Diabetes Unpacked – a new book

Last year I was asked if I would contribute to a book on diabetes. Any money made from royalties would go to The Noakes Foundation in South Africa, a non-profit organisation which aims to advance understanding of the low carb high fat (LCHF) diet, in order to help people eat more healthily. Mainly in South Africa, but also spreading the ideas around the world.

I told the publishers that my ideas on diabetes were not necessarily shared by anyone else, because my brain was turned inside-out at birth by a careless midwife, and I can never see things the same way as everyone else.

In truth, despite my in-built ‘outside in’ way of thinking, I am in (virtual) full agreement with this project, and the view that if you want to avoid diabetes, the correct diet is low carb, high fat (LCHF). If you are unfortunate enough to have diabetes, it is critically important to eat a LCHF diet.

Unfortunately, for reasons that I have discussed before, mainstream medical thinking has got this matter twisted through one hundred and eighty degrees. They tell us we must eat a high carb low fat diet. This is completely bonkers. It makes no sense from any aspect of human physiology, or science, or logic. But, there we go. To quote the film Inception. ‘The most resilient parasite is an idea planted in the unconscious mind.‘ Quite

The most resilient idea in medical science appears to be that fat, particularly saturated fat, is bad for us. Carbohydrates, on the other hand, are good for us. This idea cannot be shifted by facts, logic, science, or any argument that I have yet managed to find, at least not in the minds of most people – and all mainstream experts.

The parasitic resilience of this idea would not matter, if this idea were not underpinning the massive increase in obesity and diabetes that we are seeing in the Western World. If it were not an idea that is damaging, and killing, millions of people. But it is, so it does matter.

And so, in another attempt to change thinking, and to educate, many brilliant thinkers (including me, of course), I have contributed to the book ‘Diabetes Unpacked’. This is what the blurb says:

Diabetes used to be rare and clear. One boy in the school had type 1 and a friend of a friend’s granny had Type 2. We now see adults being diagnosed with type 1 and children growing up with Type 2. There are over 400 million diabetics world-side – 4 times are many as in 1980. The vast majority of these have Type 2 – sometimes judged as a ‘lifestyle’ disease.

The traditional view of diabetes is that it is a ‘chronic and progressive’ condition and that nothing can be done about it. Serious complications include loss of eyesight, amputations and death.

This book has gathered together some of the finest minds working in the field of diabetes and diet. The result is a collaboration of chapter by thought leaders, academics and doctors addressing the big issues. What is diabetes? What are the different types? What causes is? Who gets it? Why do we eat so much carbohydrate? Why do diabetics die of heart disease? Why do athletes commonly get Type 2 diabetes?

The writers in this book approach diabetes from many different angles, but they all share one common belief: Diabetes does not need to be ‘chronic and progressive.’ Both Type 1 and Type 2 can be substantially alleviated and the latter can be put into remission. Let us tell you how…’

The Authors are: Professor Tim Noakes; Ivor Cummins, Dr Robert Cywes, Dr Jason Fung, Dr Jeff Gerber, Mike Gibbs, Dr Zoë Harcombe, Dr Ian Lake, Lars-Erik Litsfeldt, Nina Teicholz, Dr David Unwin, Dr Neville Wellington, Jen Whitington (‘Fixing Dad’), Dr Caryn Zinn and me.

Whatever your interest – overall health, weight loss, diabetes – the importance of diabetes on heart health, I would urge you to buy this book and help The Noakes Foundation to spread the word.

(publishers’ note: Book is available as limited edition hardback and to pre-order here. General release is end August when it will be available through usual book channels as paperback and eBook)

419 thoughts on “Diabetes Unpacked – a new book

  1. Bruce Miller

    I assume you have read and are familiar with Dr. Berstien’s work and books- Diabetes Solution? He has been fighting the ADA high carb eat grains etc. for decades and decades on this side of the big pond.

  2. JDPatten

    Here in the U S we seem to be a bit less backward – at least about carbs and diabetes.
    The diabetes clinic I went to here in New England in 2010, having just been told I had “pre-diabetes”, handed out a list of high glycemic index foods to avoid. I was told that, with Asian patients, it was often enough to switch them from white to brown rice. I got the logic. I’ve been LC since and, more recently, LCHF.
    Normal blood sugar.

    1. Bob

      I’m in the UK and they advertise low carb diets in the diabetes centre in my local hospital, though I haven’t made an appointment to talk to a dietician there and find out exactly what they mean by low carb.

  3. Dana Green

    I look forward to this book. Two of my siblings have type I diabetes and three friends have reversed their type II with LCHF. I KNOW it works but now we have to convince others.

    1. AH Notepad

      Any cipy’s a good ‘n. Signatures won’t make it better, unless you want to profit by selling it.

      1. Agg

        It is of course, it just would be nice to own a copy signed by one of the co-authors; preferably, after meeting them – always an interesting experience. I have got a few signed books, but they are valuable to me only I’m afraid.

  4. dearieme

    I plan to cut down on carbohydrates but it’s not easy. Croissants. Crisps. Corn on the Cob. Beer. Beef Stroganoff with rice. Oatcakes. Toast and marmalade. Tattie scones.

    Roast beef, Yorkshire pudding, roast potatoes, roast parsnips, ….. Not easy at all. Not at all easy.

    1. JDPatten

      If you listen to that and come to believe that it’s not easy, then it WON’T be!
      If you want to make a difference for yourself, you have to make a decision. . . and act on it.
      The difficult part is weeding out all the hidden carbs. Who knew, without doing the research, that “sweet” potatoes result in a much lower rise in blood glucose than the spike of baked Idaho?

      1. AH Notepad

        If helps dearieme, I cut out the carbs (mostly) by looking at what had to go. First went wheat, and almost everything that contained it. Mustard is a pain as it has wheat and I like mustard. Wheat went because of modern wheat’s ability to damage the surface of the small intestine. Largely this was under the category of gluten, so barley and oats went as well. Some will think “bonkers”, that’s fine, I accept I’m bonkers. Then it was a case of finding an alternative energy source. Fats would do that, and so eggs and cheese are what I perceive to be good quality sources. Simple for me, eggs for breakfast, 3, omelette as it’s quick, with pepper and salt. (Good, some sodium). Lunch is cheese sandwich, I just leave out the bread and increase the cheese accordingly. Evening meal in the summer is salad with home grown broccoli sprouts, a bit of meat or fish, maybe sausages, and for afters, a plate of strawberries raspberries etc with a large dollop of unpasteurised cream.
        Now I have my alternative energy source, it is enough without adding potatoes, rice, other starchy veges or any other carbohydrates, I don’t need them. Now I no longer feel hungry, even if I miss a meal.
        If you think we need a “balanced diet”, first you won’t get one by eating commercially produced foods, as the soil has long since been exhausted of nutrients, and most of it has been grown on land which has been poisoned with glyphosate, so locking up the minerals. By the way, Monsanto has just gained EPA approval to make food incorporating vira. http://www.greenmedinfo.com/blog/gmo-agenda-takes-menacing-leap-forward-epa-s-silent-approval-monsantodow-s-rnai-0 . Back to the balanced diet, cows and sheep do nicely on almost exclusively grass, unless they are intensively reared, in which case we shouldn’t eat them anyway.

    2. Stephen T

      Dearieme, it is a change, but I now much prefer the taste of higher fat, lower carb food. Full fat yoghurt, for example, without sugar is far better.

      I used to likes lots of the things you list, but I no longer miss them. I prefer not being overweight, ill or on my way to being diabetic. At least if we get the right advice, we can make a choice.

      1. Jan B

        ……And full fat Greek yogurt – the real stuff, is divine with a generous dollop of clotted cream (a ‘dollop’ is the standard measure of Cornish clotted cream – whether it be a teaspoon, a dessert spoon, a tablespoon or a shovel is entirely up to you)

    3. Martin Back

      You need a few simple rules. Here are mine, which have enabled me to lose 20 kg and keep it off with no effort (after establishing the right habits). And, BTW, I eat carbs like my own sourdough bread, fish and chips, rice, and potatoes, but only at meal times:
      – Never add sugar or sweeteners to anything you eat (must break that sweet tooth!)
      – Never eat between meals
      – Never eat breakfast, only lunch and supper
      – Never reward yourself with sweets, pastries, or chocolate
      – Never keep snacks or easy-to-eat foods in the house
      – Prepare meals from scratch
      – Break the rules occasionally :o) (I relax them on Sundays)

      1. Peggy Sue

        I think losing the “sweet tooth” is an excellent thing to do and that includes avoiding sweetish vegetables like carrots, parsnips etc.
        If you can lose that flavour craving you suddenly find yourself naturally avoiding all manner of things (even honey roasted ham in my case) including wanting a pud after every meal.
        I used to have the most incredible sweet tooth – even the kiddy rubbish in the pick n mix. The thought of it now makes my teeth bleed.
        I just need to lose my salty tooth now if there is such a thing. Crisps are my complete downfall!

      2. Peggy Sue

        Although I will add it’s not the salt I’m avoiding – it’s all the carbs it is generally attached to!

      3. chris c

        I was never a great sugar eater, starch was my downfall.

        I do still put sweeteners in my coffee, but the most fascinating thing was how sweet things like broccoli become when you are no longer torturing your tastebuds with sugar and starch. And actually how many more subtle flavours there are in all kinds of things.

    4. Robert Dyson

      Reducing carbs gets easier the less you eat, so take the plunge. A transforming experience for me was having a colonoscopy about 20 years ago that naturally required fasting & a flush out. I was expecting to feel weak, but to the contrary I had not felt so full of energy for ages.

  5. Linda page

    It definitely needs sorting- it being the problems surrounding treatment and diagnosis. I’m firmly with Dr Kendrick et al on this one. I have the same Drs as my neighbour next door. I did the LCHF diet and dropped hba1c by 10 pts- my neighbour insistsI have had a different diabetes and continues to follow the surgeries advice. She didn’t believe me when I told her that they had asked me how I had managed to avoid being labelled diabetic. It really needs sorting.

  6. topsygirl

    Thankyou for this Dr Kendrick et al, I think this will be a great gift for those who have everything including T2Diabetes and I know quite a few, they seem to just accept the progression as normal and go along with whatever is recommended; diet only to diet & metformin to insulin injections once to three times per day, problems with eyes, feet we will just have to take those toes and finally something like failed kidneys, CVD or something takes them out. Perhaps more careless midwives are called for to get folk thinking. Like you I do not remember anyone apart from 2 during all my childhood and for most of my adult life (I am 71yrs) who had this, like so many of the current chronic maladies they all seem to have appeared fairly recently and in plague proportions I wonder could it be diet and lifestyle? Dementia appears to be more prevalent among those with T2 Diabetes which is just another horror and the issues for all the health systems around the world if changes are not made will be catastrophic. I look forward to obtaining my books and again thankyou very much for all your good work and all the laughs.

    1. Anne

      This book will also be very useful for those with Type 1 who are still frequently told to add carbs to match their insulin. I know of a Type 1 retired doctor who has several complications and has been admitted to hospital with serious hypos – she eats a lot of carbs. I read Dr Richard Bernstein’s book ‘Diabetes Solution’ when I was first diagnosed with aytpical Type 2 ten years ago – Dr Bernstein is a Type 1 himself who eats extremely low carb, 30g per day, no complications and smaller doses of insulin so no sea saw blood glucose. I see that one of the contributors to this new book is a Type 1 GP, Dr Ian Lake, who had problems until he went high fat/low carb. This new book is going to be good for all diabetics.

