A couple of night’s ago, I was watching a programme called ‘Long Live Britain’ on the BBC, co-presented by Phil Hammond. He is a UK doctor whom I greatly admire, and who mostly talks common sense. So I hesitate to criticise him. But on this programme I heard him say these very words to a volunteer on the programme (sic) ‘A lifetime of eating fatty food has made your liver fatty……’ In truth, he may have used slightly different words, but I cannot bear to watch again.
He then went on to present a lengthy clip of a very unwell lady with (I presume, though not stated), non-alcoholic steatohepatitis NASH. This is the name for a damaged, fatty, liver. A condition that can worsen and worsen and may, eventually, lead to liver failure.
Sorry Phil, but when I heard you say that eating fat caused a fatty liver, I had to switch the television off and take a few deep breaths, lest my blood pressure became too high.
What is it about diet that no-one has even the faintest damned idea what they are talking about, especially when I comes to fat consumption. I think we have demonised fat for so long that you can say anything about fat and, so long as it is sufficiently damning; no-one dares question anything you say. Science goes straight out the window.
A.N. Idiot: ‘Did you know that eating fat can make your liver explode.’
A.N. Other Idiot: ‘OMG, I never knew that.’
A.N. Idiot: ‘It’s true. It must be, I saw it on the telly.’
Well, here are a few facts that really are facts. When you eat fat it is absorbed in the small bowel, turned into triglycerides, and packaged into a lipoprotein called a chylomicron. Chylomicrons are then fed directly into the bloodstream via the thoracic duct – bypassing the liver completely. As they pass fat cells, the cells strip almost all of the fat out of them, so the chylomicrons shrink down and down in size, becoming chylomicron remnants. Once almost all fat is gone, these remnants are absorbed into the liver.
As should be clear from this, at no point in this process does the vast, vast, majority of fat we eat get anywhere near the liver. It is carried from the bowel directly into adipose tissue. So, Phil, how does eating fat make your liver fatty…exactly? When the liver has no part of play in the absorption, transport and storage of any fat we eat? Oh, sorry, you’re right, it can’t.
Carbohydrates, on the other hand, now here you are talking. All the carbohydrates we eat are converted into glucose and/or fructose in the gut [apart from fibre, and starch, which we cannot digest]. Glucose and fructose then pass directly into the liver where, if your body’s sugar stores are full, they are converted into…you guessed it…fat. [Your body can only store about fifteen hundred calories of energy as glucose/sugar before the stores are full – which is not a lot].
Imagine, if you will, a body with full sugar stores* – this would be most people, most of the time. You eat carbohydrate a.k.a. proto-sugar. With sugar stores full, there is nowhere for this excess sugar to go, so the liver converts it all into fat a.k.a. triglycerides. The liver tries to stick this excess triglyceride into a lipoprotein called a VLDL (Very Low Density Lipoprotein). However, this process is complex, so the liver starts to fill up with fat.
At the same time insulin does battle with the liver, in order to drive lipogenesis (the making of fat from sugar) in the liver. Which means that you are more likely to end up with diabetes. This is not rocket science. This is basic human metabolism/physiology. And you know what, the way to reverse this process is…TO EAT FAT.
The simple fact is that there is no way on God’s earth that eating fat can give you a fatty liver. However, the process by which eating excess carbohydrate could give you a fatty liver, and then diabetes, is simple and straightforward. Yet we have a BBC programme, with a real doctor on it, stating the exact opposite.
I suppose I don’t really blame Phil Hammond too much. We have all been fed with such unutterable balls about the dangers of eating fat for so long now that the science behind nutrition long since became an inconvenience. ‘Do not bother me with facts, for my mind is made up.’
Or ‘don’t bother me with the fats; I am going to kill myself eating carbohydrates.’ Long Live Britain indeed.
*sugar/glucose is stored in the body as glycogen, a polymer of glucose (lots and lots of glucose molecules stuck together). The body does this to reduce the amount of water required to encircle individual glucose molecules.
