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 again 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. 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 any diet that doesn’t directly deal with that will be ineffective. And 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.”

Getting Into Ketosis

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

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

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

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

Ketogenic Strategy                             —>               Ketone Levels (mmol/L)

Caffeine                                                    —>               0.2 to 0.3

Coconut Oil                                              —>               0.3 to 0.5

Vigorous Exercise                                  —>              0.3 to 0.5

Overnight Fast                                        —>              0.3 to 0.5

MCT Oil                                                      —>             0.3 to 1.0

Branched Chain Amino Acids            —>             0.3 to 1.0

Ketone Mineral Salts                            —>             0.5 to 1.0

Classic Ketogenic Diet                          —>             2 to 6

Starvation/Long-Term Fasting       —>             2 to 7

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

Diabetic Ketoacidosis                           —>            10 to 25

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

How to get into ketosis:

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

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

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

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

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

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

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

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

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

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

Official Guidelines For Low-Carb Diet

A while back, the Swedish government came around to advising a low-carb (and high-fat or at least not low-fat) diet for treating obesity, diabetes, and heart disease. They were the first Western country to do so. The government committee didn’t come to this official position casually, as they first reviewed 16,000 studies (Brian Shilhavy, Sweden Becomes First Western Nation to Reject Low-fat Diet Dogma in Favor of Low-carb High-fat Nutrition). The committee consisted of ten physicians, several of which were skeptics of the low-carb diet — far from being a foregone conclusion (Dr. Andreas Eenfeldt, “Fat Trims Your Waistline”).

The committee’s assessment of the low-carb diet was glowing: “…a greater increase in HDL cholesterol (“the good cholesterol”) without having any adverse affects on LDL cholesterol (“the bad cholesterol”). This applies to both the moderate low-carbohydrate intake of less than 40 percent of the total energy intake, as well as to the stricter low-carbohydrate diet, where carbohydrate intake is less than 20 percent of the total energy intake. In addition, the stricter low-carbohydrate diet will lead to improved glucose levels for individuals with obesity and diabetes, and to marginally decreased levels of triglycerides” (as quoted by Dr. Andreas Eenfeldt in Swedish expert committee: A low-carb diet most effective for weight loss).

As you can see, they went so far as to speak well of a stricter version of the low-carb diet. That is the way mainstream experts refer to what cannot be named. The ketogenic diet retains a stigma that isn’t easily shaken, despite a century of powerful medical research behind it. The ketogenic diet sneaks in, nonetheless — just low-carb with a bit more restriction, which sounds less threatening. But the saturated fat issue is still a sore spot, despite the lack of research ever causally linking it to any disease condition. It’s one step at a time. Openly and loudly declaring low-carb diets as an unequivocal good is a massive step forward. It swings the door wide open for the rest to follow.

The Swedish committee came out with their report in 2017. Now the Australian government has done a scientific review (Inquiry into the role of diet in type 2 diabetes prevention and management) and also taken the official position that low-carb diet should be the default diet for diabetes, although I’m not quite sure when this happened (here is a 2018 Position Statement: Low carbohydrate eating for people with diabetes). “A landmark Australian report has highlighted that remission, not just management, should be the target for type 2 diabetes interventions, and that low carb provides a valuable way to achieve this” (Jack Woodfield, Landmark Australian report promotes low carb approach for treating type 2 diabetes). The committee report even included mention of the benefits from “very low-carbohydrate” dieting, that is to say ketogenic (Ryan Mernin, Australian Lawmakers Propose Low-Carb as Official Diabetes Treatment). The Australian government has gone so far as recommending a campaign to promote diet as a primary approach, as opposed to mere treatment with drugs.

This is an amazing about-face from the position taken only a few years ago. “Fettke, an orthopedic surgeon,” Jennifer Calihan wrote, “was sanctioned in 2016 by regulators (the Australian Health Practitioners Regulation Agency or AHPRA) for recommending a low-carb lifestyle to patients he felt could improve their health by changing their diets. As we wrote in November 2016, Dr. Fettke was officially ‘silenced’ by the AHPRA; this means he was forbidden to give diet-related advice to his patients” (Dr. Gary Fettke exonerated! Receives apology from regulators).