      1. Andy S

        Anne, I ordered the book yesterday in support of the revolution. Not a diabetic but could easily be pre or pre/pre if I follow the current dietary guidelines. My interest is in the quality of life in the final 10 years of life. I believe the solution for diabetes will also apply to heart disease, cancer, Alzheimers and much more. At 77 I am close to finding out. My bet is on LCHF.

    2. Jo

      Yes! Diabetes is associated with dementia! In fact Dr Perlmutter (The Grain Brain) calls Dementia “Diabetes Type 3).

    3. chris c

      People like you and me can still remember back before there were such “epidemics”. When we are gone The Authorities think they will be home free.

      I have also known not a few long term diabetics who failed to progress in the accepted way, as have friends. One died at 89 after failing to progress satisfactorily for 42 – 43 years since he was diagnosed, which he entirely put down to the fact that back then over 50 years ago a low carb diet was de facto treatment, and he was unaccountably never taken off it and put on a low fat diet instead.

      Lots more who have been low carbing for 10 – 30 years too, but that was strictly against instructions.A few more doctors and nurses and even dieticians are starting to notice.

  7. gillpurple

    Excellent stuff, Dr K. I will certainly be buying the book – ready to lend out/recommend as I do with some other health related books. Pleased to see our good Dr Unwin contributing to the book, as well as Zoe Harcombe.

    The current damaging dietary advice given out to those with type two diabetes (and type one) by the NHS is something I feel very angry about and patients are most certainly being needlessly damaged and face earlier deaths.

    Thank you.

  8. Goutboy

    In China at moment visiting son. Apart from me at 67 seeming to be the oldest person on the street, Chengdu is carbohydrate city. Yes we had the China diet but apart from that history are we to take it that T2DM is on the increase, Yang et al seems to think it is (sorry can’t get through the great firewall for anything recent). Hang on but it was a rice based economy so if it is on the increase is this due to reduced exercise or maybe an increase in sucrose ( there’s a lot of it about). Can’t see any signs of obesity mind, and what is the average life expectancy? It’s not a China paradox is it!

    1. Sasha

      Diabetes has been around in China for centuries, in the old medical texts it’s described as “Wasting and Thirsting” disease. It is unclear whether they were describing T1D or T2D, possibly both. It is now known that prevalence of T1D in China is 1/30th of that in some developed countries with high rate of the disease like Finland, for example.

      The same probably applied to T2D until, at least, recently. It’s hard to develop it when you are chronically undernourished. One of the Chinese versions of “How are you” translates literally as: “Have you eaten today?”.

      1. Goutboy

        I guess the point I was making badly was that China eats a lot of carbs so surely if the theory of hclf is correct then there should be a recent increase post undernourished. Yang et al in 2008 says there is but it’s only one study.

      2. Dr. Malcolm Kendrick Post author

        There are a couple of other things you need to add to the equation. Amount of exercise, and total calories consumed. The problem is not necessarily carbs, the problem is excess carbs. What constitutes excess carbs does seem to vary a lot from person to person.

      3. Sasha

        Yes, I think Chinese will be experiencing an increase in all modern illnesses now that they’re adopting some of the habits of developed societies. The last time I was in China all the KFC joints were packed with young people. The old are still slurping their noodle soups for breakfast in hutongs. Much better for your digestive system, IMO.

        But you’re right, Chinese eat plenty of carbs (when they can afford it) and have done so for centuries. As do Italians while suffering few of the consequences attributed to bread and pasta by LCHF adherents.

        LCHF apparently helps people loose weight and improve their metabolic markers but once you start looking at contradicting evidence, it is clear that there’s a ton of black swans questioning the whole LCHF theory.

      4. chris c

        Also what people DIDN’T eat and do now. Such as epic quantities of Omega 6 seed oils as well as sugar and HFCS, and “food” stuffed with things that aren’t actually food, all of which may affect insulin resistance.

    1. Mark Johnson


      @ Sasha

      LCHF apparently helps people loose weight and improve their metabolic markers but once you start looking at contradicting evidence, it is clear that there’s a ton of black swans questioning the whole LCHF theory.

      What black swans did you have in mind?

      1. Sasha

        Here are two:

        1. Virtually every traditional culture in the history of the world ate and continues to eat carbs with many of them suffering few of the issues (CVD, diabetes, obesity) that afflict modern societies. If LCHF theory is correct, how is that possible?

        2. Walter Kempner was able to treat T2D and some other chronic conditions with his Rice Diet which is basically a carbohydrate nightmare. If LCHF theory is correct, how was he able to do it?

        These are just two off the top of my head, I am sure there are plenty more.

      2. joanne mccormack

        @Sasha mentioned 2 apparent black swans-
        Traditional societies eating carbs and staying slim- they do as long as they continue to live in isolation in a traditional society with traditional food. Once sugar or other western junk food is added in they get ill or fat or both. I have never seen any stay healthy- I have patients who have come over from traditional societies to the UK- but they take varying times to get ill. Irish people of the 1840s stayed slim on a diet of mainly potatoes and buttermilk. Once the potato crops failed they starved as there was little else to eat. They were poor and did have periods when they ate little if they ran out of money, lost their jobs, or became ill and could not hunt. This is helpful metabolically and keeps your weight down. The potato diet apparently works for some, as does the rice diet, or even the sugar diet. It does not defeat the LCHF theory but is a different way of challenging the metabolism to do something different. If you eat just rice five times a day and nothing else your insulin will go up five times, and it is boring food, so it is unlikely you will overeat it. It may be a lot less of a pancreatic and liver challenge than the junk food and drink you ate before. So all diets are relative, and choosing an LCHF diet works for many in terms of achieving their personal goals. As a GP with 3 years experience of LCHF I find it appeals to many, but not all. The broad range of foods are more appealing than just rice, just potatoes or sugar. I have also achieved the best results of any diet I have ever seen with meat/fish eating LCHF in terms of fast reversal of diabetes. For the record a HBA1C of 116( very badly controlled diabetic) down to 39( as low as a non diabetic) in 4 months. I have never seen anything like this with any other dietary manipulation but that does not mean it does not happen. I am searching for vegans and vegetarians who have done similar, so please send them my way as it is a frequent question. Can I do this as a vegetarian/vegan? It is a problem because of the higher intake of carbs that will be needed, it does not mean it is impossible, but in my experience I have never seen as good results. I am now part of a network of nearly 200 clinicians who share their experience of this, and the results are similar- for the record again I am not even in the top 10 even though I am shocked by how good it has been for my patients.

    1. Dr. Malcolm Kendrick Post author

      I think that the question needs to be re-arranged. Insulin resistance (not a term I like, but lets us it for now) creates a spectrum of biochemical/physiological abnormalities. Increased fibrinogen, increases PAI-1, incresed Von Willebrand factor, increased blood viscosity. Also raised blood pressure, increased visceral obesity, increased blood sugar levels. Any, or all of these, could cause CVD. In time, insulin resistance leads to type II diabetes – usually. So the thing that causes type II diabetes also causes CVD. type II diabetes causes nothing – as it is simply an abnormal blood sugar measurement.

      1. Håkan

        I have learned from you that it is not elevated blood glucose that is the problem. But is it elevated insulin levels that get those biochemical/physiological abnormalities going?

      2. Håkan

        So for what reason is the body doing this? Looks like it prepares itself to clot. Is insulin part of a defence system?

      3. Håkan

        If there is a pathway from insulin/glucagon abnormalities to CVD then I’m sure it would be of great interest for many of your readers to get a blog post from you on this topic.

      4. xtronics

        There is a key truth in that insulin resistance is a very misleading term.
        Actually – insulin resistance should be talked about in the positive term of insulin-sensitivity. There are different sensitivities in different tissues: muscle, Liver, adipose.

        The false narrative: “Insulin is a natural protein that regulates energy consumption and blood sugar levels in the body. ”

        While not exactly untrue, what it leaves out is so huge that it is wrong. While insulin has an effect on BG levels; the relative sensitivity to insulin is just as an important part of the control loop.
        But then…

        Insulin also has MANY other effects::

        controlling storage of fat – Decreased lipolysis
        as a growth factor.
        glycogen synthesis
        Increased cellular potassium uptake
        decreases production of glucose from noncarbohydrate substrates
        Increased lipid synthesis
        Increased production of trygly from fatty acids
        decreased breakdown of proteins
        Decreased autophagy – decreased level of degradation of damaged organelles. Postprandial levels inhibit autophagy completely.
        forces cells to absorb circulating amino acids
        forces arterial wall muscle to relax
        Increase in the secretion of hydrochloric acid in the stomach
        Decreased renal sodium excretion
        enhances learning and memory
        increased fertility

        When I was younger – I had GERD – saw 2 internists and 2 gastroenterologist – some were at a teaching hospital. None of them considered elevated insulin as a cause – but later when I went low-carb – my GERD suddenly disappeared.

      5. chris c

        IMO xtronics is pretty spot on.

        Here’s a way that “stress” re-enters the picture. Like many I suffered from “reactive hypoglycemia” (yes I know you are no longer permitted to diagnose this, it has been replaced by “a neurotic condition” called idiopathic postprandial syndrome, which neatly conceals from you the cause and the treatment, but bear with me)

        1: glucose shoots up after eating too many carbs, where “too many” is a fraction of what a dietician claims is essential

        2: insulin response is delayed, then the insulin shut off is delayed even further

        3: high insulin drops the post-postprandial glucose like a stone

        4: not only a genuine hypo but a rapid drop in glucose *prophesying* a hypo sets off the body’s defences

        5: not just glucagon but its big brothers CORTISOL, epinephrine, norepinephrine, peptide Y and a bunch of downstream stuff are dumped into the bloodstream

        IME that was what was behind most of my “psychiatric” symptoms, most of the physical ones came more directly from the glucose and insulin levels. I used to react “as if” I was under high levels of stress when I was actually under low levels, or none. Now I don’t, I am serene as f*ck. Honest.

        “Hangry” by Ted Naiman

        Amy Berger “It’s The Insulin, Stupid” and following posts


        David Ludwig has studies on this in “nondiabetics” though I tend to suspect they are just “not diabetic yet” like most of the population

      6. Charlie

        Like Dr. Malcolm said diabetes is complex and other systems HPA Axis may be important.
        Here are some interesting studies/full text on links:
        GABAergic system in the endocrine pancreas: a new target for diabetes treatment

        Excessive loss of functional pancreatic β-cell mass, mainly due to apoptosis, is a major factor in the development of hyperglycemia in both type 1 and type 2 diabetes (T1D and T2D). In T1D, β-cells are destroyed by immunological mechanisms. In T2D, while metabolic factors are known to contribute to β-cell failure and subsequent apoptosis, mounting evidence suggests that islet inflammation also plays an important role in the loss of β-cell mass. Therefore, it is of great importance for clinical intervention to develop new therapies. γ-Aminobutyric acid (GABA), a major neurotransmitter, is also produced by islet β-cells, where it functions as an important intraislet transmitter in regulating islet-cell secretion and function. Importantly, recent studies performed in rodents, including in vivo studies of xenotransplanted human islets, reveal that GABA exerts β-cell regenerative effects. Moreover, it protects β-cells against apoptosis induced by cytokines, drugs, and other stresses, and has anti-inflammatory and immunoregulatory activities. It ameliorates the manifestations of diabetes in preclinical models, suggesting potential applications for the treatment of diabetic patients. This review outlines the actions of GABA relevant to β-cell regeneration, including its signaling mechanisms and potential interactions with other mediators. These studies increase our understanding of the regenerative processes of pancreatic β-cells, and help pave the way for the development of regenerative medicine for diabetes.