Dr. Malcolm Kendrick 
Excellent post, thanks! Marian Marian Devlin Daisy Garland Ketogenic Dietitian (Monday and Tuesday) Paediatric Dietitian (Wed. to Fri.) Derbyshire Children’s at the Royal Derby Hospital Uttoxeter Road Derby DE22 3NE tel 01332 786252 bleep 3520 ________________________________________
I stopped watching any and all TV programmes on diet or health since only one thing is guaranteed and that is the fat and cholesterol are bad low fat low calorie is the cure for all ills messages will be present thanks to these tv whore Drs like Dr christian grrrrr that man makes my blood boil, my thanks to you Dr Kendrick you are a breath of fresh air I’m looking forward to hearing you speak.
Thank you very much
Funnily enough, I saw a bit of the programme and had immediate visions of steam coming out of your ears. The other thing that really annoyed me was that accomplished and popular TV presenters, with undoubted expertise in long distance walking and international cricket, had suddenly become medical experts and were speaking authoritatively on the usual “villains” of cholesterol et al.
That program made me so angry! I can’t believe they actually went out and poured fat down a drain to “show what happens when you eat fat”! So many people’s health is going to be damaged by that program.
Yes, I saw the programme and presumed that the BBC was doing the usual thing of dumbing down. I was also disappointed with Dr Phil and the eating fat makes your liver fat message.
There was one gentleman who visited the clinic with his wife. According to the nurse he had low risk factors (low cholesterol, low BMI) and was immediately whisked off for further tests where he was found to be suffering some form of angina and was told to start (so called) eating healthy foods.
Why didn’t they ask questions as to why his risk factors were low and yet he suffered from a dodgy heart?
I make it a point to watch programmes like this and not for the first time, I’m left wondering what on earth is going on.
People are fed (no pun intended) rubbish information which will only make their lives more miserable and if they follow the advise will possibly cause an early death.
Ho hum.
Ho hum, indeed.
absolutely brilliant write up, funnily enough a friend who is a doctor once wrote something on my facebook when i wrote something very similar about fatty burgers not being able to cause fatty liver and she said to me that it is very clear that this does happen.
now if i post this to her wall we are likely to have a fallout so i may just message it to her instead.
this is a very straight forward write up of the ways and means too which i applaud you for.
you’re not on facebook however, can you please create a page for people to follow you there?
Me and facebook. Hmmmm. I waste enough time twiddling around on the Internet.
What about twitter. Quick easy and effective
I am thinking about it – he said in less than 40 characters
oh and also: i am very glad i did not see this programme. i avoid watching any health programmes on TV these days to avoid destroying the house in my rage
To be fair, Dr Hammond isn’t completely wrong. NASH is multi-factorial, including:-
1) Too much sugar, esp. fructose (increases TAG synthesis).
2) Too little choline (reduces TAG clearance).
3) Too much omega-6 polyunsaturated fat. See http://hopefulgeranium.blogspot.co.uk/2013/08/linoleic-acid-omega-6-pufa-promotes.html
Therefore, eating too much vegetable fat that’s high in linoleic acid (e.g. sunflower oil, soya oil) can result in NASH.
I agree that Dr Hammond ins’t completely wrong. Just majority wrong. I suspect he was working from a script
Basically right, But from that first paper i linked to it seems that increased TAG synthesis will just produce fatty liver (NAFLD) whereas increased synthesis of free fatty acids and free cholesterol will cause NASH (TAG and cholesterol esters are neutral lipids and not quite as inflammatory). And linoleic acid promotes the synthesis of, and itself contributes carbon to, cholesterol and palmitate while inhibiting their esterification. And it promotes the uptake of cholesterol by the liver.
To cut a long story short, the very PUFA effect that lowers serum cholesterol will concentrate it in the liver, which isn’t a good thing.
It looks like the lipid hypothesis virtually gets things back-to-front with regard to linoleate. Even high serum triglycerides might be a good in someone with liver disease if they’re eating a normal diet that gives everyone else high TG.
Hi George,
I was treating NASH & NAFLD/fatty liver as the same disease. Is it reasonable to say that a high wrong sort of fat diet contributes to NASH?
Test.
Reminds me of a talk I went to a few years ago (employer’s annual talk for cholesterol awareness month). I challenged the speaker about why consuming saturated fat is bad and she trotted out an ad hoc theory about saturated fats changing the shape of the lipoprotein and thus damaging the artery wall (just someone else’s hypothesis – nothing published). Of course, as stated in the article, LDL is full of saturated fat made in the liver and what you eat is in chylomicrons, and nobody blames them for anything! She was a cardiologist/assistant professor at Johns Hopkins! Apparently cardiologists can believe/say anything.
