[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  ‘They spend billions of dollars trying to convince you of that because it absolves them and their products of any guilt in causing the obesity epidemic,’ Eenfeldt said. For proof, you just have to look at what food and drink companies get up to. For example, in the US, Coca-Cola, Pepsi and Kellogg’s have all sponsored the country’s largest association of nutrition professionals, the Academy of Nutrition and Dietetics (AND). In Canada, Coca-Cola sponsored Ontario’s 2012 Healthy Kids Strategy, the goal of which was to reduce childhood obesity by 20 per cent over five years.

  In 2016, the US Observer-Reporter revealed how Coca-Cola bought off top scientists and funded millions of dollars’ worth of research to downplay the link between sugary beverages and obesity. Instead, the company used its massive financial muscle to demonise fat.1 Coca-Cola has also continued to promote the idea that, provided people exercise enough, they can eat (and drink) whatever they like – including sugar-sweetened beverages.2

  Eric Westman got straight to the point at the start of the second day with a presentation titled ‘LCHF treatment of obesity and metabolic syndrome’. As an academic and associate professor of medicine at Duke University in Durham, North Carolina, Westman is at the coalface of the fight against obesity and related diseases. His research interest is disease prevention. Because smoking and obesity are the major causes of morbidity and mortality in modern society, his research involves clinical trials of new therapies for smoking cessation and obesity. He also runs a weight-loss clinic at Duke. In his extensive research, Westman has described the clinical use of LCHF for the treatment and prevention of both obesity and metabolic syndrome.

  Westman said that people are always demanding to see the science for LCHF eating, yet the evidence is all there. ‘It is not hard to get this information,’ he said. ‘It’s out there.’ He presented significant evidence from clinical trials demonstrating the efficacy of LCHF diets compared to Mediterranean-style, low-fat and low-GI diets. One of the best studies, at the time, to support LCHF diets was the Israeli-led, multi-year DIRECT study, published in the New England Journal of Medicine in 2008, which showed improvements in carotid thickness – a measure of atherosclerosis – on an LCHF diet.3 Westman also referred to a comparison of four diets – Atkins (low carb), Zone, Weight Watchers and Ornish – published in the Journal of the American Medical Association (JAMA) in 2005. It showed that Atkins achieved the most weight loss at six and 12 months.4

  Westman’s second presentation on the final day of the conference was titled ‘Practical implementation of a low-carb diet’. While less scientific and more entertaining, it was just as compelling and informative as his previous talk. Donning a white coat and addressing the members of the audience as if they were his obese patients, he took them step by step through the basics of LCHF for weight loss and maintenance thereafter. His message was as simple as it was key to nutrition and health: for long-term health and weight control, a conscious reduction in carbohydrate intake is essential. He also made the case for ‘real food’ – asking the audience: ‘Have you ever seen a bread or pasta tree?’ – but made it clear that he is no fan of fruit because of its high sugar (fructose) content. Fruit, Westman said, is ‘nature’s candy’.

  Next up was Canadian nephrologist (kidney specialist) Dr Jason Fung, who focused on another powerful conference theme: why so many doctors and dietitians still tell patients that diabetes is a chronic, degenerative, irreversible and ultimately incurable disease. Fung used to believe that, too. He said the driver for change was his own professional frustration after 10 years of religiously adhering to orthodox treatment protocols for his diabetic patients. When he looked back, Fung told the audience, he realised that he had not helped his patients much – he had just made them fatter, sicker and more reliant on drugs.

  Fortunately for his patients, Fung doesn’t suffer from cognitive dissonance. Cognitive dissonance occurs when a person who is confronted with compelling evidence that contradicts a deeply held belief chooses to ignore the evidence in favour of belief. Fung started researching alternatives. He came across evidence on the role of insulin and IR in diabetes that flatly contradicted his beliefs. He changed his mind to accommodate the evidence, and began advising his diabetic patients to ditch the conventional low-fat, high-carbohydrate dietary advice, and try LCHF. Fung said that he was amazed by the results. In most cases, his patients showed a significant reduction in symptoms. Better still, some patients were able to do without medication altogether.