        Here is a link/complete text for study with more on the same idea:
        Artemisinins Target GABAA Receptor Signaling and Impair α Cell Identity

        Type 1 diabetes is characterized by the destruction of pancreatic β cells, and generating new insulin-producing cells from other cell types is a major aim of regenerative medicine. One promising approach is transdifferentiation of developmentally related pancreatic cell types, including glucagon-producing α cells. In a genetic model, loss of the master regulatory transcription factor Arx is sufficient to induce the conversion of α cells to functional β-like cells. Here, we identify artemisinins as small molecules that functionally repress Arx by causing its translocation to the cytoplasm. We show that the protein gephyrin is the mammalian target of these antimalarial drugs and that the mechanism of action of these molecules depends on the enhancement of GABAA receptor signaling. Our results in zebrafish, rodents, and primary human pancreatic islets identify gephyrin as a druggable target for the regeneration of pancreatic β cell mass from α cells.

    2. Sharon

      I’m reading the book just now and the one thing that has ‘clicked’ for me (very much a medical layperson) is that it is raised insulin rather than raised blood sugar levels that seems to be the problem. I believe that raised cortisol and smoking also cause insulin levels to rise. Perhaps all the things we see as risks for CVD are related in that they all raise insulin levels both in terms of volume and/or over time? Maybe of course I am looking at a complex problem, seeing a simple solution and being wrong!

  9. joanne mccormack

    Great post Malcolm. I have bought 18 Diabetes Unpacked to give to colleagues and interested patients. I was shocked when I realised we had been treating diabetics *completely in the wrong way*. That was over 3 years ago and I have been trying to right the wrong ever since. If any doctors, nurses or dietitians are reading, please read the book, also consider joining http://www.PHCuk.org and the doctors hyperinsulinaemia and insulin resistance group(HAIR for short)
    joannemccormack@nhs.net to join. David Unwin and Campbell Murdoch are also administrators.
    We need to understand this HAIR stuff, but carbohydrates are definitely the food type to avoid as a diabetic, and even NICE have changed their advice for type 2 diabetes to low GI- Dec 2015.
    Any patients there- there is a free 10 week programme on http://www.diabetes.co.uk which is low carb
    Also Diabetes university video clips on YouTube by Dr Richard Bernstein and his excellent books are highly recommended.

  10. Anne

    I just pre-ordered the hardback edition. I’ve been eating low carb/high fat for the past ten years since being diagnosed with atypical Type 2 diabetes and reading Dr Mike Eades’ book ‘Protein Power’ and Dr Richard Bernstien’s ‘Diabestes Solution’. But I welcome any new book which supports low carb, and especially Prof Tim Noakes – I have his cookery book ‘The Real Meal Revolution’: even though it’s aimed at overweight people and I am thin, verging underweight, but his recipes are absolutley delicious. On low carb/high fat my HbA1c has never been above 5.3 or 33 new measurement. Low carb works and it’s about time mainstream medecine learns this. In additon to working it’s also much easier than people imagine to give up carbs, especially carbs as in bread, rice, potaotes etc – those have no flavour whatsoever in themselves, it’s what you have with them that is flavoursome and that’s what I have, lots of the flavoursome and highly nutritious foods with none of the carby fillers. Thanks for alerting us to this book Dr K !

    1. Sylvia

      May I go a little astray. Anne, just looked at Dr Mike Eades blog and found an interesting TED talk by Allan Savoury about herd grazing and then looked at others who hotly dispute his claims. You have led me down a very interesting path about sustainable food production.
      The agri business rather like the pharmaceutical industry is as we know a force to be reckoned with. More power to your elbow Dr Kendrick, hope the book is well received. Not enough commas I know!

      1. Bill In Oz

        Hi Sylvia, my background is in organic farming ( 25 years ) I attended a talk by Alan Savoury a few years back. And he talks god sense for farmers in the dryer parts of the world, like East Africa, the Sahel and parts of Australia. But these regions are not huge on a planetary scale. So while he is right, also his ideas cannot be applied in say most of Europe or tropical areas..

  11. John Collis

    I am type 2 and I am trying to follow a LCHF type diet on the advice of my GP(!). Back in 2014 at my diabetes review it was indicated that I would need to go onto insulin, in response to this I decided to try and lose some weight. Over a period of about 20 weeks I lost a total of 20 kg, and, touch wood, I have maintained my weight. Since trying to follow a LCHF and stopping the obligatory statin my HbA1c has dropped, albeit slightly to 7%, but it was 8.6% in 2014. Like other people, when I was younger diabetes was a rarity, despite people having sugar in drinks and on their breakfast cornflakes, and white bread and potatoes as staples; we also ate food fried in lard, cuts of meat that were fattier than those of today (pork crackling), full cream milk(also provided at school for free). When yoghurt was introduced it was unpleasantly sour, not like the modern version. Confectionary was a treat not the norm. We ate fruit in season, usually British only; we ate tinned fruit as a treat, usually for Sunday tea; fresh tropical fruit was unknown with possibly the sole exception being bananas. Is there a correlation between the rise in the consumption of sweet tropical fruit and the increase in diabetes? Is there a correlation between the rise in low fat foods and the increase in diabetes?

    1. Stephen T

      John, low fat equals high carb, so there’s definitely a connection. Take the fat out and replace with sugar was a common ploy by food manufacturers. They could then make ‘healthy’ claims about what was really sugart junk. Yoghurt is a good example, but I’ve noticed that natural unsweetened yoghurt is now easily available.

  12. Dr Nick Melhuish

    In 20 years of looking at T1 diabetic athletes online, I have never seen anyone on a Bernstein type diet report great success, except for a few in long, slow, ultra events, or in very short events. Team Novo all eat carbs on race day. The best T1 masters half marathoners all race on carbs.The LCHF lobby has consistently refused to provide me with the name of even one person who has run a fast half marathon without carbs.

    1. Dr. Malcolm Kendrick Post author

      This is interesting and not my area of knowledge at all. My own sense is that type I diabetes is a very different thing in this regard. Perhaps someone else here can answer you. I understand that Tim Noakes has looked at this area in some detail – though I am not sure he has looked at type I athletic performance.

    2. Solomon

      Dr. Nick Melhuish, are you not muddying the waters with what is healthy versus sprinting athletic performance? A lot of what improve athletic performance have had to be regulated. They mess with health later in life. Not necessary healthy. This is a new area and most scientists are now having the guts to study it in the first place. What we want to know now is: Is it carbs or fat that exacerbate insulin resistance and diabetes? Do I have to drop the carbs and up the fats?

    3. Stephen T

      Dr Melhuish, you raise an interesting question. I think Prof. Tim Noakes or Jeff Volek and Stephen Phinney, who have written on low carb sporting performance, would be the people to ask.

      However, what helps athletic performance for super-fit twenty year olds isn’t the same subject as public health. Indeed, looking at now overweight middle-aged athletes, what once helped their performance might be what’s now hurting them.

      1. sasha

        I think what hurts middle aged overweight athletes is that appetite stays the same for a while and the level of physical activity drastically reduces. At least that’s been my experience as an ex athlete. i put on a lot of weight for the first few years after stopping intense training. To this day people keep commenting how much I eat even though I’m not overweight anymore.

  13. Gary Ogden

    Good news! Will be ordering shortly, for my GP, after I’ve read it. All the usual suspects involved in this.

  14. nickmelhuish

    In 20 years of looking at T1 diabetic athletes, I am yet to see anyone on a Bernstein type diet report good results, except in very long, slow ultra events, or in very short events. Team Novo all eat carbs on race day. The LCHF lobby has consistently refused to provide me with the name of even a single T1 who has run a fast half marathon without carbs. There is no T1 my age who has even come close to my sporting success while following Dr Bernstein.
    T1s will not reach their full potential by eating low carb all the time. Learn about the limits of LCHF.

      1. Robert Dyson

        They are different in a similar way to drought and flood. The history of diabetes has tied them together because the standard test has been serum glucose levels. Had we started measuring serum insulin levels we would have had very different names for them.

  15. Anne Lucas

    Although not a diabetic I fully support the LCHF way of eating and I have reaped the benefits. Very happy to contribute to the Noakes Foundation by buying the hard copy of this book. Thank you to your good self and the others who have contributed their valuble message in an effort to educate the public about one of the greatest threats we face to good health.

  16. Mark Johnson

    I’m surprised Dr Unwin hasn’t been struck off.
    I mean the audacity of the man, to actually reverse and dare I say “cure” type 2s whilst saving the NHS £1000s. I thought doctors’ just followed guidelines these days…?

    PS Just ordered 2 hardbacks. Might just give one to the local doctors’ surgery.

    1. Andy S

      Hi Gaetan, he concluded that if fruit diet does not work out he will try something else. I’ll check back in 30 years to see how he made out. Did he get fat by eating fat?

      1. Gaetan

        I don’t know why he got fat. do you?

        He said he tried the LCHF diet, things improved first and declined so he went vegan and he says his health markers are fine now.

    2. KidPsych

      I like Denise Minger’s review of evidence in regard to possible benefits of diets that are not LCHF. I personally follow an LCHF diet, but I keep my eyes open to other points of view.


      From Ms. Minger: “I do want to make one thing abundantly clear before we continue, though. The title “In Defense of Low Fat” doesn’t imply its inverse, “In Attack of High Fat.” Quite the opposite! My goal here is to create a space where two very different dietary approaches can sit down for tea, respectfully coexist, and interact without any subsequent homicide investigations. In fact, I’ll be arguing for a more panoramic view of nutrition where the success of both high-fat and low-fat diets are compatible, and maybe even make sense. It just requires zooming out farther than we’re used to looking, and acknowledging that our ever-rivaling communities could actually learn a lot from each other.”

    1. Robert Dyson

      Joseph Kraft, who died at 95 earlier this year, was promoting the view that insulin was the important factor for about 40 years. He published a small book that also mentioned the cholesterol non-factor in 2009. If only – people had noted the research 40 years ago.

      1. chris c

        Yup, an ignored genius alongside John Yudkin, Peter Cleave, Gerald Reaven (many of whose papers are still paywalled even after decades, I wonder why they don’t want you reading them) Mary Enig, Fred Kummerow and many more.

        My current joke:

        It’s like a crime movie where the FBI have “cholesterol” under 24 hour surveillance. Meanwhile insulin and its gang go around totally unobserved, creating mayhem.

    1. Dr. Malcolm Kendrick Post author

      Others have commented on this, included Gary Taubes. If it were not such a serious matter, this article would be simply hilarious. It relies on four studies, mainly done in the 1960s, and refuses to use any other evidence. Quite amazing.

    2. Andy S

      All except one of 12 authors is FAHA (Fellow of American Heart Association) all suffering from groupthink.