Cardiologists are very good at believing the thing that earns them the most money – I find.
Quite – cardiologist Conrad Murray justified giving Michael Jackson Propofol for insomnia for $150,000 per month – dread to think what his opinion is on eating fats!
And the media in New Zealand lap it all up. Latest reports this week suggest the old ‘fat tax’ idea and then a few days later front page in the paper – a study by Otago University – about long term cardiovascular risks. NZ population are being fed statins to lower our risk of cardiovascular disease, how come the rates of injury are still increasing. Plus we have an increase in musculoskeletal disorders . AGAIN – maybe statins? There is no doubt that raising awareness of diseases which contribute to a poor quality of life are vitally important. I applaud the concept of further taxing and trying to remove tobacco related products and having sustainable healthy diets. Telling people to eat margarine and polyunsaturated food may not be the answer. In fact my understanding of trans-fats is that they are poison to our systems. Many studies suggest a reduction in sugars would be beneficial but lets not get carried away and ban healthy fats like butter, cream and milk. Any chance Dr Kendrick is planning to visit New Zealand so we can the voice of sanity?
I would love to visit New Zealand. I keep planning to, but somewhow or another I cannot get organised enough.
Wordup Malcolm! Keep the truth alive.
Extremely interesting. I’ve said this before, but surely there should be a TV programme about this. Maybe there has been and I missed it? If not, why not?
It’s a pity you are one of only a handful of doctors who actually knows anything about human physiology and nutrition.
Most doctors aren’t much interested in this area. They only know four things 1: Eating fat makes you fat 2: To lose weight exercise more and eat less 3: Eating fat makes you diabetic 4: Saturated fat causes CVD. A slight problem is that everything they know is wrong. Hey ho. Still, I suppose, it means I can stroll up the high fat aisle at the supermarket unimpeded by crowds.
Sad to relate, the high sat-fat aisle at my supermarket is getting less well stocked as time rolls on and nasty hell-brew foods are creeping in. The butter shelf is narrowing, crowded out by packets of p.u. fats that would be better used as machine lubricants or bio-diesel. In desperation I went to a butcher to buy some plain fat to render – alas, he doesn’t bother to keep it since there is ‘no call for it now’.
Craig.
“There is no doubt that raising awareness of diseases which contribute to a poor quality of life are vitally important.” There’s something about the expression “raising awareness” that gets my hackles up; perhaps the problem is that it’s a needless syllable longer than “propaganda”.
Excellent! A link to this was posted in the yahoo group Stopped Our Statins- the word is getting out. I just read Gary Taubes’ book Why We Get Fat, another that flies in the face of everything we’ve been brainwashed into believing.
To quote H.L. Mencken: “For every complex problem there is an answer that is clear, simple, and wrong.” This applies to Gary Taubes and his theory, which works for him, but not for everyone, as he seems to believe.
Richard,
Yes, Gary Taubes has a belief. I think that much of what he says is good, but he has just taken it too far and tries to fit all evidence into the Procrustean bed of carbs kill.
My son eats nothing but carbs (virtually), and is recognized by all as pretty skinny.
I have set up a clinic for weight loss, using indirect calorimetry, and it is fascinating how different people’s metabolisms are. Low carb mostly helps, most people, but not all.
Malcolm
On Tue, 13 Aug 2013 22:07:14 +0000
There is a new rodent model of obesity (about time) where some rats get fat on high-fat and others on high-carb. But to fatten a rat on high-fat diet takes 2 things; high-polyunsaturated omega 6 fat, and a decent amount of sugar.
Phil Tufnell doen’t look too healthy to me!
I wondered where he got his croaky voice from so Googled to see if he is a smoker. He is, though has tried to quit on a more or less permanent basis. So, having watched the clown dispensing health advice with a straight face just ramps my contempt at up the utter uselessness of programmes such as this. Pumping out the same old same old with the public putting their faith in the ‘experts’ means people are getting sicker and sicker and even more bewildered.
I quite like Phil Tufnell. I do like Phil Hammond. I find Jameie Oliver quite endearing (though he has never read a book, yet astoundingly knows all about healthy eating). But when it comes to food, and health, and suchlike. They should all just damned well shut up. I note an interesting story that the mortality rate of the elderly has suddenly shot up in the UK – wonder why? Could it be QoF?