How did that end? Two years later, those attacking him were forced to admit that they had wronged Dr. Fettke. “We are pleased to report that after careful review, the AHPRA has repealed its decision in its entirety, and cleared Dr. Fettke of all charges. He also received a written apology…” As when Tim Noakes won his case in South Africa, this was one more victory for the validity of low-carb diets. Other incidents where doctors have been attacked for advocating for their patients’ health have ended similarly. The tide has turned. It didn’t come out of nowhere, though. In 2017, an Australian government research agency put out a low-carb diet book (Dr. Andreas Eenfeldt, Australian Government Research Agency Releases Low-Carb Diet Book). It’s sad that they were doing this at the same time that regulators were attacking Dr. Fettke.

Some signs of change are seen in the UK as well. The UK National Health Service has officially stated that, “The Low Carb Program can help anyone with type 2 diabetes or pre-diabetes take better control of their condition” (Low Carb Program). That is a good start and might begin to catch the attention of policymakers in the US. The fact that the Pentagon and US military have been researching the ketogenic diet is a massive step forward (Obese Military?), but there seems to be resistance in implementing it, maybe because that would put the Pentagon in opposition to official USDA policy and there might be pressure in the government to not allow internal conflict.

Such shifts don’t happen easily or evenly. Governments lurch back and forth before finally taking a new direction. It’s been building up for a while. This has been true for many governments and health institutions, as they slowly and quietly shift away from the old high-carb dogma without ever admitting they were wrong, instead often hiding the changes of position on a back page of their official website without any public announcement reported by every major news outlet. This is how, without most people realizing it, new viewpoints take hold. Only future historians will look back and realize the dramatic paradigm shift that occurred.

Yet sometimes the shift is quite dramatic. Belgium’s Royal Academy of Medicine recently stated in no uncertain terms that children, teens, pregnant women, and nursing mothers should not follow a vegan diet. A precedent was set with a 2017 case of a child’s death from a vegan diet where the parents were given suspended jail time (Mitchell Sunderland, Judge Convicts Parents After Baby Dies from Vegan Diet). The Belgian government has decided that from now on they will legally prosecute other parents in cases such as these (Susan Scutti, Is vegan diet healthy for kids? Belgian doctors say no). In other countries, there have been similar prosecutions against vegan parents when children have died. And before this decision in Belgium, there was a 2016 proposal for prosecution in Italy (BBC, Italy proposal to jail vegans who impose diet on children).

This fits into the larger shift I’m talking about. Veganism is typically high-carb and low-fat, not to mention low-protein (e.g., fruit smoothies loaded with sugar) — the complete opposite of the typical LCHF diet that emphasizes moderate-to-high protein intake, such as fatty animal foods. It’s true a vegan could go on a LCHF diet and some do and yet few choose to do so since, without animal fat, it seems glucose becomes the preferred fuel for the body.

The prosecution of vegan-related childhood death is a real shocker, considering veganism has been held up as the ultimately healthy plant-based diet for decades. Veganism had become quite trendy among celebrities, but that is likely reversing as well. This past year or so, a large number of well known vegans, many of them vegan advocates with sizable followings, have given up the vegan diet and gone back to eating animal foods. Other than some Hollywood stars, the most famous example is that of Tim Shieff, a professional athlete who had become a leader in the vegan movement but began eating meat again because of serious health concerns. So, along with an emerging shift in public policy, there has also been a shift in public perception about diets.

This new dietary attitude is not limited to more progressive countries elsewhere. We are seeing these same trends even in the corporatist United States, the epicenter of high-carb advocacy by government authorities and institutional experts and big food lobbyists. There has been a slow revolution. Some years back, the American Heart Association snuck in some changes to sugar intake and it barely received any media attention — no public announcement, no apologies, as if that was always their position. That was amazing. All the way back to the 1950s, the AHA had led the charge in blaming fats and exonerating sugar. Almost three quarters of a century of being wrong and now they’re backtracking. The U.S. government followed suit in 2015 (Jen Christensen, 2015 Dietary Guidelines). Neither of these was a defense of low-carb diets, but it was a reversal of course without explanation. Even Walter Willett who followed in Ancel Keys footsteps admitted that they had been wrong in having put all blame on saturated fat and that was a mind-blowing admission, considering how hard those like him had defended the status quo and attacked all alternative views with many careers destroyed in the process.