    3. Robert Dyson

      “I read it and found myself gradually drifting into ‘incompehensibility’”
      Actually you have understood it perfectly as your sentence shows. It selects some trials, not the totality of evidence and then proceeds to spin the results. I could write pages, but one study – The Wadsworth Hospital and Veterans Administration Center in Los Angeles is indeed a high quality trial with that wonderful double blind etc that went on for I think 6 years. However, the group that had the saturated fat also had more heavy smokers, and guess what – they had more CVD than the group on polyunsaturated fats. If you factor the expected CVD from smoking there is nothing left for the fats. And, oddly the group on polyunsaturated fats had more cancers showing up at the end of the trials than the smokers, and we thought smoking caused cancer.
      However the AHA thinks this shows that saturated fats are bad and polyunsaturated fats are good. So, yes, incomprehensible.

  17. David Bailey

    There is one part of this story that puzzles me. I don’t understand how cultures that consume a mainly rice-based diet manage to survive. Regardless of whether they eat polished rice or wholegrain rice, what they consume is largely carbohydrate, and breaks down into glucose eventually. I can think of a few possibilities:

    1) These cultures suffer a lot of disease from their diet.

    2) Somehow the equation carbohydrates =>sugar isn’t the whole story.

    3) Sugary foods contain sucrose which is half fructose, and that is part of the problem. (I.e. sugar is somehow much worse for you than the same amount of carbohydrate, even disregarding the issue of its rate of absorption).

    4) If complex carbohydrates make it down to the gut, the microbes there make other, more useful molecules from it.

    I know I have asked this before, but I have never got a really satisfying answer.

    1. Bill In Oz

      David, my lovely wife is Filipina. She eats white or brown rice every day almost. And her weight is stable. And she is fit and harder working than I am. fancies herself as a “Ninjarette”.
      I know I could eat the food she eats and long survive this world.

      The only way I can explain this is via genetics. As Dr Malcolm says below, some people can do well on a high carb diet.. And the peoples of SEA have survived on a high rice diet for a couple of thousand years. Those who couldn’t there were lost in the evolutionary process. But me, in Australia, well my genes are from Liverpool, North Wales and Ireland. Evolutionary speaking I think I am better evolved to handle breads ( sourdough ) & porridge etc..And less adapted to spuds ( which I love ) that my ancestors only started eating in the 17th century

      1. David Bailey

        Thanks for that – I’d love to get a discussion going about this, because I feel it is the one weak point in the ‘new’ diabetes theory – and as such it should get more attention rather than being ignored (which has been the approach that created this mess!). I imagine that the existence of races that consume mainly rice, also contributed to the original idea that carbs are healthy.

        Can genetics influence which sort of carbs we can eat – as opposed to how much carbs we can eat?

        Gary Taubes seems to focus his concern on sugar, but in his book he doesn’t seem to clearly explain how this might extend to other carbohydrates. He seems to make a good case that sugar is uniquely bad for us (at least in the quantities people are inclined to consume) and I wonder if sugar somehow upsets the body’s feedback loop so that nothing that breaks down into sugar is then safe?

      2. Dr. Malcolm Kendrick Post author

        I think the word ‘excess’ is too often missing here. Fruit is lovely and wonderful, and healthy. But two liters of fruit juice a day is going to lead to health problems. Probably half a litre a day is going to lead to health problems.

    2. Martin Back

      Good question. And it’s not just the rice-eaters. Americans ate maize and cassava; Africans ate millet and sorghum (now also maize and cassava); Polynesians ate yams; Middle Easters ate wheat; the Irish ate potatoes. So many cultures have eaten carbs and thrived.

      1. Sasha

        And the list goes on and on. There’s no culture in the history of the world, none, that had access to carbohydrates and didn’t eat them. And they all seemed to thrive provided they kept to their traditional ways of growing and preparing food, as Weston Price’s research shows, for example. That’s why, in my opinion, the whole LCHF theory is based on some seriously faulty assumptions and has more black swans than most other theories it’s trying to disprove.

      2. Dr. Malcolm Kendrick Post author

        Sasha. The Masai would be one culture with access to carbs, who didn’t eat them. So, be careful with statement of fact, that are not actually facts. I would agree, however, that some ‘paleo’ followers can get a little extreme, but I would suggest you do not tar everyone with the same brush. Personally I would agree that carbs are not a problem, in isolation. They become a problem when people live sedentary lives, eat highly processed carbs, with a particular emphasis on fructose, fruit juice and the like, and then eat far too many calories in total. At which point, all hell breaks loose. Unfortunately, this describes much of Western Civilization today.

      3. Sasha

        Dr Kendrick, I will need to read up on the Masai to see how they are able to choose not to eat carbs. It must mean they are quite wealthy! At least in cattle… In that they are different from any other culture I am aware of. People have always eaten carbs because they couldn’t afford not to. Food has been scarce for most of human existence.

        My larger point – unless someone can prove that Masai outperform all other cultures in the health metrics, it doesn’t make sense to assert that people should stay away from well made bread, fresh fruits, grains, carrots/beets/turnips and even good chocolate once in a while. I don’t follow LCHF/paleo blogs so the only LCHF views I have seen expressed have been on this blog and some of them are quite wrong nutritionally, at least in my opinion.

      4. Dr. Malcolm Kendrick Post author

        Look up George Mann and the Masai. He went to study them as the population with the highest saturated fat, lowest carb consumption he could find, in the world. Tallest people in the world, super-healthy, tend to win all the gold medals in long distance running, almost zero CVD. Very low cholesterol levels? Of course, things have now changed somewhat. [It was also the men who avoided carbs, it made them ‘weak’ the women were quite happy to eat carbs, I believe].

      5. Sasha

        I will look it up, thank you. But a quick look around the internet shows that according to some studies, Maasai level of physical activity is about 75% higher than that of an average Westerner. How do you know that this isn’t the reason (or one of the major reasons) for lack of CVD in their population? Besides, aren’t there other populations around the world, like Kitavans for example, who eat plenty of carbs and fruits and still have very low levels of CVD?

      6. Sasha

        Also, quite a few sources on the Internet mention that Maasai don’t have high life expectancy. Maybe they don’t account for usual confounders but they also say that plenty of Maasai don’t live past the age of 60. I don’t know if it’s true or not.

      7. Charlie

        There may be a benefit on keeping insulin lower like in LCHF, the study is in mice but the MOA could apply to humans. Maybe those eating a very high carb diet without an apparent harm could do even better with a diet that will reduce insulin need.

        Reduced Circulating Insulin Enhances Insulin Sensitivity in Old Mice and Extends Lifespan


        In Brief
        In a study examining the life-long effects
        of lowering insulin levels in mice,
        Templeman et al. provide evidence that
        elevated insulin levels contribute to age-
        dependent insulin resistance. Moreover,
        they show that slightly reducing
        circulating insulin is sufficient to extend
        mammalian lifespan, independently of

      8. chris c

        IMO look at what they DIDN’T eat and do now.

        Further hint: what “cures” a disease state may not be the reciprocal of what causes it.

    3. Sasha

      And I don’t think you’ll get a satisfying answer from anyone telling you that carbohydrates just equal sugar for the simple reason that they don’t have it and it doesn’t exist. That belief is “paleo” dogma not supported by any scientific evidence and it leads to some trippy assumptions like: bread is of the devil and fruits are bad for you because they have fructose. Properly made bread has nutritional qualities that no other food group has and the same goes for fruits. Earlier on this blog there was a commenter Diana who did a good job of dispelling some LCHF myths and providing excellent scientific evidence to back it up. If you scroll to the beginning of this blog, you will find her entries. Too bad she hasn’t been active recently, she was bringing some much needed sanity to the discussion…

      1. Dr. Malcolm Kendrick Post author

        Sasha, carbohydrates are all sugar(s). Simple sugars bound together in various different ways. From chitin (lobster shells) to wood, to grains, pasta, potatoes… They truly are, all, simple carbohydrates linked together, and all carbohydrates must be broken down into simple sugars to be digested, by humans. Carbohydrates are all, as far as human physiology is concerned, sugar. That is an inarguable, basic, scientific fact. It is not dogma. As regards fructose, you may find this paper of value. It is called Fructose, insulin resistance, and metabolic dyslipidemia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC552336/

      2. Sasha

        I will read the paper, thank you. By dogma, I was referring to the belief, as I have seen it expressed by LCHF and paleo followers that people should avoid grains, fruits, and starchy vegetables like potatoes because “it’s just sugar”. The sugar in those foods is bound up with other nutrients that are very important for the body and they don’t exist in fat or protein. The body processes these sugars quite differently when they are part of a whole food. And they are very much needed despite what some LCHF people say.

      3. Sasha

        Oh, I would have to look that up. But I think that if you scroll back to some of your conversations with Diana, she provided some pretty good links on why grains and vegetables are important.

        Are you saying that vegetables contain no nutrients that aren’t present in animal protein and fat?

      4. Dr. Malcolm Kendrick Post author

        No, I am asking you to provide me with a list of nutrients present in vegetables that are not present in animal protein and fat. It was you who made that claim, not me. If you are going to make a claim, then you need to be able to support it. It is a thing I always try to do.

      5. Sasha

        Essential as in “absolutely necessary”, its classical definition? They’re probably not “absolutely necessary” for the survival of the body.

      6. Dr. Malcolm Kendrick Post author

        The currently established human essential nutrients are water, energy, amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine), essential fatty acids (linoleic and α-linolenic acids), vitamins (ascorbic acid, vitamin A, vitamin D, vitamin E, vitamin K, thiamine, riboflavin, niacin, vitamin B-6, pantothenic acid, folic acid, biotin, and vitamin B-12), minerals (calcium, phosphorus, magnesium, and iron), trace minerals (zinc, copper, manganese, iodine, selenium, molybdenum, and chromium), electrolytes (sodium, potassium, and chloride), and ultratrace minerals. http://ajcn.nutrition.org/content/75/5/951.2.long

      7. Sasha

        I am not sure what the link you provided proves or disproves. Determining what human essential nutrients are or that exogenous carbohydrates aren’t necessary for human function (as it says in the letter) doesn’t really answer the question: “what nutrients are essential for human health”.

      8. Dr. Malcolm Kendrick Post author

        Sasha. You appear to be saying that there are other nutrients essential for human health that have, as yet, not been identified? And they can be found within carbs? That is one approach to assessing human health. Your argument appears to be that there are nutrients essential for human health that can only be found within carbohydrates. You have listed some things that can be found, but have not provided any evidence that they are required for human health.

      9. Sasha

        Dr. Kendrick, you first asked what nutrients vegetables have that fat and protein don’t have and then asked if they are “essential for human health”.

        The link you provided lists the nutrients that are essential for human function, not human health. And it specifically says that at this point the studies listed cannot determine whether extreme carbohydrate restriction could be detrimental to human health.

        So, how do you define what “health” is? Are Maasai and Eskimos healthier than other populations that eat carbs in the form of fruits, vegetables, and grains? Maasai can take all the prizes in long distance running but a Polynesian raised on the diet of fish, fruit, and poi (made from very starchy taro) can probably kill a Maasai with one punch. Does that make Polynesians healthier than Maasai?

        Do Maasai and Eskimo have lower rates of chronic illnesses and longer life expectancy? I don’t know about Maasai much but a quick look at the internet sources shows that they aren’t known for their longevity. Is that true?

        What about Eskimos? Are they known for lack of degenerative diseases and long life spans?

        And in determining what’s responsible for their “health” how do you control for all the confounders?

        So how can we look at Eskimo and Maasai diet and determine what nutrients are “essential for human health”?