Thanks for the additionnal details, Dr. Kendrick.The distinction between raw and cooked starch had mostlty escaped me.
Yes, sorry I got a bit snappy. I must remain polite at all times rpt. It always amuses me that everyone says how healthy vegetables are. Well, try eating nothing but uncooked vegetables and see what happens. Do you think, maybe, we were not actually designed to eat vegetables? Of course they taste nice, and some can be eaten uncooked. In general, however, we are designed to eat meat, fat, some fruit, a few nuts here and there. Until we learned to cook most vegetables, and all grains, were not food we could eat.
Dr Kendrick, I am puzzled by these words from your blog entry:
[apart from fibre, and starch, which we cannot digest].
I thought that we can’t digest fibre, but I have always understood that we do digest starch.
Bernard. When writing a blog, there is a need for a certain flexibility with the science. We can absorb a little starch – although we have generally have to cook it first. Try eating a raw potato, or raw kidney beans some time and see what happens.
🙂 Love this article and your general no-nonsense, common sense approach! Much needed and much appreciated!
🙂 Great article! Love the straight forward common sense approach too. I can’t eat starches, cooked or raw, they make me tired and grouchie but I’ve never avoided fat, am 36 and a size 8, but that’s because I stay away from wheat, and grains in general. That’s just from listening to my body!
Well I would hope you are not absorbing much starch, it would mean there was a problem with your intestinal lining. Amylase allows us to absorb glucose from the breakdown of starch that it can reach, so non-resistant starch.
Yes well Johnny, one can have micro-reductionistic pseudo-legal discussions, picking holes in anything you want. It does not, however, get you very far. Starch is a complex carbohydrate, our GI systems are very poor at breaking down starch into forms of carbohydrate that can be absorbed. We are not herbivores, end of. That’s why we have to cook most vegetables before we can eat them.
Starch is the most common carbohydrate in the human diet and is contained in many staple foods. The major sources of starch intake worldwide are the cereals (rice, wheat, and maize) and the root vegetables (potatoes and cassava). Many other starchy foods are grown, some only in specific climates, including acorns, arrowroot, arracacha, bananas, barley, breadfruit, buckwheat, canna, colacasia, katakuri, kudzu, malanga, millet, oats, oca, polynesian arrowroot, sago, sorghum, sweet potatoes, rye, taro, chestnuts, water chestnuts and yams, and many kinds of beans, such as favas, lentils, mung beans, peas, and chickpeas.
Widely used prepared foods containing starch are bread, pancakes, cereals, noodles, pasta, porridge and tortilla.
Digestive enzymes have problems digesting crystalline structures. Raw starch will digest poorly in the duodenum and small intestine, while bacterial degradation will take place mainly in the colon. When starch is cooked, the digestibility is increased. Hence, before humans started using fire, eating grains was not a very useful way to get energy…….as wikipedia would say.
Most people cook starches, they tend to taste disgusting otherwise.
You should have just said resistant starch in your post, the proportion of people who eat raw potatoes compared to cooked(or even boiled and then cooled which does increase the % of resistant starch via some recrystallization) for instance is small.
“our GI systems are very poor at breaking down starch into forms of carbohydrate that can be absorbed. We are not herbivores, end of. That’s why we have to cook most vegetables before we can eat them.” A counter-example that occurs to me is peas: we eat them raw straight from the garden – pods and all, for some varieties. Is there something special about peas? Could a bit of GM be used to make other starchy food more digestible? Think how much less CO2 we’d all release if we didn’t have to cook our starches.
Our problem, if it is a problem, is that breaking down complex carbohydrates e.g. beans, grass, wood, lobster shells, is not something our GI systems are very good at. Unless we smash them to bits, or cook them first – in order to break those very strong bonds.
Young, freshly picked peas straight from the pod taste sweet as they contain sugar which has not yet turned to starch. Older peas, whether in pods or not, are mostly starch and are uneatable until cooked. Young broad beans are similar, though they are best cooked for just a couple of minutes rather than eaten raw.
Good grief, can this be true? “About a quarter of the population over 40 are on statins.”
