Dietary Dogma: Tested and Failed

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

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

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

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

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

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

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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.”

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.

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For more info, see:

Slow, Quiet, and Reluctant Changes to Official Dietary Guidelines

Recommendations for your Mind and Imagination

Do you need to blow out the dust and cobwebs from your mind?  Here are my recommendations (in no particular order):

Robert Anton Wilson – He is the penultimate countercultural writer.  He knew how to make conspiracies fun.  The Illuminatus! Trilogy was entertaining fiction that covers a lot of the same material he writes about in his nonfiction.  If you just want his ideas straight, then a good book would be Prometheus Rising.  I personally think the world would be a better (or at least more interesting) place if everyone read some RAW.

Terence McKenna – In the area of psychedelics, he is my favorite writer.  But his mind is wideranging which covers similar topics as Robert Anton Wilson.  I started with True Hallucinations, but any of his writings are quite enjoyable.  For the sake of variety, The Archaic Revival is a good collection of essays and interviews.  I have a book that has these two published together which is quite nice.  I’d also recommend listening to recordings of him speaking because his enthusiasm is contagious.

John Keel – A truly weird writer in the Fortean tradition.  The first book of his I read was the The Mothman Prophecies which is a good introduction to his ideas, but for his full weirdness read The Eighth Tower.  By the way, the movie based on the first book was decent entertainment (and I do recommend it as worthy attempt at portraying difficult material), but a lot of the weirdness got left out.

Patrick Harpur – Read Daimonic Reality.  Not quite as all-out weird, but still helpful in shifting your view on reality.  It’s probably the best all-around introduction to help you grasp the wide spectrum of the strange and the paranormal.

Jacques Vallee – A scientist with a very respectable intellect who doesn’t let his evenhandedness get in the way of his appreciation of the oddness that is the human being.  He is well known fo his Passport to Magonia where he discussed the connection of UFOs with folklore, mythology, religion and non-ordinary experiences, but there is no need to seek out that out-of-print book.  He reworked at least some of the material in his more recent book Dimensions: A Casebook of Alien Contact

George P. Hansen – I’ve read The Trickster and the Paranormal which I highly recommend.  However, it’s no casual read.  He packs in a lot of info that you probably won’t see connected together by any other author.  If you can read this book and not feel a little uncertain about objective reality, then I’ll be impressed.

Victoria Nelson – Her book The Secret Life of Puppets was an inspiration to me.  She gave me new appreciation for some authors I was already familiar with and made me aware of some works I’d never heard of.  I found it very enjoyable the way she connected certain strains of Western thought, popular culture and weird fiction.  It’s a very accessible book of very deep ideas.

Eric G. Wilson – His writing is directly in line with Victoria Nelson, but with more emphasis on philosophy and religion.  Both authors look at the underbelly of Western thought.  I find his mix of ideas appealing, and I like how he keeps his focus on what it means to be human.  I first read his The Melancholy Android, but his Secret Cinema might be a better intro to his thinking.  Neither are massive tomes, but he packs a lot in.

William S. Burroughs – He is best known for his fiction, but I’m going to recommend some of his other writings instead.  One book that offers an interesting glimpse of an interesting mind is The Cat Inside.  It’s partly autobiographical and partly musings about life.  Another one that I really enjoyed is My Education: A Book of Dreams.  Burroughs had a rare mind.  He is one of those writers who I can sense the actual person behind the words.  If you really want to get the sense of Burroughs, then you have to listen to his recordings.  He read many excerpts from his works and he did some interviews, but what I love is simply the sound of his voice.  Once his voice is firmly implanted in your brain, then read some of his books.  A very odd and entertaining adaptation was made of Burroughs’ Naked Lunch by David Cronenberg, but actually it’s also an adaptation of Burroughs’ life and writing in general.  I really liked Cronenberg’s loose adaptation and he has done a number of enjoyable weird movies worth watching such as eXistenZ.