      10. Dr. Malcolm Kendrick Post author

        We don’t look at the Inuit and Masai to determine what nutrients are essential for human health. Over hundreds of years people have suffered from various illness e.g. scurvy, or pellagra, or pernicious anemia, or rickets or kwashiorkor, or suchlike. It has been found that the underlying cause of these diseases is a lack of an essential nutrient e.g. vitamin C, vitiman D, or Protein, or suchlike. It has been found that, if you replace the lacking essential nutrient the underlying disease goes away and the person becomes fully healthy again. When it comes to macronutrients. Protein(s) and fat(s) are essential nutrients – you will die if you do not eat them. There is no evidence, from anywhere, that carbohydrates are essential nutrients.

        The link I have provided makes a correct scientific statement. As extreme long-term carbohydrate restriction has never been studied in a controlled trial. Therefore, it cannot be stated – for certain – that no harm will occur. However, thus far, over many hundreds of years, it has never been established that carbohydrates, in the diet, are required for human health. Thus, is is highly probable that carbohydrates are not required. There is no biochemical process in the body that requires dietary carbohydrate to function. The Inuit and Masai are probably the extreme examples of (close to) a zero carbohydrate diet. Whilst these groups, like all ‘primitive’ groups have a lower life expectancy than that to be expected in the West, they compare very favorably with most of the other ‘primitive’ peoples examined.

      11. Sasha

        While I agree with you in reference to scurvy, pellagra, etc, I think that it points more to absence of illness, not necessarily presence of health. Some low carb commenters say that advent of agriculture and cultivation of grains ushered in a decline in human health. I find the evidence they present unconvincing.

        Regarding Masai and Inuit, here’s one link challenging some of the conclusions people draw from Dr Mann’s research:


        The author also co-wrote “The China Study” so he may have his own biases to work through but some of his claims are corroborated by other research I have read on Masai in the last day or so.

        The original researchers themselves said that “the accurate measurement of dietary intake of these people proved extraordinarily difficult”. One thing everyone seems to agree on is that they drink a lot of milk.

        The piece also challenges some of the assumptions we have about the health of Inuit.

        More importantly, George Mann and his researchers looked at prevalence of CVD and presence of CVD markers in a population that:

        1. Derived a lot of their nutrition from drinking milk (in case of women and children most of their nutrition, it seems).

        2. Had very high levels of physical activity. Some researchers say 75% higher than an average Westerner, others say that an American would have to add 12 miles of walking daily to their level of physical activity to match Masai.

        3. Has relative calorie insufficiency (according to 1982-83 survey) – a well studied factor promoting longevity.

        And then the researchers compared their findings to CVD stats in a US population from 1960’s with: Standard American Diet, smoking, environmental pollutants, sedentary lifestyles, etc.

        Wouldn’t you agree that such comparisons have too many confounders and that it’s hard to determine whether Masai health is due to one particular factor? Especially since Dr Mann later did autopsies of Masai men and found evidence of extensive atherosclerosis.

      12. Dr. Malcolm Kendrick Post author

        There is a saying in the legal profession. If you are winning an argument, tighten it. If you are losing, widen it. This discussion started as an attempt to define what nutrients are essential for health, and whether or not carbohydrates contained any nutrients essential for health. Now we are talking about high levels of physical activity in the Masai. May we return to the original question? Do you have any evidence that carbohydrates contain nutrients essential for human health. As far as I am able to establish, the answer is no, and I do not think you have provided any evidence that would require me to change my mind. This does not, necessarily, mean that carbohydrates are unhealthy. However, that is an entirely different discussion. As is a review of calorific consumption of the Masai.

      13. Sasha

        Yes, I have evidence that dietary sources of carbohydrates (in the form of whole grains) contain nutrients essential for human health. Here is a link to Linus Pauling Institute discussion of whole grains:


        Whole grains contain: folate, Vitamin E, potassium, magnesium, selenium, vitamin B6, etc. They also contain dietary fiber and phytonutrients both of which have been shown to promote health according to the link.

        The reason I brought up calorie restriction and levels of physical activity in the Masai is because you yourself have said: “look up George Mann and the Masai. Super healthy, no CVD, skinny, win running competitions, etc”. (I am paraphrasing what you said but it’s pretty close).

        People then use Masai diet which is only one factor of their lifestyle and say: LCHF or paleo is the best. Look at the Masai! Or Inuit. I’m gonna eat mostly meat and fat and be skinny with no CVD and win running competitions.

        But maybe their lack of outward signs of CVD is due to them walking like crazy not because of their diet? Or calorie restriction. How do you know that it is not so? Maybe the fact that most autopsied Masai men showed atherosclerosis (provided it’s true) is due to the fact that their diet is nutrient deficient. Thus, they may not show clinical deficiencies (all the diseases you mentioned) but they may still show subclinical deficiencies. Which is not health by any measure.

      14. Dr. Malcolm Kendrick Post author

        Whole grains contain: folate, Vitamin E, potassium, magnesium, selenium, vitamin B6, etc. They also contain dietary fiber and phytonutrients both of which have been shown to promote health. Are you saying that these nutrients are only available from whole grains, and cannot be found in animals?

      15. Sasha

        Not B vitamins, potassium, etc but there are types of dietary fiber or phytonutrients that are unique to whole grains and some that are unique to vegetables (like carotenoids, for example).

      16. Sasha

        Yes, Dr Kendrick, unique and essential are not the same thing.

        I have a question then: do you believe that a ketogenic diet (like that of the Masai from what I understand) leads to better short and long term health outcomes?

      17. Dr. Malcolm Kendrick Post author

        There is not enough evidence, in my view, to answer that question. Let me change it round a bit. Do I believe you can achieve, or get close to, optimal health with a ketogenic diet (assuming all other things are equal). Yes, I cannot see that a ketogenic diet would be harmful to human health in any way. Do I think eating carbohydrates is damaging to human health. No, I do not. You need a perfect storm:

        1: You have excess calorie intake
        2: You do not take any exercise
        3: You are more prone to release excess insulin in response to carbohydrates (see under PIMA Indians)
        4: Your system struggles to convert fat to glucose in the liver

        At which point things start to go wrong, ending up with a very high blood sugar level, which is clearly unhealthy.

        You cannot, by definition, end up with a high blood sugar level on a ketogenic diet. Ergo, a high fat diet has clear metabolic advantages to a high carbohydrate diet. Having said this, it is clear that many people can live perfectly well, in good health, on a high carbohydrate diet.

      18. joanne mccormack

        As a GP I see 2/3 of us become overweight through our current way of eating and drinking and this is not a problem per se, but the refined carbohydrates do lead to more dental decay and an increasing incidence of fatty liver in adults and children- they harm. The ability to get fat is protective up to a point, and that may be why we cannot show increased mortality through increasing BMI, until people are morbidly obese. People who stay thin are not necessarily the lucky people they are made out to be. They may see no reason to reject a diet of junk food and drink, and may be harmed by nutritional deficiencies and by excess sugar leading to dental decay. They also be slim because of undiagnosed illness eg coeliac disease. They are assumed to eat just the right amount of food and get just enough exercise and not to be greedy, but I see them become diabetic and have heart attacks. I assume these people have abnormal insulin responses( as per the Kraft experiments), but it is not routine to check insulin in the UK or Ireland yet, so we cannot know.
        I see the harm refined carbohydrate does- dental decay, fatty liver, mental ill health, coeliac to name a few. The trouble is that foods consisting of refined carbohydrates lack essential nutrients and to have a diet of mostly refined carbohydrates is to become nutritionally deficient. Some patients I know only eat that stuff. The arguments about low fat vs low carb make me laugh. I do not think people who do research realise how appalling some diets are. I have had people go for days, weeks or months on just tea and sugar, or biscuits. As they are fat, they do not want to eat real food, in case it makes them fatter. Some of them can be persuaded to eat real food, and their health improves in weeks.

      19. Dr. Malcolm Kendrick Post author

        Absolutely Joanne. To an extent all the academic stuff is a distraction – but I am a science geek, so I love it. We know that many of those with obesity/metabolic-syndrome/diabetes are eating far too many carbs. Sweets, coke, cakes, cornflakes, bread, pasta etc. etc. We know that if you can persuade them to stop eating this stuff and eat ‘real food’, by which I mean food without an ingredients list stamped on the side (other descriptions are valid), then they will lose weight, feel better and most of the metabolic abnormalities will improve, even disappear. This is not rocket science, but the mainstream medical thinking has driven itself into a place of maximum stupidity and will not, dare not, engage reverse. Well, they can stay there, but hopefully people who read your stuff, and Tim Noakes’s stuff and Aseem and Zoe and David Unwin’s stuff… will be able to see how ridiculous it has all become. This revolution can only come from the public, for the ‘experts’ will never shift – until the last ice floe melts beneath them.

      20. Sasha

        I do think it would be interesting to have a study that compares ketogenic diet to a diet that includes fats, proteins, AND carbs ( in the form of whole grains, fresh fruit, lentils, and fresh vegetables). No processed foods in either group.

        I listened to a talk yesterday between Rhonda Patrick, Ph.D and Dominic D’Agoustino Ph.D. D’Agoustino has been on ketogenic diet since 1998. Reading the comments by people who adopted ketogenic diets it’s hard not to wonder (for me, at least) if those experiences can be studied both short and long term.

      21. Sasha

        Ok, thank you for answering all my questions. I will look into this more. Rhonda Paul, Ph.D. seems to have a lot of info on ketogenic diets in her interviews of people.

      22. Bill In Oz

        I’m a newcomer here. But in the past 2 weeks I read through almost all the posts. There has been hardly any mention, never mind advocacy of a paleo ultra low carb diet. This post on diabetes is the first time that Dr Kendrick has discussed it at any length.

        I am not on a paleo diet. Nor a particularly low carb one either. I am simply careful about what carbs I eat and especially how they are prepared.

        So I have followed your comments here with a bit of interest. And with some dismay. I think you are in the wrong forum. You are commenting as if this Blog and Dr Kendrick was advocating a Paleo/ultra low carb diet. In fact in my opinion your extended criticisms amounts to trolling.

        If you really want to have an extended conversation on this issue, surely you should take it one of the forums where it is relevant : Bill Davis’ Wheat Belly blog or Grundry’s Paradox Plants blog. There you could fight the good fight with all your heart and not be wasting anyone’s time.

      23. Sasha

        Well, if you feel like I am trolling or wasting people’s time, I will stop asking these questions as it wasn’t my intention. Also, I never said that Dr Kendrick advocates ultra low carb or paleo diet. My questions were in response to some LCHF comments questioning the value of whole grains and fruits. And they were by commenters on this blog.

      24. Bill In Oz

        There seems to be no moderating or censorship on this Blog. At least none I can detect.
        Comment are owned by each commentator. And commentators despite despite being able to express opinions or relate personal matters, may be uninformed or biased or simply have a different life story or genetic background..

        This is the nature of the human condition. Most of the time people express a view in the hope of being listened to. They do not require contradiction or criticism or even to be ‘set straight’

      25. Dr. Malcolm Kendrick Post author

        There is both moderating and censorship on the blog – by me. Very occasionally I stop a comment. I have only three rules. One, no personal insults – although a bit of tetchiness is OK. Two, no adverting – I get a few of these, that never see the light of day. Three, nothing incomprehensible (that can be subjective, but some comments are impenetrable, and very long, and they get blocked). Anyone is free to disagree with anything anyone else says – that is what debate is all about. But the disagreement should be about the comment, or the science, not the person. People can fight their corner, and should. I do not want an echo chamber, or for people to feel they are being hounded out. A few recent comments have got quite close to this. My judgement will never be perfect.