Just this year, the American Diabetes Association also changed its tune. Once again, there was little fanfare. It’s as if a volcano erupted in the middle of New York City and no media outlet thought to send a reporter to the scene to see what happened. Suddenly, a volcano in New York City is the new norm. The ADA went even further than did the AHA, in that they specifically and clearly declared that LCHF diets are not a fad and are not dangerous. This thawing of dietary ideology has been slowly cracking the edifice of the glacier that had enclosed public debate since the mid-20th century. The growing evidence simply can’t be denied, as the research on low-carb including keto has shown positive results, the shift having taken hold in the 1990s with the Charlie Foundation. The new direction was initially imperceptible to anyone not paying attention. I barely noticed this myself until quite recently, even though I’ve long thought of sugar as an addictive drug and even though I did experiment with the low-carb diet earlier last decade, but I didn’t realize how much the science itself was going down a different path.

Dr. Robert Lustig points out how he was taught this information in his nutritionist education, but then had it drilled out of him in medical school. He forgot about what he had learned and followed establishment thought for the next twenty years. It’s maybe not surprising that he re-awoke to his horrible mistake around the time the Charlie Foundation was established. He was angry, presumably for having failed his patients in providing them the best care but no doubt also for allowing himself to be duped. Many other doctors and other health experts have grown angry as well and that anger has driven a sense of passionate advocacy and moral responsibility. It wasn’t merely a personal failure but that of an entire field and public health was the victim, that is to say hundreds of millions of Americans suffered the consequences.

It’s been building up for a while. And the public hasn’t been entirely kept in the dark. The internet opened up public debate like never before. At the same time research was proving that low-carb works, people were experimenting on themselves and discovering the truth of this. This initially led to a backlash by the powers that be, but the public awareness keeps gaining momentum. The ketogenic diet has become the most Googled diet. One hears about low-carb diets all the time thee days, even when it is simply another denial of the facts. Suppression of truth through silence is no longer an option. Authorities are forced to respond one way or another, and increasingly that has meant a gradual movement toward low-carb. Maybe unsurprisingly, as more Americans embrace low-carb diets following the peak of sugar intake in 1999, for the first time in decades the diabetes epidemic seems to be subsiding.

There have been widely read journalistic accounts of what has gone so wrong in the field of diet and nutrition, specifically the work of Gary Taubes and Nina Teicholz. Several popular documentaries have also had quite an impact, from Pete Evans’ The Magic Pill to Tom Naughton’s Fat Head. On social media, there has been growing influence of low-carb advocates, including many doctors and scientists. Some low-carb Facebook groups have millions of members. And a video of a biochemistry talk criticizing sugar by Dr. Robert Lustig has received millions of views.

I’ve argued that changes will come from below before we see changes in public policy, but in some countries the government is taking the lead. In the United States, it’s going to take a while for low-carb diets to make their way into the official dietary recommendations. The main problem is the U.S. was the original force behind the high-carb, low-fat fad diet and the reason other governments adopted it. There are too many American experts who built their careers on it and several highly respected institutions that fully embraced it. They can never admit they were wrong. I’m sure many of the people involved see the writing on the wall, but they are trying to figure out how to switch their position while saving face and without too many people noticing. Only after many other Western governments take up the low-carb approach will the U.S. government follow their example. Then and only then, if we are lucky, the entire food system of transnational corporations might begin to fall in line.

Consensus will eventually shift. Most of the experts that once were against low-carb will suddenly be for it or else they’ll simply become irrelevant and forgotten. A generation will grow up not knowing anything else and the former dietary ideology will quickly fade from public memory, but the consequences on public health will epigenetically linger for many generations more. Fortunately, individuals don’t have to wait for the rest of society to catch up. What you do as an individual can improve your health, along with the health of your children and grandchildren. One thing that is guaranteed is that low-carb is a vast improvement over what most Americans are eating and what the United States government is recommending. That much is clear from the science.

* * *

For more info, see:

Slow, Quiet, and Reluctant Changes to Official Dietary Guidelines

“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.”

Like water fasts, meat fasts are good for health.

I was on a low-carb paleo diet for about a year with a focus on intermittent fasting and ketosis. Influenced by Dr. Terry Wahls and Dr. Will Cole, both former vegetarians converted to paleo, this included large helpings of vegetables but without the starchy carbs. It was a game-changer for me, as my health improved on all fronts, from weight to mood. But every time my carbs and sugar intake would creep up, I could feel the addictive cravings coming back and I decided to limit my diet to a greater extent. Zero-carb had already been on my radar, but I then looked more into it. It seemed worth a try.