Philip K. Dick – He is another writer who I have the sense of knowing as a person because his writing was often autobiographical.  He didn’t travel widely as Burroughs had, but his mind certainly travelled widely.  I’ve enjoyed all of the fiction I’ve read by him.  One of his more interesting novels might be Valis which is the first in his Valis Trilogy.  However, to really appreciate his fiction it’s necessary to read some of his nonfiction.  I’d suggest reading either In Pursuit of Valis: Selections from the Exegesis or The Shifting Realities of Philip K. Dick: Selected Literary and Philosophical Writings.  Even if you’re not someone who normally likes theology and philosophy, PKD’s odd take on them might amuse you.  It’s hard to find non-fiction writings any weirder than what he has to offer.  If you want to read some writings about PKD, there is a lot of good stuff out there (for instance, those who’ve written about him include some writers I’ve mentioned above: Terence McKenna, Victoria Nelson, and Eric G. Nelson).  My favorite book about him is Pink Beams of Light from the God in the Gutter: The Science-Fictional Religion of Philip K. Dick by Gabriel Mckee.  Mckee provides some useful context by which to understand PKD’s philosophizing.  Also, my favorite movie adaptations are Blade Runner and A Scanner Darkly.  I really love the latter done by Richard Linklater who also made Waking Life which is an even stranger film.  Some people didn’t like the rotoscoping technique of Linklater’s adaptation, but personally I thought he captured PKD like no other movie.  A Scanner Darkly is one of those stories that is so mindblowing in it’s depressing darkness that I was glad it’s balanced with a playful attitude and the actors in the film captured well that playfulness.

Franz Kafka – Now, this guy is a writer who can always lift my mind out of mundane normality.  His fiction is required reading and personally I’d recommend his short stories, but if you’ve already read some of his fiction then I’d recommend the Blue Octavo Notebooks.  These notebooks were different than his diaries and they contain some very interesting musings and fictional snippets.  By the way, I’d recommend Jeremy Irons‘ simply titled movie Kafka and Orson WellesThe Trial.

Douglas Adams – I figured I should include this author simply because he has a very weird imagination that is endlessly humorous.  He throws out a lot of odd ideas and manages to tell an enjoyable story at the same time.  If you feel like you’re taking life too seriously, any of his fiction would be a good antidote.  His most popular work is his Hitchhiker Trilogy, but I think I might’ve enjoyed even more his novel Dirk Gently’s Holistic Detective Agency.

Barry Yourgrau – His stories are just outright goofy but in a good way.  The only book I’ve read by him is A Man Jumps Out of an Airplane and so that is the one I’d recommend.  He has also written children’s stories, and he has done some spoken word which can be found online (check out The Sadness of Sex on Youtube which is just the first part of a larger work). 

Thomas Wiloch – I just like his imagination and the fantastic images he creates can be quite striking at times.  I suppose one could think of him as a darker version of Yourgrau.  I have read some of his stories from different collections, but the only book of his that I own is Screaming In Code which has some nice pictures in it.  I don’t know which would be his best book, but if you just want a taste of his writing you can find some of his stories online.

Neil Gaiman – His Sandman series is some of the best graphic novels around.  They’re strange stories with high quality artwork.  He manages to create some very distinctively intriguing characters and places them in equally intriguing worlds.  I won’t vouch for all of Gaiman’s work, but I’ve enjoyed all of the graphic novels I’ve read by him.   A good graphic novel is always nice when you’re trying to escape from reality.  Gaiman has also been involved in films and shows either in writing the scripts or in having his work adapted.  I’ll mention only two notable examples.  He wrote the story for Dave McKean‘s move MirrorMask (and they’ve worked together before in graphic novels).  McKean has a surreal visual imagination that goes well with Gaiman’s writing.  His story Coraline (which I’ve never read) was made into a delightful animated stop-motion 3-D film.  It was actually a bit freaky considering its target audience would seem to be young kids.

Alan Moore –  He has done a lot in the field of graphic novels and I’ve only read a small portion of it.  I started with his Promethea which I absolutely loved.  It’s an imaginative work about imagination.  Moore has also done some darker stuff which is also good such as Watchmen (a decent movie adaptation was made of it, but it’s seems surprisingly difficult to do justice to a graphic novel in the constraints of Hollywood).  What I like about his imagination is that it has some intelligence to it.  I like seeing interesting ideas placed in a visually stunning medium.

Grant Morrison – I first read his Doom Patrol which is truly bizarre.  I’ve since read some of The Invisibles and The Filth.  Both of those are equally bizarre.  If you like weird, this as weird as you can get and still tell a good story.