      26. Bill In Oz

        Dr Kendrick, I am happy to stand corrected. And your 3 ‘rules’ for moderating seem appropriate and useful to me. And i appreciate that you do not wish the comments to ‘echo’ your own thoughts.

      27. Sasha

        But I would think they’re essential for human health unless someone can prove that Maasai and Inuit are “healthier” than Kitavans, Okinawans, Pioppi who were mentioned here, etc.

      28. Sasha

        Dr. Kendrick, it seems that the paper you linked talks about high fructose corn syrup and packaged foods with fructose additives. That’s quite different from eating fresh fruit. That’s the nature of my disagreement with statements like “avoid fruits, it’s just sugar”.

        I agree that people should avoid HFCS but it doesn’t mean people should avoid fruits.

      29. Jan B

        Sasha – much as I agree with you regarding the nutritional goodness and desirability of fruits (and starchy vegetables) you should see what they do to my blood glucose levels, even the humble apple. I appreciate that I am a metabolic freak but for people like me most fruit is a definite no-no (apart from small servings of berries, that is – thank goodness)

      30. Sasha

        Jan B – have you always not been able to eat an apple without a large spike in BG or did it happen to you at some point in life?

      31. Jan B

        Hi Sasha – well, I was diagnosed back in 1958 when I was 15 with type 2, except that then it was called ‘mild diabetes’ and much later by an endocrinologist ‘Mody’ on account, I suppose of the low renal threshold that I had. At that time the regime was very strict with some foods allowed freely, e.g. Meats, fish, eggs, cheese, butter, lard, cream, salads, leafy greens, (how ironic is that?) others, e.g. fruits, starchy vegetables, bread, certain cereals limited and always weighed to be served in units of 10 grs carbohydrate. Others were NOT ALLOWED at all, e.g. Biscuits, cakes, sweets, pies, pastry, thickened soups, gravies, sauces, jams etc. etc. Of course, back then there was no pasta, no pizza, rice was served only as a pudding on a Sunday, if we were lucky. Naturally enough, I suppose, growing up I got cheesed off with the whole palaver and just wanted to be ‘normal.’ It wasn’t until decades later that I became the proud possessed of a blood glucose monitor and was shocked at what I’d been putting my poor body through. My highest reading ever was 26 mmols though that was after a steroid injection into my shoulder joint, so a bit out of whack. Anyway, to cut a long story short, about four years ago I decided to take proper care of myself, went low carb and ate to my meter having discovered that an awful lot of ordinary everyday foodstuffs, e.g. apples were not for me. I’ve never been overweight but now I am a rather stringy old bird (but I am rather proud of my 25″ waist.)
        P.s. I love apples. We have a rare Cornish apple tree in our garden, variety ‘Johnny Voun’ – a wonderful thing whose fruit has the keeping qualities of a snow flake so in September I have one every day picked from the tree and damn the consequences.

      32. Sasha

        Jan, I think you’re more of an exception than a rule, then. Most people get to be diabetic or pre-diabetic later in life and by then they have done a lot to their endocrine and digestive systems. One of my points was that sensible carb and fructose (from fruit) consumption rarely leads to diabetic state.

      33. Jan B

        “More of an exception than a rule” – that sounds like the story of my life. Actually, Sasha, diabetes runs like a river through my family – grandmother, mother, brother, niece, though NOT my children, so far; they are now in their 50s and seem to tolerate carbs very well. Thank goodness for sexual reproduction, eh.

      34. Bill In Oz

        Sasha you write “This belief is “paleo” dogma not supported by any scientific evidence and it leads to some trippy assumptions like: bread is of the devil and fruits are bad for you because they have fructose.”

        There are a couple of very well known examples putting out such stuff : Bill Davis the Wheat Belly man is one, and Gundry in his the Paradox Plants is another, even more extreme in his views. But both are writing for people who have such problems as Crohn’s disease or various auto-immune diseases. And maybe for such individuals grains and most carb sources are off limits.

        But I don’t think that this is true of even most of us. I have never had a problem eating good well made bread, But I prefer oats & rye bread.

        PS Dr Kendrick I have read that the Masai do trade for carbohydrate foods with other tribal groups nearby..But it’s not something I know from my own experience.

      35. Sasha

        Bill, rye bread is still bread and rye is a grain. I hear some LCHF people say – avoid all grains, you don’t need them. And vegans say – avoid all animal products, you don’t need them.

        And I think that as long as people eat a clean diet, they can eat all three food groups: proteins, fats, and carbohydrates.

      36. AH Notepad

        A component of gluten causes damage to the villi of the small intestine. For some people this is more pronounced than for others, but as far as I understand it has the effect to some degree on everyone. That is the reason for avouding wheat, barley and rye. If you are happy with what was once the norm for lifespan, you could eat almost anything you choose. Living longer requires some selectivity in what is consumed. Animal protein is useful in smallish quantities, but it is the fats which have much of the nutrition, yet people equate meating eating with always having great lumps of muscle, that is not a reasonable approach, either from the eater or the commentator.

      37. Sasha

        I have no problem with animal fat, I eat it myself. But is there evidence that people who derive most of their nutrients from fat have longer life spans than other populations?

      38. AH Notepad

        Is longer lifespan the most important parameter? I don’t believe it is, so I don’t care if various substances increase the length of life. What I am interested in is to have maximum function of all parts of the system.

      39. Sasha

        Is there evidence that people who derive most of their nutrients from fat have all parts of their systems function at higher level than people who derive a large part of their nutrients from: protein or fructose or carbs in the form of whole grains?

        If there is, can you send a link that shows what functions were measured and what types of diets were compared?

      40. Dr. Malcolm Kendrick Post author

        ‘All parts of all systems operating at a higher level?’ Sorry, that is a question that has no meaning. There are seventy five thousand enzymes in the human body, just for starters. Do you honestly think anyone has ever studied all parts of all systems, in relation to all possible diets?

        In short, the answer is, no.

      41. AH Notepad

        Thank you Dr. K, I was about to answer that discussion widening point when I noticed you have already answered it far more succinctly that I would have been able to do. I note the same with many of your answers, accurate, to the point and knowledgable.

        I once contributed to a forum where many points were argued by apparently one poster, with side tracking and a somewhat strange train of thought. This turned out to be from a university group who were doing it as a psychological exercise, by posting points designed to elicit an aggravated response. I wonder if I am seeing something similar here. I could well be wrong.

      42. Sasha

        AH Notepad, that question applies to you!

        You first said “That is the reason for avouding wheat, barley and rye. If you are happy with what was once the norm for lifespan, you could eat almost anything you choose. Living longer requires some selectivity in what is consumed.”
        And talked about deriving most of the nutrients form fat.

        I then asked you if there is evidence that people deriving most of their nutrients from fat live longer.

        To that you said: “Is longer lifespan the most important parameter? I don’t believe it is, so I don’t care if various substances increase the length of life. What I am interested in is to have maximum function of all parts of the system.”

        So, my question to you was: is there evidence that people who derive most of their nutrition from fat have all parts of their system function at a higher level than those who don’t?

        And my other question to you – Are you part of a university group conducting psychological exercise?

      43. Sasha

        This question was in response to what AH Notepad said is important to them in deriving most of their nutrition from fat – “to have all parts of the system operate at a higher level”.

      44. Sasha

        Also, the reason I asked for evidence about longer life spans is because you earlier said: “If you are happy with what was once the norm for lifespan, you could eat almost anything you choose. Living longer requires some selectivity in what is consumed.”

        So, which one is it: living longer or having all parts of your system function at a maximum level?

      45. David Bailey

        “Sasha, carbohydrates are all sugar(s). Simple sugars bound together in various different ways.”

        I don’t think anyone here denies here denies that, but you yourself singled out “highly processed carbs” for criticism in a previous post – so somehow some carbohydrates are more equal than others! Doesn’t that mean there is something going on here. I don’t know, but is it possible that less processed carbs make it into the intestine and get metabolised into different molecules?

      46. Martin Back

        Countries with a life expectancy over 80
        Japan, Singapore, Australia, Italy, Canada, France, Spain, Sweden, Switzerland, Israel, Iceland, Netherlands, New Zealand, Norway, Ireland, Germany, United Kingdom, Jordan, Greece, Austria, South Korea, Belgium, Finland

        Countries with a life expectancy under 60
        Cote d’Ivoire, Sierra Leone, Zimbabwe, Ethiopia, Democratic Republic of the Congo, Republic of Congo, Angola, Cameroon, Burkina Faso, Niger, Mali, Botswana, Uganda, Malawi, Tanzania, Nigeria, Mozambique, Zambia, Lesotho, Central African Republic, Somalia, Gabon, Swaziland, Afghanistan, Namibia, Guinea-Bissau, Chad, South Africa

        Draw your own conclusions as to whether carb-eaters live longer.

        Data from http://www.geoba.se/population.php?pc=world&type=015&year=2017&st=rank&asde=&page=1

      47. Sasha

        A person defending LCHF (or paleo) will tell you that there are a lot of factors determining life expectancy…

      48. David Bailey


        Is it really logical to claim that while all carbohydrates are broken into glucose, a few are not harmful because they are contained in foods with some extra trace nutrients?

        I mean unless these trace nutrients happened to be hugely beneficial to glucose metabolism, sure people consuming such a diet would get whatever benefits the trace chemicals conferred, plus T2D?

        Is there any data that might relevant to this. Surely many British Asians must eat a traditional diet, but eat well above subsistence levels?

      49. Sasha


        To me it’s very logical to claim it. If you look at that link from Linus Pauling Institute that I posted earlier, they cite studies of whole grains. The manner in which glucose is absorbed from them is different from refined carbs.

        However, it seems that both paleo and LCHF think that all foods rich in carbs and fructose (grains, fruit, starchy vegetables) are ultimately harmful.

        So, to that I have a question: is there evidence that paleo/LCHF/ketogenic diets provide long term health benefits exceeding those of other diets?

      50. Gaetan

        M. Black,

        You can do better than that!

        I am sure the diet overall has nothing to do with life expectancy between the 2 lists. In the top 20 countries, citizens of those probably eat whatever, carbs and fat and meat without emphasizing on one or the other.

        Clean water is probably a huge factor here, as well as social peace. Much less stress overall and much higher income from the first list. Probably many other factors i am not thinking of right now.

      51. Martin Back

        In order to extend our lives we are encouraged to:
        – get plenty of moderate exercise
        – avoid processed foods
        – avoid pollutants from car exhausts, fabric conditioners, plastic bottles, etc etc
        – not eat to excess

        …which is what people in poorer countries do by virtue of being poor. This must counteract to some extent the bad housing and public health and stressful environment they live in.

        From a dietary point of view, those who live on a starchy staple diet who become wealthier and can afford more than the basics, generally choose to add fat and protein to their diets rather than more starch and vegetables. It seems to be instinctive, not the result of being persuaded by advertising.

        For me, the ideal diet is whatever the mix of macronutrients is that provides the essentials that Dr Kendrick listed, while at the same time being mostly natural, easy to prepare, and enjoyable to eat. The percentage carbs could be anywhere from 20% to 80% (thumbsuck) and meet these requirements.