  Fung began his presentation by asking how resistance develops in a biochemical system. After all, the body is naturally designed to function properly, so why does it sometimes become unable to fend off resistance? He told the audience that just as taking antibiotics is the precursor to developing antibiotic resistance, so insulin is the precursor to IR.

  Fung said that there are two ‘big lies’ in the treatment of type-2 diabetes mellitus (T2DM). The first is that type-2 diabetes is a chronic, progressive disease that can’t be cured. The second is that lowering blood sugar is the primary goal. The truth, Fung said, is that diabetes is a ‘curable’ dietary disease. That’s because it is a disease of high insulin resistance, which can be treated, and eventually reversed, by lowering that resistance. Conventional treatment with ever-increasing doses of insulin simply worsens the patient’s state of IR, he said.

  Fung took the audience down the intriguing new path of the insulin theory of obesity, which he has documented in his book The Obesity Code: Unlocking the Secrets of Weight Loss. In his presentation, Fung painted a chilling picture of a vicious cycle in which insulin drives IR, which in turn drives obesity. He explained that obesity is not the cause of diabetes. Rather, it is excessive insulin levels over time that causes both obesity and T2DM. And the cause of all that insulin? Not just carbohydrates, Fung said. Bad dietary advice to the general public, and especially to diabetics, which prescribes ‘grazing’ on carbohydrates, was also to blame. (British obesity researcher and speaker Dr Zoë Harcombe had caused much mirth in her presentation when she said, ‘Don’t graze, unless you are a cow or want to be the size of one.’)

  Fung’s message was one of the most important to come out of the conference. He made a clarion call for doctors and dietitians to recognise that diabetes is curable, or at the very least reversible. He also said that diabetics should avoid not just carbohydrates, but also insulin. In an ideal world, even type-1 diabetics should have so little carbohydrate that the need to take insulin is at least drastically reduced, perhaps in a few cases even eliminated.

  Insulin resistance quickly became a leitmotif at the conference. Speaker after speaker explained why doctors, dietitians and patients should all take IR seriously. They emphasised that high-carbohydrate diets increase the likelihood of IR developing. Noakes, for example, argued that ignoring IR undermines the practise of chronic medicine. If all the conditions attached to IR are linked to nutrition, as he believes they are, then patients don’t need drugs. Obesity, diabetes, heart disease and many other life-threatening conditions are not caused by a lack of pharmaceutical drugs, he said. ‘They are caused by too many carbohydrates in the diet. We fuel the fire with carbohydrates and try to put it out with pharmacologic drugs that don’t work.’

  Other speakers focused on the urgent need for a revision of the official dietary guidelines that favour LFHC foods. Harcombe presented the results of her research for her PhD, a meta-analysis of the evidence for dietary guidelines in the US and the UK.5 The timing couldn’t have been better. Open Heart had published her first paper on the topic a week before the summit. Harcombe’s conclusion: there was no evidence from randomised controlled trials (RCTs) – the supposed ‘gold standard’ of scientific research – to support the official dietary guidelines when the US and the UK introduced them in 1977 and 1983 respectively.6

  The official guidelines affected the health of more than 270 million people at the time, said Harcombe. That number is likely to have risen to billions in the interim, she concluded.


  American physician Dr Michael Eades was another speaker who focused on the weaknesses of the conventional guidelines. Eades has practised bariatric, nutritional and metabolic medicine since 1986. In his presentation, he gave evidence from his book Protein Power and other research showing how studies biased against saturated fat worked their way into government recommendations.

  British consultant cardiologist Dr Aseem Malhotra also took broad aim at the guidelines7 and the diet-heart hypothesis.8 Malhotra is science director of Action on Sugar, a group in the UK comprising respected scientists and doctors who campaign to reduce the public’s sugar consumption and raise awareness of the ubiquitous presence of sugar in many processed foods.

  Malhotra spoke eloquently of the basic conditions necessary for efficient healthcare to exist. These demand that both doctors and patients are informed, he said. He referred to the ‘seven sins’ that contribute to a lack of knowledge on both sides. These sins include biased funding of research (i.e. research funded because it is likely to be profitable, not because it will be beneficial to patients), financial conflicts of interest, a culture of ‘defensive medicine’, and a corresponding attitude that ‘more treatment is better’.