From the Old England Journal of Medicine
http://www.dailymail.co.uk/news/article-2396381/Four-million-patients-statins-dont-need-Half-cholesterol-reduction-pills-risk-effects-little-chance-benefit-doctors-warn.html
I found this paper about starch digestion interesting and informative: “Starch digestion and absorption in nonruminants.”, Gray GM., J Nutr. 1992 Jan;122(1):172-7 (http://jn.nutrition.org/content/122/1/172.full.pdf+html)
Yes, well. Perhaps I should have said ‘uncooked starch.’ Although that will probably get me into trouble as well. For myself, I like to cook my starches, lest they cause indigestion and enormous wind. Followed by even less pleasant things.
Following on to your reply to my comment about Gary Taubes and that a low carb diet does not work for everyone, the only person I know of who has attempted a scientific analysis of available data to classify people into types that can be used as a basis of dietary recommendations is Dr. Peter D’Adamo.
I have been following his “genotype diet” (http://www.genotypediet.com/index.shtml) for nearly two years and it has worked well for me as well as other family members. His diet divides people into six different types, some of which do well on a low carb diet and others that do well on a near vegetarian diet, although his actual recommendations about good and bad foods are more complex. He also talks about the differences in metabolism of these types. He explains his methodology at http://www.dadamo.com/B2blogs/blogs/index.php/2010/03/27/hows-and-whys?blog=24. I found it fascinating and impressive. Unlike someone who conceives an ideological concept of diet and then dogmatically tries to prove it, he performed a statistical analysis of actual data to see whether a meaningful program could be determined from the data.
I struggle with this, as I have never seen any diet that has ‘worked’. So, what data did he use? The data on useless diet a, or useless diet b? Maybe I am not understanding what you are saying. Also, if it works long-term, how come it seems so little known.
He’s not analyzing data from other diets. To try and give an idea about what he has done I’ll quote from the above link about his methodology,
– the different types “stem from the phenotypic (real world) characterizations reported for the ABO groups, Rh, secretor and additional biometric markers (D2-D4, fingerprints, etc)”
– “The base data includes virtually all published scientific tabular data on variations in physiology and pathology associated with these parameters, in addition to our own profiles of roughly 3,000+ additional people. At that point the data was filtered according to degrees of three basic metabolic ‘biases’: ‘thriftiness’ (metabolic compromise), ‘receptorism’ (immune tolerance) and ‘reactance’ (auto-immunity)”.
– Only after identifying six types did he try to match food choices to each type: “the next step was to match the expected physical manifestations to a large database of foods that I’ve been collecting for the last two decades … and each food is evaluated constituent-wise based on a weighed value system … For example, evidence of developmental instability or constrained growth (differences between left/right sides of body, certain fingerprints, short leg length) might result in limiting foods that cause excess glycation.”
But I would recommend reading the whole article to get a better understanding.
You ask why is it so little known. One reason, I would guess, is a lot of mud slinging because it challenges all other diets!
My wife and I watched the programme, which is the subject of your blog, as healthy eating and good nutrition is something we are both passionate about. However, it immediately became clear that the programme had been intentionally made to be very simplistic to get it’s message across. I was incensed at the way in which they rolled out apparent truths just to make an impact with their subjects (the people being treated and the wider public tuning in). A much better programme is Food Hospital, where nutrition is advocated ahead of drug therapy as a cure for a number of common conditions.
The pouring of fat down a drain to compare this to the fat clogging up our arteries was laughable!
Liking your comments Dr. Kendrick! My wife and I are big fans and loved your book.
With diet, people seem to think that if you keep saying something often enough, and loudly enough, it will be true.
“Just the place for a Snark! I have said it twice:
That alone should encourage the crew.
Just the place for a Snark! I have said it thrice:
What I tell you three times is true.”
The Hunting of the Snark by Lewis Carroll.
“What I tell you three times is true.”
Reminds me of Margaret Thatcher, who, if nothing else, was a master of simple rhetoric.
Dr. Kendrick, I’d be interested in your reaction and thoughtful response to the article which made headlines on the Daily Mail today (12th October 2013) on the success of statins in lowering the number of strokes in the UK? Thanks.
