and officials are changing their opinion. Better late than never. Mark this date for it is a historic moment.

* * *

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report
by Alison B. Evert et al, American Diabetes Association
(also see here)

EATING PATTERNS: Consensus recommendations

  • A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.
  • Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key
    factors that are common among the patterns:
    ○ Emphasize nonstarchy vegetables.
    ○ Minimize added sugars and refined grains.
    ○ Choose whole foods over highly processed foods to the extent possible.
  • Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.
  • For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very lowcarbohydrate eating plans is a viable approach

New Consensus Report Recommends Individualized Eating Plan to Meet Each Person’s Goals, Life Circumstances and Health Status
news release from American Diabetes Association

“‘What can I eat?’ is the number one question asked by people with diabetes and prediabetes when diagnosed. This new Consensus Report reflects the ADA’s continued commitment to evidence-based guidelines that are achievable and meet people where they are and recommends an individualized nutrition plan for every person with diabetes or prediabetes,” said the ADA’s Chief Scientific, Medical and Mission Officer William T. Cefalu, MD. “The importance of this consensus also lies in the fact it was authored by a group of experts who are extremely knowledgeable about numerous eating patterns, including vegan, vegetarian and low carb.”

Nina Teicholz:

Just out: @AmDiabetesAssn guidelines–most comprehensive review to date of Dietary Patterns + diabetes prevention/treatment. What’s new: low-carb recommendations are prominent. (Says low-carb “are among the most studied eating patterns for T2 diabetes.”) […]

This is the key advancement of new @AmDiabetesAssn guidelines. Low carb is no longer “dangerous”‘or “fad”‘but a “viable”‘diet supported by “substantial”‘research and considered best for a number of T2 diabetes outcomes.

Dr. John Owens:

This is an historic day! My case managers and dietitian have been supporting my low-carb recommendations for years, going against ADA guidelines. Now they don’t have to!

Dr. Eric Sodicoff:

Still….They seem a little backward here. Bust out the low carb diet when meds not working?? Really? IMHO-Carb restriction is JOB #1 in diabetes management for use early and always. It is NOT second to medication my treatment protocol.

Starofthesea:

If you go back to the beginning, like back in the 1930’s, the doctors were telling diabetics to stop eating carbohydrates. Then somebody fabricated the cholesterol theory of heart disease and invented a drug called statins. Then suddenly carbs were okay for diabetics.

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report — American Diabetes Association
from r/ketoscience

lutzlover:

“Eating patterns that replace certain carbohydrate foods with those higher in total fat, however, have demonstrated greater improvements in glycemia and certain CVD risk factors (serum HDL cholesterol [HDL-C] and triglycerides) compared with lower fat diets.”

Yay! Ack that higher fat isn’t deadly.

“The body makes enough cholesterol for physiological and structural functions such that people do not need to obtain cholesterol through foods. Although the DGA concluded that available evidence does not support the recommendation to limit dietary cholesterol for the general population, exact recommendations for dietary cholesterol for other populations, such as people with diabetes, are not as clear (8). Whereas cholesterol intake has correlated with serum cholesterol levels, it has not correlated well with CVD events (65,66). More research is needed regarding the relationship among dietary cholesterol, blood cholesterol, and CVD events in people with diabetes.

Or, in layman’s language: While the data doesn’t support vilifying cholesterol as causing heart attacks, we’re going to keep on searching in hopes we find the answer we want.

dem0n0cracy:

Are protein needs different for people with diabetes and kidney disease?

“Historically, low-protein eating plans were advised to reduce albuminuria and progression of chronic kidney disease in people with DKD, typically with improvements in albuminuria but no clear effect on estimated glomerular filtration rate. In addition, there is some indication that a low-protein eating plan may lead to malnutrition in individuals with DKD (317–321). The average daily level of protein intake for people with diabetes without kidney disease is typically 1–1.5 g/kg body weight/day or 15–20% of total calories (45,146). Evidence does not suggest that people with DKD need to restrict protein intake to less than the average protein intake.

dem0n0cracy:

“The amount of carbohydrate intake required for optimal health in humans is unknown. Although the recommended dietary allowance for carbohydrate for adults without diabetes (19 years and older) is 130 g/day and is determined in part by the brain’s requirement for glucose, this energy requirement can be fulfilled by the body’s metabolic processes, which include glycogenolysis, gluconeogenesis (via metabolism of the glycerol component of fat or gluconeogenic amino acids in protein), and/or ketogenesis in the setting of very low dietary carbohydrate intake (49).”

dem0n0cracy:

Low-carbohydrate (110–112) Emphasizes vegetables low in carbohydrate (such as salad greens, broccoli, cauliflower, cucumber, cabbage, and others); fat from animal foods, oils, butter, and avocado; and protein in the form of meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds. Some plans include fruit (e.g., berries) and a greater array of nonstarchy vegetables. Avoids starchy and sugary foods such as pasta, rice, potatoes, bread, and sweets. There is no consistent definition of “low” carbohydrate. In this review, a low-carbohydrate eating pattern is defined as reducing carbohydrates to 26–45% of total calories. c A1C reduction c Weight loss c Lowered blood pressure c Increased HDL-C and lowered triglycerides

Very low-carbohydrate (VLC) (110–112) Similar to low-carbohydrate pattern but further limits carbohydrate-containing foods, and meals typically derive more than half of calories from fat. Often has a goal of 20–50 g of nonfiber carbohydrate per day to induce nutritional ketosis. In this review a VLC eating pattern is defined as reducing carbohydrate to ,26% of total calories. c A1C reduction c Weight loss c Lowered blood pressure c Increased HDL-C and lowered triglycerides”

dem0n0cracy:

Low-Carbohydrate or Very Low Carbohydrate Eating Patterns

“Low-carbohydrate eating patterns, especially very low-carbohydrate (VLC) eating patterns, have been shown to reduce A1C and the need for antihyperglycemic medications. These eating patterns are among the most studied eating patterns for type 2 diabetes. One metaanalysis of RCTs that compared lowcarbohydrate eating patterns (defined as #45% of calories from carbohydrate) to high-carbohydrate eating patterns (defined as .45% of calories from carbohydrate) found that A1C benefits were more pronounced in the VLC interventions (where ,26% of calories came from carbohydrate) at 3 and 6 months but not at 12 and 24 months (110).

“Another meta-analysis of RCTs compared a low-carbohydrate eating pattern (defined as ,40% of calories from carbohydrate) to a low-fat eating pattern (defined as ,30% of calories from fat). In trials up to 6 months long, the low-carbohydrate eating pattern improved A1C more, and in trials of varying lengths, lowered triglycerides, raised HDL-C, lowered blood pressure, and resulted in greater reductions in diabetes medication (111). Finally, in another meta-analysis comparing lowcarbohydrate to high-carbohydrate eating patterns, the larger the carbohydrate restriction, the greater the reduction in A1C, though A1C was similar at durations of 1 year and longer for both eating patterns (112). Table 4 provides a quick reference conversion of percentage of calories from carbohydrate to grams of carbohydrate based on number of calories consumed per day.

“Because of theoretical concerns regarding use of VLC eating plans in people with chronic kidney disease, disordered eating patterns, and women who are pregnant, further research is needed before recommendations can be made for these subgroups. Adopting a VLC eating plan can cause diuresis and swiftly reduce blood glucose; therefore, consultation with a knowledgeable practitioner at the onset is necessary to prevent dehydration and reduce insulin and hypoglycemic medications to prevent hypoglycemia.

“No randomized trials were found in people with type 2 diabetes that varied the saturated fat content of the low- or very low-carbohydrate eating patterns to examine effects on glycemia, CVD risk factors, or clinical events. Most of the trials using a carbohydrate-restricted eating pattern did not restrict saturated fat; from the current evidence, this eating pattern does not appear to increase overall cardiovascular risk, but longterm studies with clinical event outcomes are needed (113–117).”

dem0n0cracy:

What is the evidence to support specific eating patterns in the management of type 1 diabetes?

“For adults with type 1 diabetes, no trials met the inclusion criteria for this Consensus Report related to Mediterraneanstyle, vegetarian or vegan, low-fat, low-carbohydrate, DASH, paleo, Ornish, or Pritikin eating patterns. We found limited evidence about the safety and/or effects of fasting on type 1 diabetes (129). A few studies have examined the impact of a VLC eating pattern for adults with type 1 diabetes. One randomized crossover trial with 10 participants examined a VLC eating pattern aiming for 47 g carbohydrate per day without a focus on calorie restriction compared with a higher carbohydrate eating pattern aiming for 225 g carbohydrate per day for 1 week each. Participants following the VLC eating pattern had less glycemic variability, spent more time in euglycemia and less time in hypoglycemia, and required less insulin (130). A single-arm 48-person trial of a VLC eating pattern aimed at a goal of 75 g of carbohydrate or less per day found that weight, A1C, and triglycerides were reduced and HDL-C increased after 3 months, and after 4 years A1C was still lower and HDL-C was still higher than at baseline (131). This evidence suggests that a VLC eating pattern may have potential benefits for adults with type 1 diabetes, but clinical trials of sufficient size and duration are needed to confirm prior findings.”