  Malhotra also spoke about the benefits of a Mediterranean diet – but only if it is high in good fats and low in carbohydrates.

  A conference sub-theme around the diet-heart hypothesis was the overuse and abuse of cholesterol-lowering drugs known as statins. Noakes is also not a fan of statins. He has called them the ‘single, most ineffective drug ever invented’.**

  Another vocal statin critic was American family physician Dr Jeffry Gerber, who is known as Denver’s Diet Doctor. He gave a lively presentation titled ‘Cholesterol OMG!’. He used the catchy title, he said, to make people realise that there are some issues related to the non-standard LCHF diet and concerns about cholesterol, cardiovascular risk and health. Traditionally, dating back even to the days of Dr Robert Atkins, doctors tried to scare people off LCHF diets and onto statins by saying that their levels of low-density lipoprotein (LDL) – the so-called bad cholesterol – would go up. The idea was that Atkins and similar diets would clog the arteries and cause fatal heart attacks and strokes.

  Gerber predicted that statins have passed their sell-by date. Despite being the most prescribed drug on the planet, they will probably be ‘gone in 10 years’, he said.

  Another major focus of the conference was the benefits of fat adaptation: being able to use fat rather than glucose from carbohydrate metabolism as an energy source. An expert on this topic is Stephen Phinney, an American physician-scientist and emeritus professor of medicine at the University of California, Davis. One of Phinney’s presentations covered the benefits for sports performance – and overall health – of nutritional ketosis. Much of his presentation was taken from his book The Art and Science of Low Carbohydrate Performance, co-authored with Professor Jeff Volek. Phinney coined the term ‘nutritional ketosis’ 30 years ago. He did so, he said, because of confusion and fear around ketones, ketosis induced by dietary carbohydrate restriction (nutritional ketosis), and ketosis caused by an absence of insulin (a condition known as ketoacidosis, which can be fatal).

  He explained that many doctors and dietitians are fearful of ketosis and ketones, and that they instil this unnecessary fear and anxiety in their patients. It’s all down to ignorance, Phinney said. Doctors and dietitians are still classically taught that ketones are ‘toxic by-products of fat metabolism’. That can be true, but only in the case of extremely high levels of ketones coupled with a complete absence of insulin. In that case, it is ketoacidosis, which occurs in type-1 diabetics and more rarely in end-stage type-2 diabetics. For the rest, Phinney showed why ketosis is an essential, normal and benign bodily state.

  Intriguing insight into the addictive properties of sugar and other carbohydrate foods came from adult and paediatric bariatric surgeon Dr Robert Cywes. Cywes was born in South Africa but now lives and works in the United States. He pointed to a disturbing health pattern. Sixty years ago, experts were wringing their hands about the rise in lung cancer, heart disease and emphysema. They completely ignored and argued against the evidence that tobacco was the culprit. Today, they sit wringing their hands about obesity, diabetes, cholesterol and hypertension while ignoring what Cywes called the ‘culprit’ drugs. ‘The most prevalent chronic NCDs killing us as a species are a consequence of drugs not well tolerated by human systems,’ he said. These drugs are alcohol, tobacco and the obesogenic drug – carbohydrates.

  One of many strengths of the low-carb summit was that speakers often spoke personally and from the heart. Canadian physician Jay Wortman is a public-health specialist and clinical assistant professor at the University of British Columbia’s Faculty of Medicine. His research was featured in the hit Canadian Broadcasting Corporation news documentary, My Big Fat Diet. Wortman told the summit how he reversed his own T2DM in 2002 by going on an LCHF diet while waiting for advice from his orthodox peers on what medication to take. He said that he has been free of any evidence of the condition ever since. He also addressed concerns about the safety of LCHF regimens for children and pregnant women, saying that his extensive research into traditional diets shows that there are no safety issues.

  Australian nutrition therapist Christine Cronau told how she lost weight and eliminated serious health issues on an LCHF diet. She dispelled many myths that still exist about the LCHF lifestyle.