So, I went carnivore for the past couple of months, mostly as an experiment and not as an idea of it being permanent. It is the best elimination diet ever and it definitely takes low-carb to another level, but I wanted to be able to compare how I felt with plants in my diet. So, a couple weeks ago with spring in the air and wild berries on their way, I ended my zero-carb carnivory with a three-day fast and reintroduced some light soup and fermented vegetables. I felt fine. Even after the extended period of low-carb diet, this zero-carb experiment made me realize how much better I feel with severely restricting carbs and sugar. Now back on a paleo-keto diet, I’m going to keep my focus on animal foods and be more cautious about which plant foods I include and how often.

Dr. Anthony Gustin offers an approach similar to Siim Land, as discussed in the first four videos below. A low-carb diet, especially strict carnivore (no dairy, just meat), is an extremely effective way of healing digestive issues and reducing bodily inflammation. The carnivore diet is a low residue diet because meat and fat gets fully digested much earlier in the digestive tract, whereas lots of fiber can clog you up in causing constipation. A similar kind of benefit is seen with the ketogenic diet, as microbiome imbalance and overgrowth is improved by initially starving and decreasing the number of microbes, but after some months the microbiome recovers to its original numbers and with a healthier balance.

Still, as Gustin and Land argue, it’s good to maintain some variety in the diet for metabolic flexibility. But we must understand plants stress the system (Steven Gundry, The Plant Paradox), as they are inflammatory, unlike most animal foods (though dairy can be problematic for some), and plants contain anti-nutrients that can cause deficiencies. There are other problems as well, such as damage from oxalates that are explained by the oxalate expert Sally K. Norton in the fifth and sixth videos; she argues that plants traditionally were only eaten seasonally and not daily as she talks about in the seventh video (also, written up as an academic paper: Lost Seasonality and Overconsumption of Plants: Risking Oxalate Toxicity).

Even so, one might argue that small amounts of stress are good for what is called hormesis — in the way that working out stresses the body in order to build muscle, whereas constant exertion would harm the body; or in the way that being exposed to germs as a child helps the development of a stronger immune system — with a quick explanation by Siim Land in the second video below. Otherwise, by too strictly excluding foods for too long you might develop sensitivities, which the fourth video is about. As cookie monster said about cookies on the Colbert Show, vegetables are a sometimes food. Think of plant foods more as medicine in that dose is important.

Plant foods are beneficial in small portions on occasion, whereas constantly overloading your body with them never gives your system a rest. Fruits and veggies are good, in moderation. It turns out a “balanced diet” doesn’t mean massive piles of greens for every meal and snacks in between. Grains aren’t the only problematic plant food. Sure, on a healthy diet, you can have periods of time when you eat more plant foods and maybe be entirely vegan on certain days, but also make sure to fast from plant foods entirely every now and then or even for extended periods.

That said, I understand that we’ve been told our entire lives to eat more fruits and veggies. And I’m not interested in trying to prove zero-carbs is the best. If you’re afraid that you’ll be unhealthy without a massive load of plant nutritients, then make sure to take care of potential problems with gut health and inflammation. In the eighth video below, a former vegan explains how she unknowingly had been managing her plant-induced inflammation with CBD oil, something she didn’t realize until after stopping its use. She later turned to an animal-based diet and the inflammation was no longer an issue.

But for those who don’t want to go strictly low-carb, much less carnivore, there are many ways to manage one’s health, besides anti-inflammatory CBD oil. Be sure to include other anti-inflammatories such as turmeric (curcumin) combined with, for absorption, black pepper (bioperine). Also, intermittent and extended fasting will be all the more important to offset the plant intake, although everyone should do fasting as it is what the human body is designed for. A simple method is limited eating periods, even going so far as one meal a day (OMAD), but any restriction is better than none. Remember that even sleeping at night is a fast and so, skipping breakfast or eating later, will extend that fast with its benefits; or else skipping dinner will start the fasting period earlier.