Bill Willingham – I include him for reasons of basic amusement.  Like Gaiman, Willingham draws on folklore in his Fables series.  Otherwise, they’re very different in style.  His Fables series tell the stories of the fairytale characters we’re all familiar with but mixes them together with an overarching plot.  It’s just fun to read.

Harlan Ellison – He was friends with Philip K. Dick for a time.  He isn’t as well known as PKD, but Ellison was also one of the early innovators who helped popularize the field of weird fiction.  He is a very prolific writer and I certainly haven’t read all or even most of his work, but what I have read I’ve enjoyed.  Even though he doesn’t quite have the philosophical depth of PKD, he does have a strange imagination.  There was an interesting graphic novel adaptation of his work called Dream Corridor.  It’s uneven in the quality of different adaptors, but overall his stories translate well to a visual medium.  Another very interesting collection is Mind Fields: The Art of Jacek Yerka, the Fiction of Harlan Ellison.  The art in that book is truly surreal and Ellison wrote his stories as direct inspirations of each picture.  It’s been a while since I read the stories in that collection, but the pictures have stuck in my mind.

Thomas Ligotti – Something about Harlan Ellison’s work reminds me of Ligotti.  I’m sure I like Ligotti better, but I don’t think they’re really comparable.  Ellison is dark and Ligotti is even darker.  However, by saying he is even darker I don’t mean grotesque or violent.  It’s dark in a more subtle sense.  Many consider Ligotti to be the best or at least most weird writer in horror fiction.  A good collection of his stories is Teatro Grottesco, but maybe the reason Ellison made me think of Ligotti is because the latter also has a graphic novel adaptation of his work (i.e., Nightmare Factory).  I should mention that some serious Ligotti fans dislike the adaptations.  I understand that much of the enjoyment of Ligotti’s work comes from his mastery of language, but still some of the artwork in the adaptations is truly compelling.  His story The Frolic was made into a very good film.  Although I’m not sure that Ligotti’s writing will blow out the dust or cobwebs from your mind, his stories probably will do something to your mind.

 Matthew Rossi – I own his Things That Never Were: fantasies, lunacies & entertaining lies.  As far as I know, this is his only published book, but I’d hope he would continue writing.  I don’t know the type of person that this book would appeal to.  It isn’t exactly either fiction or nonfiction.  It’s just intelligent silliness.  Obviously, he is someone who has accumulated lots of useless information in his head and so decided to try to put it together in such a way that it made it somewhat plausible.  He mixes up history, mythology, religion, genre fiction, conspiracy theories and pseudo-science.  As Paul Di Filippo says in the Introduction: “Rossi’s several incompatible mindchildren aren’t fighting. they’re violently screwing, and out of this brain-intercourse is going to arise an unpredictable hybrid of startling portent.”  Also, if you like Rossi’s writing, you might enjoy Myths for the Modern Age: Philip Jose Farmer’s Wold Newton Universe by Win Scott Eckert.

Some collections that are required reading:

 
I Saw Esau: The Schoolchild’s Pocket Book
Edited by Iona & Peter Opie
Illustrated by Maurice Sendak
 
This is a well-chosen collection of songs and rhymes that children have repeated for many generations.  I was only familiar with some of them probably because the editors collected these 50 years ago in British schools, but I enjoyed many of them that were new to me.  These songs and rhymes are just pure silliness, and Sendak’s pictures are almost on every page.
 
Greasy Grimy Gopher Guts: the subversive folklore of childhood
By Josepha Sherman & T.K.F. Weisskopf
 
This is a great find.  I recognized many of the songs and rhymes.  This is the unedited version of your childhood.  A nice thing about it is that the collectors provide multiple versions which demonstrates the innovativeness of children.  Some people might be surprised by the dark perversity of the child’s mind, but I can’t say I was surprised.
 