      52. Martin Back

        Another one for the meat-eaters…

        “The inhabitants of Iceland offer a similar and even more interesting picture of carcase diet. McCollum and Simmonds, in The Newer Knowledge of Nutrition (1929), summarize the chief facts. “This island was settled in the ninth century by colonists from Ireland and Scandinavia, who took with them cattle, sheep, and horses. Their diet was practically carnivorous in nature for several hundred years. Martin Behaim (quoted by Burton), writing of Iceland about A.D. 1500, stated: ‘In Iceland are found men of eighty years who have never tasted bread. In this country no corn is grown, and in lieu fish is eaten.’ Burton, quoting Pierce, states that rickets and caries of the teeth were almost unknown in Iceland in earlier times … The health conditions were good and dental caries was unknown until after 1850.” — http://journeytoforever.org/farm_library/Wrench_WoH/WoH4.html

      53. David Bailey

        I came here originally because I had a very unpleasant reaction to Simvastatin. Fortunately I don’t have a stake in the T2D debate because the only time i was diagnosed with raised blood sugar was while I was taking statins. This went away because I reduced my sugar intake, and I keep this up now, even though I don’t take statins!

        However, with my science background, I’d really like to get a firm grip on the actual science – which I find amazingly elusive!

        1) Everyone condemns ‘junk food’, but isn’t the problem that its definition has changed over time. For example I have seen it defined as food laden with salt and saturated fat! Does it make sense to use this term?

        2) Most seem to think processed food is bad, but again doesn’t that need some sort of a definition – I mean, is cooked food bad? Should we eliminate all preservatives from food (which might expose us to some really nasty fungal diseases). Does grinding grain into flour constitute processing?

        3) If some chemical additives are bad – surely it would be nice to know which (even sodium chloride has an E-number). Is there any convincing evidence against these chemicals?

        4) Assuming all carbohydrates get digested at some point, does it really matter much if this happens sooner or later? If it doesn’t, why is there so much discussion about refined carbohydrates (or indeed sugar)? Is it possible that that assumption is somehow wrong – e.g. (perhaps) that carbohydrates that reach the intestines, can be digested into something other than glucose by the gut flora – or maybe the glucose feeds the gut flora?

        5) Is fructose worse than glucose (despite its attractive association with fruits), as that might explain why sucrose is more damaging than the equivalent amount of starch, or is there really no difference in the harm they do (I know they are metabolised differently)?.

        6) Is the discussion of micro-nutrients really relevant to those eating a normal British diet? I ask that because Sasha seems to think that we suffer from a shortage of some, if we eat a LCHF diet.

      54. Andy S

        Hi David Bailey, suggest adding item #7 PLANT ANTI-NUTRIENTS. I am beginning to suspect that plants do not want to be eaten and can fight back. A quick google turned up the following:

        PHYTIC ACID (Also Called Phytate) This is probably the most well-known antinutrient that’s found in grains and legumes and interferes with the absorption of minerals. …
        GLUTEN. can contribute to leaky gut syndrome or autoimmune disease
        TANNINS. type of enzyme inhibitor that prevent adequate digestion and can cause protein deficiency and gastrointestinal problems
        OXALATES. Oxalate sensitivity should be suspected if you have any of the following symptoms (in addition to a thyroid condition like Hashimoto’s or Graves’): joint pain, pain in the body, burning with urination (interstitial cystitis). burning with bowel movements, leaky gut, depression, kidney stones
        LECTINS. Lectins can cause GI upset similar to classical food poisoning and immune responses like joint pain and rashes. Improperly prepared raw grains, dairy and legumes like peanuts, and soybeans have especially high lectin levels.
        SAPONINS. Similar to lectins, saponins affect the gastrointestinal lining, contributing to leaky gut syndrome and autoimmune disorders. They’re particularly resistant to digestion by humans and have the ability to enter the bloodstream and trigger immune responses.
        TRYPSIN INHIBITORS. Similar to lectins, saponins affect the gastrointestinal lining, contributing to leaky gut syndrome and autoimmune disorders. They’re particularly resistant to digestion by humans and have the ability to enter the bloodstream and trigger immune responses.
        ISOFLAVAONES, These are a type of polyphenolic antinutrient found in highest levels in soybeans that might cause hormonal changes and contribute to digestive issues.
        INSECT RESISTANT BT GMO CROPS. in government-sponsored research in Italy, mice fed Monsanto’s Bt corn showed a wide range of immune responses, such as:Elevated IgE and IgG antibodies, which are typically associated with allergies and infections. An increase in cytokines, which are associated with allergic and inflammatory responses. The specific cytokines (interleukins) that were found to be elevated are also higher in humans who suffer from a wide range of disorders, from arthritis and inflammatory bowel disease, to MS and cancer. Elevated T cells (gamma delta), which are increased in people with asthma, and in children with food allergies, juvenile arthritis, and connective tissue diseases.
        SOLANINE. FOUND in nightshade vegetables like eggplant, peppers and tomatoes, this is actually a beneficial antinutrient in most cases. But in high levels and in those sensitive to eating nightshades, it can cause “poisoning” and symptoms like nausea, diarrhea, vomiting, stomach cramps, burning of the throat, headaches and dizziness.
        CHACONINE. Found in corn and plants of the Solanaceae family, including potatoes, this compound is beneficial when eaten in small doses because it has antifungal properties, but in some people it’s capable of causing digestive issues, especially when uncooked and eaten in high amounts.

      55. Sasha

        Andy, regarding plants (not grains) I remember seeing somewhere that some of the things in them that could be considered mildly poisonous stimulate our immune system and are good for us.

      56. Sasha

        It doesn’t look like that there’s long term data comparing LCHF/paleo with diet that includes whole grains and/or abundance of fresh fruit. There is a talk on YouTube with Rhonda Patrick, PhD and Dominic D’Agoustino, PhD. He’s been on some variation of ketogenic/Atkins diet since 1998. And since he’s a scientist he’s measuring his markers. Maybe he’d have some data on himself, at the very least.

      57. chris c

        Great list, Andy S!

        Someone put it quite succinctly – animals defend themselves with teeth and claws, or by running away. Plants defend themselves with toxins. Over time we have evolved to detoxify many of them, and even use them as drugs and dietary supplements.

        IMO a big problem is that we have concentrated on breeding not just increased yield but “pest resistance” into our modern crops – true of classic breeding techniques, not just GMO – but we haven’t worked out how to tell them that we are not pests and would they please not poison us as well?

        A corollary is that increased yields, especially in more and more nutrient-deficient soils,also makes them less nutritious so there’s a double whammy. To a degree the same is true of animals, modern fast-growing breeds are less nutritious than the older ones, and also far less flavoursome. They are also less able to look after themselves without more antibiotics etc. much like us. Feed them nutrient-depleted crops as food and there’s a triple whammy.

        One good thing though, I woke up this morning and thought “My God, I stink!” but then I went outside and the smell was much worse – pig manure/slurry being spread liberally on some of the stubbles. Phew!

      58. Craig E

        On reading the linked study “Fructose, insulin resistance and metabolic dyslipidaemia”, I can see many correlations that seem to be largely derived from animal (rat) models. I can’t see much that “proves” fructose causes anything in humans. Most of ingested fructose (at normal levels of consumption) is converted to glucose or lactate in the liver….de novo lipogenesis is a minor pathway. I am happy to see something definitive that shows for example how fructose leads to fatty liver, insulin resistance (ie what’s the mechanism?) but I think we’re in danger of doing to fructose what we’ve done to saturated fat and cholesterol. All non-glucose simple sugars are largely metabolised by the liver (eg galactose, mannose, fructose). There are enzymatic pathways that reliably achieve this. I personally don’t believe that our obesity/diabetes epidemic is caused by any one (or group) of nutrients. Rather, it’s the excess that’s the problem. This would apply equally to fats as it does to carbs. The argument that fat doesn’t make you fat seems to be mounted on the assertion that it’s hard to over-consume fat. This may be true but if fat IS over-consumed, unless it’s substantially ramping up metabolism it surely would have to be stored in the adipose tissue. Where else would it go?

      59. Martin Back

        It’s not only depleted soils that cause food to be less nutritious. Plants are bred to increase the yield — bigger peaches and tomatoes, fatter wheat berries and corncobs, etc — which effectively means the breeder looks for more carbohydrate but not more vitamins and minerals. As a result we are getting something like 20% fewer nutrients per gram of carbohydrate compared to early last century. See e.g. Declining Fruit and Vegetable Nutrient Composition: What Is the Evidence?

        Which implies we have to eat 20% more carbs to get the same nutrition as our forefathers did.

        Another factor seldom mentioned is food variety. Before the development of agriculture, our ancestors used to eat something like 150 different varieties of plants. Now we’re down to 50 varieties. You have to wonder if we aren’t missing out on some nutrients which are important for good health.

    4. A Man

      It seems likely to me that it is excess carbs that are the problem. Most of the Asians have historically been thin. They are eating no excess carbs. I suspect carbs become a problem only when one begins eating too many of them. If you eat only 1200 calories per day, you could probably eat nearly 100% carbs and not get diabetes.

      1. Sylvia

        When I was a girl, I am 76 , there were very few obese people. We ate all the food groups. No GM, mostly locally grown, I assume the soil was not impoverished and fewer chemicals. The fast food was beans on toast, bread was tasty, especially if home made. Not suggesting can all spend time harvesting and baking, but as a busy district nurse, not a domestic goddess, always made real food, husband did also. Now, I eat LCHF because after health scare, all markers up, I am healthier and slimmer. so many young families buy factory made stuff, it is heartbreaking. Good nutrition is more expensive and families have a hard time making ends meet. All anecdotal, I confess but I agree, excess rubbish carbs equals poorer health.

      2. Jan B

        I totally agree with you, Sylvia- I’m about the same age as you and when I was a child food was prepared in the kitchen not a factory. For example, we had mashed potatoes not ‘potato products.’ The main problem with carb foods now is that they’re all RUBBISH and too many of them are eaten. Have people forgotten how to cook? It would seem so, especially among the younger generation. All these cookery programmes, all these cook books and yet people buy and eat manufactured ‘food.’
        To quote Zoe Harcombe “EAT REAL FOOD.” and eat it in moderation.
        Oh dear, I’m turning into a grumpy old woman.
        Oh, and make sweets into a proper once a week treat, while we’re about it.

  18. Martin Back

    Tim Noakes says his Banting (i.e. LCHF) diet is for “carb-intolerant” people such as himself. Is carb-intolerance the same thing as insulin resistance? How are either measured?

    1. Dr. Malcolm Kendrick Post author

      I am not sure carb-intolerance is the correct expression – at least I do not think so. Some people, not sure how many, seem capable of remaining fully healthy on a very high carb diet, other struggle to metabolise carbs – for whatever reason. I think it depends mainly on how efficiently the liver can convert sugar to fat (lipogenesis) and then transport the fat out of the liver within VLDL. Fatty liver is a good sign of people who are having difficulty, such people often have high insulin levels and ‘pre-diabetes’. Does this mean they are carb-intolerant? I think I would be better to say that they should not eat more than x calories as carbohydrate unless they exercise like made to burn them up.