Even on a vegan or vegetarian diet, one can also do a ketogenic diet, which is another way of reducing inflammation and healing the gut. For this approach, I’d suggest reading Dr. Will Cole’s book Ketotarian; also helpful might be some other books such as Dena Harris’ The Paleo Vegetarian Diet and Mark Hyman’s Food: What the Heck Should I Eat?. Anytime carbs are low enough, including during fasts, will put the body into ketosis and eventually autophagy, the latter being how the body heals itself. Carbs, more than anything else, will knock you out of this healthy state, not that you want to be permanently in this state.

Still, I wouldn’t recommend extreme plant-based diets, in particular not the typically high-carb veganism. Even with the advantages of low-carb, I would still avoid it as this will force you to eat more unhealthy foods like soy and over-consume omega-6 fatty acids from nuts and seeds, one of the problems discussed in the fourth video. Some vegetarians and vegans will oddly make an exception for seafood; but if you don’t eat seafood at all, be sure to add an algal-source supplement of EPA and DHA, necessary omega-3 fatty acids that are also beneficial for inflammation and general health. If meat, including seafood, is entirely unacceptable, consider at least adding certain kinds animal foods in such as pasture-raised eggs and ghee.

If you still have health problems, consider the possibility of going zero-carb. Even a short meat fast might do wonders. As always, self-experimentation is the key. Put your health before dietary ideology. That is to say, don’t take my word for it nor the word of others. Try it for yourself. If you want to do a comparison, try strict veganism for a period and then follow it with carnivore. And if you really want to emphasize the difference, make the vegan part of the experiment high-carb and I don’t necessarily mean what are considered ‘unhealthy’ carbs — so, eat plenty of whole wheat bread, rice, corn, and beans, — that way you’ll also feel the difference that carbohydrates make. But if you don’t want to do carnivore for the other part of the experiment, at least try a ketogenic diet which can be done with more plant-based foods but consider reducing the most problematic plant foods, as Gundry explains.

Of course, you can simply jump right into carnivory and see what happens. Give it a few months or even a year, as it can take a while for your body to heal, not only in elimination of toxins. What do you have to lose?

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I’ll add a personal note. I’ve long had an experimental attitude about life. But the last year, I’ve been quite intentional in my self-experimenting. Mainly, I try something and then observe the results, not that I’m always that systematic about it. Many of the changes I’ve experienced would be hard to miss, even when I’m not paying close attention.

That playing around with dietary parameters is what I’m still doing. My dietary experiments likely will go on for quite a while longer. After a few days of fermented vegetables, I felt fine and there were no symptoms. I decided to try a salad which is raw vegetables (lettuce, green onions, and radishes) and included fermented vegetables. Now I notice that the inflammation in my wrist has flared up. I’ll take that as my body giving me feedback.

One of the best benefits to zero-carb was how inflammation had gone away. My wrists weren’t bothering me at all and that is a big deal, as they’re has been irritation for years now with my job as a cashier and all the time I spend on the computer. Inflammation had gone down with low-carb, but it was still noticeable. There was further decrease with zero-carb and I’d hate to lose those gains.

As I said, I’m being cautious. The benefits I’ve seen are not slight and far from being limited to joint issues, with what is going on with my wrists probably being related to the crackling in my knees I experience earlier last decade before reducing sugar. A much bigger deal is the neurocognitive angle, since mental health has been such a struggle for decades. Possible inflammation in my brain is greater concern than inflammation in my wrists, not that the two can be separated as an inflammatory state can affect any and all parts of the body. I take depression extremely seriously and I’m hyper-aware to shifts in mood and related aspects.

I’ll limit myself to fermented vegetables for the time being and see how that goes.

Having written that, I remembered one other possible offending food. The day before the salad I had a slice of oat bread. I had asked someone to make me some almond bread, as I explained to them, because of the paleo diet and they misunderstood. They apparently thought the paleo diet was only about wheat and so they got it in their head that oats would be fine. Because they made it for me, I decided to have a slice as I’m not a dietary Puritan.

So maybe it wasn’t the salad, after all. Still, I think I’ll keep to the fermented veggies for a while. And I’ll keep away from those grains. That was the first time I had any oats in a long time. I’ll have to try oats again sometime in the future to see if I have a similar response. But for now, I’m keeping my diet simple by keeping animal foods at the center of of what I eat.

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My own experience with diets makes me understand the attraction of carnivore diet. It isn’t only the most effective diet for healing from inflammation and gut problems. Also, it is so simple to do, it is highly satisfying with lots of fat and sat, and the results are dramatic and quick. You just eat until you’re no longer hungry.