In Propaganda (1928), Bernays argued that the manipulation of public opinion was a necessary part of democracy:
The conscious and intelligent manipulation of the organized habits and opinions of the masses is an important element in democratic society. Those who manipulate this unseen mechanism of society constitute an invisible government which is the true ruling power of our country. …We are governed, our minds are molded, our tastes formed, our ideas suggested, largely by men we have never heard of.
https://en.wikipedia.org/wiki/Edward_Bernays#Propaganda
Like informing your friends that cholesterol does not cause heart disease , which immediately makes you a nutcase .
Isn’t some dietary fat transported to the liver from the small intestine via the portal vein?
Yes, not sure how much
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As a type 2 diabetic I still find things confusing ie the several books from Sweden on the low carbohydrate/high fat diet seem to say do not eat fruit or even vegetables if you want to control type 2 diabetes by diet. There is a lot of commentary on the blog by scientists and others but it looks as if we diabetics are our own scientists with ourselves as guinea pigs. What is really needed is practical advice on :
1. How an ordinary person can monitor important factors relating to diabetes and what those factors are ; any helpful suggestions on books to read would be great ?
2. What books to read ( have read Dr Kendrick’s book – really impressed ) on diet LCHF ?
3. Whether taking things to extremes eg in terms of cutting out all carbs / fruit / veg can do more harm than good – what are reasonable levels to eat daily .
4. Whether 3 main meals should be taken ( no inbetween snacks ) and whether fruit and a few carbs ok with main meals
I am male 6 foot 4 inches and physically active.
Here is a typical diet for 1 day – please let me know if a reasonable diet to curb type 2 diabetes :
1 Breakfast – bowl of Greek yoghurt with 6 Brazil nuts , 2 tablespoons of processed linseed ( with some almond/walnut/Brazil flakes and q10 in it, some sunflower and pumpkin seeds.One peach or plum. A half teaspoon on Maca ( a starch ) to finish off the packet. Cup of tea.
2 Mid morning – 3 small cups of ground coffee no sugar ; later on a Chai ( no sugar but with semi skimmed milk and some hemp milk ).
3 Lunch – fish ( or meat stew ) , one small potato, veg eg runner beans, cheese on a rye crisp ( or rye bread or). Water to drink.
4 Supper – on small plate – slices of meat, dollop of houmus , cheeses , small beet root, quarter of an avocado. With tea.
5 Before bed – mug of milk or hemp milk
The nonsense health advice dispensed on TV is enough to give me a stroke. We have a show here called ‘how to save your life tonight’ Australia. I watched the show on heart disease. They talked about ‘bad cholesterol’. They showed a man who had a heart attack. He was fit and ‘looked after himself’. His wife said he had no risk factors and his cholesterol was low. I suppose he was there to show that anyone can have a heart attack at any time, and symptoms to watch out for. But his cholesterol was low. They did not discuss that but ignored those words! They took everyone’s cholesterol level in the audience. They did not discuss other risk factors like infection, stress, alcohol etc etc etc, only cholesterol and blood pressure. Ironically this guy who ‘looked after himself’ (ex footballer or something) had been out jogging after ‘a few big nights’ and had problems before his heart attack. perhaps jogging is the cause then if cholesterol wasn’t. Or binge drinking… but they were not interested in discussing WHY…someone with no risk factors had a heart attack.
Dr. Kendrick, I just sent you a message through your “contact me” page, but now I’ve found this post that covers the same topic. I’m still left with the same question though. You say “the vast, vast, majority of fat we eat get anywhere near the liver. It is carried from the bowel directly into adipose tissue.” but my question is, doesn’t that dietary fat still require insulin in order to get it into our fat cells?
No
As I understand it, while fatty acids can enter the fat cells without the help of insulin, until they are linked together as triglycerides, they are free to leave too. The glycerol linkage itself is made from glucose, which does need insulin to enter the fat cell. Once the triglyceride has formed, it is locked into the fat cell until the blood insulin level drops, because insulin inhibits the enzyme needed to release the fatty acids from the triglyceride.
This much simplified version of events helps explain why it is so difficult to lose weight except on a low carbohydrate diet, because otherwise the circulating insulin prevents the body from getting to its fat stores to use them as fuel.
If I am wrong about this, please explain further.
Right. Insulin blocks the burning of the fat you want. But it’s not her fault, it’s her fault, it’s about what’s going to raise her. She just does her part