  United States Air Force veteran and psychiatrist Dr Ann Childers told of how she developed metabolic syndrome and subsequently reversed all her symptoms by going on a ketogenic diet (an extreme form of LCHF). Childers explained that metabolic syndrome is an umbrella syndrome that encompasses a cluster of problems, including heart disease, lipid (blood fat) problems, hypertension, T2DM, dementia, cancer, polycystic ovary syndrome and non-alcoholic fatty liver disease (NAFLD). As an adult and child psychiatrist, Childers has a special interest in nutrition and mental health. She has researched the effects of nutrient-poor, high-carbohydrate diets, as well as high-grain diets, through the ages. These foods don’t just contribute to weight gain, Childers told the conference, they are also not good for body or brain.

  And despite what many dietitians still believe and teach, Childers said, fats, including saturated fats, are the brain’s best foods, not carbohydrates. She also criticised food companies for changing health patterns with their processed foods. ‘The bottom line is their obligation to their stockholders,’ she said. ‘They do what they need to do to make a profit. They embed themselves in nutrition organisations.’

  Eades and Childers also looked at LCHF from an evolutionary perspective. Eades recalled how he had first been alerted to the dangers of the ‘conventional’ LFHC diet when he came across research showing that the Ancient Egyptians, the first population to attempt this diet between 2500 BC and AD 395, were anything but healthy. ‘The fondness of Egyptians for bread was so well known that they were nicknamed “artophagoi” or eaters of bread,’ he said. ‘Their diet consisted primarily of bread, cereals, fresh fruit, vegetables, some fish and poultry, almost no red meat, olive oil instead of lard, and goat’s milk for drinking and to make into cheese.’ Eades called these foods a ‘veritable [modern] nutritionist’s nirvana’.

  If these foods were so healthy, then ‘the Ancient Egyptians should have lived forever or at least should have lived long, healthy lives and died of old age in their beds’, he said. But did they? On the contrary. Eades found ‘an Egyptian populace rife with disabling dental problems, fat bellies and crippling heart disease … Sounds a lot like the afflictions of millions of people in America today, doesn’t it?’

  The Egyptians did not eat much fat or refined carbohydrate. They ate almost nothing but wholegrains, fresh fruit and vegetables, and fish and fowl. Yet they suffered from the same diseases that afflict modern man. ‘The same modern man,’ Eades said, ‘who doctors and dietitians advise to eat lots of wholegrains, fresh fruits and vegetables, to prevent or reverse
these diseases.’

  Australian orthopaedic surgeon Dr Gary Fettke gave one of the most exciting and controversial presentations to the conference, on cancer and nutrition. Fettke is a senior lecturer at the University of Tasmania and a cancer survivor. He is another who has paid a heavy price for daring to go against nutrition orthodoxy. In 2016, the Australian Health Practitioner Regulation Agency (AHPRA) banned Fettke for life from talking to his patients about sugar. That was after a dietitian complained about the dietary advice he was giving to his patients. Fettke has sensibly chosen to ignore the ban. He continues to advise patients with obesity and T2DM to reduce their intake of sugar and other carbohydrates. By doing this, he tells them, they can significantly reduce their risk of limb loss.

  In his presentation, titled ‘So you think you need sugar? Your cancer needs it even more!’, Fettke looked at the science behind the metabolic model of cancer therapy, which is based on the work of Nobel Prize–winning German biochemist Dr Otto Warburg in the 1930s.9 Fettke presented research suggesting that dietary intervention, in particular a ketogenic diet, is the cancer treatment of the future.

  One of the strengths of the summit was that it included a lay speaker. Jimmy Moore runs the hugely successful Livin’ La Vida Low-Carb blog. In his presentation, he described his momentous decision in January 2004 to lose the weight that was literally killing him. At age 32 and weighing 410 pounds (185 kilograms), he began eating LCHF. Within a year, he had lost 180 pounds, shrunk his waist by 20 inches (50 centimetres), and dropped his shirt size from 5XL to XL. Moore started his blog and related podcast in response to a flood of requests from family and friends for help and information. It hasn’t all been plain weight-loss sailing for Moore. He is open about his battles to stay at a healthy weight and the new approaches he has tried.