Few other diets compare. The one exception being the ketogenic diet, which is unsurprising since zero-carb will obviously promote ketosis. Both of these diets have the advantage of simplicity. One quickly learns that all the struggle and suffering is unnecessary and undesirable. You eat until satiety and then stop. Overeating is almost impossible on carnivore, as the body returns to normal balance without all those carbs and sugar fucking up your metabolism and hormonal signaling for hunger.

We live in a dominator society that is drenched in moralistic religion and this impacts everyone, even atheists and new agers. This shapes the stories we tell, including dieting narratives of gluttony and sin (read Gary Taubes). We are told dieting must be hard, that it is something enforced, not something we do naturally as part of a lifestyle. We are taught to mistrust our bodies and, as if we are disembodied ego-minds, that we must control the body and resist temptation… and when we inevitably fail, one might argue by design, we must punish ourselves and double down on self-denial. If it feels good, it must be bad. What bullshit!

The addictive mentality of diets high in carbs and sugar are part of a particular social order built on oppressive social control. Rather than an internal sense of satisfaction, control must come from outside, such that we become disconnected even from our own bodies. It is a sense of scarcity where one is always hungry, always worried about where the next meal will come from. And in order to control this addictive state, we are told we have to fight against our own bodies, as if we are at war with ourselves. We lose an intuitive sense of what is healthy, as everything around us promotes imbalance and disease.

But what if there could be another way? What if you could feel even better with carnivory or in ketogenic fasting than you ever felt before?

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I’ve written before about low-carb, fasting, ketosis, and related dietary topics such as paleo and nutrient-density:

Ketogenic Diet and Neurocognitive Health; Fasting, Calorie Restriction, and Ketosis; Fasting and Feasting; The Agricultural Mind; Spartan Diet; Sailors’ Rations, a High-Carb DietObese Military?; Low-Carb Diets On The Rise; Obesity Mindset; Malnourished Americans; Ancient Atherosclerosis?; Carcinogenic Grains; The Creed of Ancel Keys; Dietary Dictocrats of EAT-Lancet; Clearing Away the Rubbish; Damning Dietary Data; Paleo Diet, Traditional Foods, & General Health; and The Secret of Health.

This is the first post about the carnivore diet. Some of the other posts come close to it, though. In a couple of them, I discuss diets that were largely centered on animal foods, from the Mongols to the Spartans. It was specifically my reading about and experimenting with fasting and ketosis that opened my mind to considering the carnivore diet.

I bring this up because of another interesting historical example I just came across. Brad Lemley, a science journalist, is a LCHF practitioner and advocate. He writes that, “I’ve always been fascinated by Lewis and Clark’s expedition. What gave the 33 men and one dog the strength to traverse the wild nation? Nine pounds of meat per day per man”.

From the journal of Raymond Darwin Burroughs, there was a tally of the meat consumed on the expedition: “Deer (all species combined” 1,001; Elk 375; Bison 227; Antelope 62; Bighorn sheep 35; Bears, grizzly 43; Bears, black 23; Beaver (shot or trapped) 113; Otter 16; Geese and Brant 104; Grouse (all species) 46; Turkeys 9; Plovers 48; Wolves (only one eaten) 18; Indian dogs (purchased and consumed) 190; Horses 12″ (The Natural History of the Lewis and Clark Expedition).

“This list does not include the countless smaller or more exotic animals that were captured and eaten by the Corps, such as hawk, coyote, fox, crow, eagle, gopher, muskrat, seal, whale blubber, turtle, mussels, crab, salmon, and trout” (Hunting on the Lewis and Clark Trail). “Additionally, 193 pounds of “portable soup” were ordered as an emergency ration when stores ran out and game was scarce or unavailable. The soup was produced by boiling a broth down to a gelatinous consistency, then further drying it until it was rendered quite hard and desiccated. Not exactly a favorite with the men of the Corps, it nonetheless saved them from near starvation on a number of occasions.”

That would be a damn healthy diet. Almost entirely hunted and wild-caught meat. They would have been eating head-to-tail with nothing going to waste: brains, intestines, organ meats, etc. They also would’ve been getting the bone marrow and bone broth. This would have provided every nutrient needed for not just surviving but thriving at high levels of health and vitality. Yet they also would have gone through periods of privation and hunger.