Grimm’s Fairy Tales
By Jacob and Wilhelm Grimm
 
If you haven’t ever read any of these, you should.  And if you haven’t read them in a long while, then you should read them again.  I really love these stories.  There are many different versions and I don’t know which is the best.  I’d probably go with the Jack Zipes edition.  I didn’t read these as a kid and I doubt many parents these days would read them to their children.  Some of them are fairly dark, but that is part of what makes them amusing.  The Grimm brothers supposedly had even cleaned these stories up a bit when they realized that their target audience might actually be children.  I would love to see the original versions, but I don’t know if there is such a collection.  Anyways, the Grimm’s versions are enjoyable.  I personally find something immensely appealing in the simplicity of a fairy tale.  Many fairy tales (especially in their earliest unpolished form) have a dream-like quality about them.  The only modern fiction that comes close are prose poems or flash fiction.

I’ve already mentioned some movies above.  Here are some other movies that just amuse me or in some cases help free my imagination and inspire a sense of wonder (I’ll only list my top favorites, but you can find all of my favorites on my About page):

Monty Python – Pretty much anything by them is amusing.

The Rocky Horror Picture Show – I enjoy this movie in the same way I enjoy Monty Python.  Inane weirdness and silly songs and dance.

Army of Darkness – This is one of the best cult classic horror camp movies ever made.  I’m a fan of Bruce Campbell’s brand of humor.  If you’ve already seen this movie and enjoyed it, then I’d recommend Cemetery Man.

Waking Life – Strange ideas presented in a strange style.  This was Richard Linklater’s first use of rotoscoping which he later used in A Scanner Darkly (which I also highly recommend).

The Nines – It’s hard for me to judge this movie for it is strange to the extreme and yet certainly not weird simply for the sake of weird.  It’s an amazing movie, but it probably requires watching it more than once.

Donnie Darko – Another movie that really makes you ponder reality.  There is some very startling imagery in this movie that sticks in my mind.

Dancer in the Dark – I realize this is a movie people either love or hate.  I admit it’s a bit difficult to get into at first, and of course not everyone appreciates Bjork’s singing.  However, there is no movie like it.  After a while, I was completely pulled into the world of the protagonist and I thought it a very fascinating world.  It shows how imagination helps someone survive even the bleakest of situations.  So, if you like despairingly depressing movies where the characters break out into song and dance, then this is for you.

Eternal Sunshine of the Spotless Mind – This also was a movie I had a hard time getting into the first time I watched it, but it’s grown on me.  This movie literally takes you into the mind of the protagonist.  It’s both funny and sad, something like life itself but with more entertainment value.

The Truman Show – This is one of the best Philip K. Dick movies ever made that wasn’t specifically based on a Philip K. Dick story.  All I can say is I hope I’m not trapped in a reality tv show.  That would be truly sad, especially for those watching.

Dark City – This is an even darker and more fantastically weird version of The Truman Show.  Being trapped in a reality tv show might not be such a bad fate afterall.  It’s an awesome movie and the visuals are just amazing.  By the way, it’s somewhat similar to the Matrix Trilogy, but Dark City was made first.

What Dreams May Come – This is a more positive view of the imagination, but it has plenty of dark to it as well.  Even if you discredit it for the romantic optimism, I hope you can appreciate some of the stunning visual scenes.  This is the only movie I’ve ever watched that made the afterlife seem compellingly real.  For certain, the Hell that is presented feels much more convincing than the Christian version.

The Fountain – This is one of my all-time favorites, but I can understand why others might not like it.  Similar to What Dreams May Come, it plays with ideals of romantic love but it stays away from sentimental superficialities.  It’s a very convoluted movie which some have complained about.  However, if you’re like me and have some ability to understand complexity, then it shouldn’t bother you.  There is some very intelligent use of visual language that helps hold the narratives together.

Altered States – This was a very original take on the scientist that goes too far, but in this case he nearly falls off the edge of reality.  Psychedelics and monkey-men, sex and religious imagery… what isn’t there to like?

Return to Oz – If you liked the original The Wizard of Oz movie (or maybe even if you didn’t), then you should see this.  It’s Oz transformed.  I’ll just say that, upon her return, Dorothy isn’t greeted by singing Munchkins.

If you don’t have the time to read a book or watch a movie and need some quick amusement or mind-expanding edification, then here are some websites for you.

The Church of the SubGenius

Church of the Flying Spaghetti Monster

The Landover Baptist Church

The Onion

Uncyclopedia

Principia Discordia

fUSION Anomaly

The Deoxyribonucleic Hyperdimension

deviantART

TV Tropes

Thomas Ligotti Online