“Despite the apparent bounty of the ever-changing landscape and the generosity of local tribes, many were the nights when the crew of the Corps went to sleep hungry. Many were the days when shots went awry and missed their mark, or game remained hidden from sight. Relentless rain ruined drying meat, punishing heat spoiled perishable provisions, and clothing rotted right off the backs of the men.”

That means they also spent good portions of time fasting. So, there was plenty of ketosis and autophagy involved, further factors that promote health and energy. Taken together, this dietary lifestyle follows the traditional hunter-gatherer pattern of feasting and fasting. Some ancient agricultural societies such as the Spartans intentionally mimicked this intermittent fasting through the practice of one-meal-a-day, at least for young boys training for the life of a soldier.

Nina Teicholz has pointed out that a meat-heavy diet was common to early Americans, not only to those on expeditions into the Western wilderness, and because of seasonal changes fasting and its results would also have been common. The modern industrial style of the standard American diet (SAD) doesn’t only diverge from traditional hunter-gatherer diets but also from the traditional American diet.

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Video 1

Video 2

Video 3

Video 4

Video 5

Video 6

Video 7

Video 8

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Bonus Video!

This one particularly fits my own experience with mental health. The guy interviewed offers a compelling conversion story, in going from the standard American diet (SAD) to carnivore after decades of everything getting worse. His example shows how, as long as you’re still alive, it is never too late to regain some of your health and sometimes with a complete reversal.

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General online resources for carnivory:

Eat meat. Not too little. Mostly fat.
by L. Amber O’Hearn

Facultative Carnivore
A hypertext book (in-progress) by L. Amber O’Hearn
with audiobook version

The Ultimate Guide to the Carnivore Diet
co-Written by L. Amber O’Hearn and Raphael Sirtoli

An article that includes several videos on carnivory:

HOW CAN A MEAT-ONLY DIET REVERSE CHRONIC DISEASE? FIVE DOCTORS SHARE THEIR INSIGHTS
by Afifah Hamilton

Other videos:

Carnivore Diet Gut Microbiome Case Study … Carneval

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There hasn’t been many studies on carnivory. But one research paper concluded, “Our study has shown that Austrian adults who consume a vegetarian diet are less healthy (in terms of cancer, allergies, and mental health disorders), have a lower quality of life, and also require more medical treatment.” The researchers were comparing a ‘vegetarian’ diet with a ‘carnivore’ diet.

It’s a bit confusing, though. The carnivore category was divided into sub-categories that I didn’t quite understand. At least one of the sub-categories of carnivore might better be described as omnivore. It’s not clear that any of the subjects ate animal foods only. Also, the ‘vegetarian’ group included multiple diets. Part of them (“pure vegetarians”) apparently were vegans while others ate certain animal foods, the latter including not only dairy and eggs but in some cases fish as well. Basically, the comparison was more broadly between plant-based diets and meat-based diets.

Possibly problematic, it is unclear if the differences in health outcomes are dietary or environmental, as the authors discuss major differences in lifestyle. The ‘vegetarians’ sought out less preventative healthcare, presumably out of a mistrust of mainstream medicine. Even so, it’s interesting in how it demonstrates that it’s more complicated than simply eating more plants will make people healthy.

Vegetarians Are Less Healthy Than Carnivores
by Steve Parker, M.D. (text below from link)

From Independent:

Vegetarians are less healthy than meat-eaters, a controversial study has concluded, despite drinking less, smoking less and being more physically active than their carnivorous counterparts.

A study conducted by the Medical University of Graz in Austria found that the vegetarian diet, as characterised by a low consumption of saturated fat and cholesterol, due to a higher intake of fruits, vegetables and whole-grain products, appeared to carry elevated risks of cancer, allergies and mental health problems such as depression and anxiety.

While not mentioned in the Independent article, the full PLOS One report defined “vegetarian”:

While 0.2% of the interviewees were pure vegetarians (57.7% female), 0.8% reported to be vegetarians consuming milk and eggs (77.3% female), and 1.2% to be vegetarians consuming fish and/ or eggs and milk (76.7% female).

I haven’t read the whole thing, but if you’re a vegetarian, you should digest it. Note the study was done in Austria. And if vegetarians are so unhealthy, why do Seventh Day Adventists in Loma Linda, CA, seem to have a longevity benefit. Do ya think maybe there’s more involved than diet, like culture or genetics?