      1. Craig E

        Dr Kendrick this got me thinking…in terms of one’s ability to metabolise carbs. Ingested carbs are used for immediate energy needs, converted to glucose or glycolytic intermediates (in the case of fructose, galactose, maltose etc) or stored as glycogen…once glycogen stores are full the excess carbs are converted to fatty acids in the liver which are exported as vldl. Presumably those with lower metabolisms and more sendentary lifestyles would fill up glycogen quicker and therefore fatty acids would be produced more often. A few years back you wrote about the only source of ldl being vldl. Ldl is formed via idl once vldl delivers its payload of lipids to cells (. So once glycogen stores are full, vldl (also called triglycerides) should rise and therefore so should ldl. So all your posts seem to tie in. For me, problems with carbs seem likely to be influenced by sedentary lifestyle or inability to store much glycogen – or both

  19. Bill Miller

    > In studying the history of the human mind one is impressed again and again by the fact that the growth of the mind is the widening of the range of consciousness, and that each step forward has been a most painful and laborious achievement. One could almost say that nothing is more hateful to man than to give up even a particle of his unconsciousness. Ask those who have tried to introduce a new idea! > ~ Carl Jung


  20. Hugh Mannity

    I preordered the book, when Zoe Harcombe mentioned it a couple of months ago. I’m really looking forward to reading it and am delighted that you’re a contributor.

    I’m T2 — have been for 10 years. After a couple of years on Metformin and the “standard” American diabetic diet (45 – 60g carb x3 meals daily, +3 15g carb snacks), I decided to try cutting carbs dramatically. I’d worked for a GP in London in the late ’70s and he had a couple of diabetic patients who had been doing well on 50g carb/day, and he’d given me Banting’s “Letter on Corpulence” to read at one point. Over the past 7 years or so, I’ve achieved a net weight loss of about 40lb. (Every so often I fall off the LCHF wagon and put a few pounds back on again. You’d think I’d have learned by now.)

    My A1c has hovered between 5..6 and 6.3. My main goal at the moment is to lose another 16 pounds by June 2018. This will mean I’ll have lost all the weight I put on when I moved to the land of sugar and refined carbs (AKA the USA!) in June 1988. My highest weight was around 270lb — way too much for someone a mere 5’7″…

  21. Dr. Göran Sjöberg

    Thank you for joining in on this book project – I have just ordered my copy!

    Am I right in thinking that you, Malcolm, have slowly turned into a LCH-adherent which I for sure would be the first to appreciate?

    As always I find the price lecture by Prof. Roger Unger very revealing and “revolutionary” in its dissection of the physiology of the insulin/glucagon.

    1. Dr. Malcolm Kendrick Post author

      Goran. For many years I have been looking for the cause(s) of cardiovascular disease. Thus, inevitably, I became caught up in the diet-heart hypothesis (saturated fat causes CVD). It was clear pretty early on that this was bunk, based on nothing at all, and it also made no sense from a detailed examination of fat metabolism/biochemistry/physiology. I was reluctant, and still am, to jump from one dietary hypotheses as to the causes of CVD, to another one. This seemed highly restrictive to thinking more broadly about the issues.

      I am however, broadly convinced of the hypothesis that (for many people) excess carbohydrate intake is a certain route to type II diabetes. I am also convinced of a causal role of type II diabetes (or to be more accurate the physiological and biochemical abnormalities that we, horribly inaccurately, call type II diabetes) as playing an important causal role in CVD (in a large number of people). HCLF starts one of the important pathways that leads to CVD, along with ‘stress’ and ‘smoking’ and ‘SLE’ and ‘air pollution’ and ‘heavy metal toxicity’ and many other things. It is not THE cause. It is, however, A cause. That seems inarguable to me.

      1. Dr. Göran Sjöberg

        Malcolm, thank you for elaborating on this – it is all along my line of thinking.

        As you, I have been struck by the physiological complexity of this issue, although getting into this field from “the outside” I sometimes think that I have an advantage to “clearly understand” (if this is at all possible in physiology) since I have not been trapped trapped by my eduction. It must be extremely difficult to see “the light” when you have been educated to “stay in the dark” if you didn’t have a good (?) midwife as yours to start with.

        And more it strikes me that we all tend to get caught in the simplistic, one cause explanations, i.e. turn dogmatically religious. I.e., myself, when asked about “what to do” to restore health I often blurt “Don’t eat carbs!” or “Don’t eat vegetable oils!”.

        But as always, finding the “truth” is an everlasting philosophical question and a challenging task when you care and have made up your mind to find it. With my own favorite greek philosopher, Xenophanes (not very popular among the authorities, like Platon, at his time) I agree that “We will never find the truth and if we inadvertently will do that we will never not know about it!”.

      2. Martin Back

        – excess carbohydrate intake
        – stress (excess cortisol)
        – smoking (excess nasty chemicals)
        – SLE (Systemic lupus erythematosus) (excess inflammation)
        – air pollution (excess nasty chemicals)
        – heavy metal toxicity (excess nasty chemicals)

        Hmmmm… I’m seeing a pattern here. Chronic overloading of the body’s disposal mechanisms.

  22. xtronics

    Sometimes if I can’t sleep, I will go to Wallmart and walk a few laps. I see so many people carrying huge amounts of weight. My heart really goes out to them. If I look in their carts and see the food they buy – lots of chips, processed foods, even diet-foods all full of PUFA’s. I don’t think any of them want to be so heavy. But it is more than that – even the younger one’s skin looks off to me.

    We have focused a lot on carbs here – but what if the carb consumption is driven by the over storage of lipids? Not that people get fat because they eat too much – but they are hungry because they store too much? If the energy from fat is locked up on adipocytes it isn’t available for respiration in mitochondria.

    How can we explain why someone 100LB overweight feels hungry? So hungry they can’t stick to their diet – they have given up – ride around in electric carts because their knees hurt from being overloaded?

    I’m old enough to remember the early 1960’s – there were few people overweight – and don’t remember ever seeing anyone carrying an extra 100+Lbs – but in a single trip to Walmart today I might see several at once. There were people in the early 1960’s with a taste for donuts – they might have gained a few pounds, but not like this. (donuts cooked in lard).

    What if a low-carb diet is mostly covering up the problems caused by PUFA’s?

    The understanding of how PUFA’s modulate insulin sensitivity in adipose tissue explains all this.The shift that happens in ion levels when the mitochondria burns PUFA is hard science. That this shift changes insulin sensitivity is known. Yet somehow, someway, the world can’t see it.
    In the end – adipocytes start leaking FFA – causing insulin resistance in other tissues.

    I suppose it is the long half life that is the problem – most people won’t stick to any diet more than a few weeks, and to get a change of weight by restricting PUFA could take a couple of years(PUFAs have a 600day half life in adipose tissue).. The long time lag means people don’t connect the dots.

    It upsets me to see those suffering – at the hand of the PUFA=healthy narrative.

    Increase in adipose tissue linoleic acid of US adults in the last half century.

    Concentrated seed oils have only been on the market from the early 1960’s and their adoption in other countries appears to be followed by an increase in type II.

    There is research that suggests via a different mechanism, that LA(Linoleic Acid) is converted to 4-HNE which plays a role in Type-II.
    Carbonylation of Adipose Proteins in Obesity and Insulin Resistance Identification of Adipocyte Fatty Acid-binding Protein as a Cellular Target of 4-Hydroxynonenal
    Seed oil effects over time

    1. Gaetan


      So you are saying Polyunsaturated fats are dangerous and could cause diabetes, especially when they replace saturated fats? I have heard of the theory where PUFA vs SFA ratio (omega-6 and omega-3) is completely off today, a ratio like 10+ to 1, where it used to be 1-3 to 1.

      Omega-6s are inflammatory (those coming from vegetable oil) and omega-3 are not…


      1. xtronics

        The narrative that O-3 block the bad effects of O-6 is not about the effect of PUFAs on insulin sensitivity of adipose tissue and there are papers that put the narrative into serious question for other reasons. ( Even if long chain O-3s block the production of prostaglandins – they don’t effect the production of 4-HNE nor the change in FADH2:NADH ratios that effects insulin sensitivity )
        We know that the effect of insulin is modulated by these ratios.
        But we also know that
        LPL moves fat in to fat cells.
        HSL moves fat out of fat cells.
        Insulin is known to activate LPL in adipocytes
        HSL is inhibited by insulin.

        That is the definition of weight gain.

        The insulinotropic potency of fatty acids is influenced profoundly by their chain length and degree of saturation.

        A very good explanation of the effect of FADH2:NADH ratios has been explored by Petro Dobromylskj’s under his 46 proton blogs postings. I recommend reading the whole series – but this one is perhaps an overview:
        Protons: Obesity and diabetes

        He covers papers from Speijer, Schönfeld, – many more – read the proton thread .

        What is important to realize is there is a lot of newer work on mitochondria – the electron-transport chain – kerbs cycle that have not made it into med-schools yet.

      2. gollum

        Peter D@hyperlipid had a nice plot on the effects of O3 vs. O6.

        O3 is even a bit more fattening (when combined with sucrose).

        O3 does somewhat against O6 pro-inflammatory properties, but it is not practically possible to “detox” O6, because seeds and oils contain O6, you will just dump more O6 and PUFA into your body. Exceptions are linseed oil (comes with lignan phytoestrogens and many people cannot convert ALA well to DHA/EPA) and, well, animal sources.

        For a perspective on the carb being blamed for everything issue, you may want to read Ray Peat. He is the mirror image of all Low Carbers, he thinks you should burn carbs not fat. While I maintain that is not a terribly bright idea with a preexisting fatty liver and glucose intolerance, his arguments do have a logic of its own. Perhaps we should cycle and eat only (a few) fruits and moderate rice in summer.

      3. AhNotepad

        This seems as good a place as any to post a link outlining the history of the diet religion. Found while looking up Gary Fettke.


        Looks to be caused by Ellen White in the late 1800s who had visions. Later a research organisation took up the banner to support the truth of her visions, not to contradict.

        This seems to be the basis for the scientific claims regarding the vegan diet, it may include vegetarianism, but regardless it is plainly nothing to do with science but everything to do with business and profits.

      4. Robert Dyson

        A problem is that though we now know an astonishing amount of biochemistry (physiology and nutrition), that very quantity makes it difficult to see the big picture. Simple, easy to understand, misinformation from vested interests is well publicised. The reason that I am a fan of Malcolm Kendrick is that he has clinical expertise that he then attaches to relevant science, which for practical purposes must be the best way to go. [I hope this bit of praise of the moderator is allowed!] I think it must be very difficult for a GP to go against the consensus. I still remember how John Yudkin, not a front line clinician, who was right on sugar, was trashed in the 1970s – not criticized, trashed.

      5. Andy S

        The danger of groupthink in religion, politics, and medicine, from Wikipedia:

        Groupthink is a psychological phenomenon that occurs within a group of people in which the desire for harmony or conformity in the group results in an irrational or dysfunctional decision-making outcome. Group members try to minimize conflict and reach a consensus decision without critical evaluation of alternative viewpoints by actively suppressing dissenting viewpoints, and by isolating themselves from outside influences.

        Groupthink requires individuals to avoid raising controversial issues or alternative solutions, and there is loss of individual creativity, uniqueness and independent thinking. The dysfunctional group dynamics of the “ingroup” produces an “illusion of invulnerability” (an inflated certainty that the right decision has been made). Thus the “ingroup” significantly overrates its own abilities in decision-making and significantly underrates the abilities of its opponents (the “outgroup”). Furthermore, groupthink can produce dehumanizing actions against the “outgroup”.

    2. Andy S

      Xtronics, in the abstract “High carbohydrate, high fat feeding of mice resulted in a ∼2–3-fold increase in total adipose protein carbonylation.” Proof that eating processed high carb foods made from corn, soybeans, rice, wheat, with addition of vegetable oil can be harmful.
      Briefly, linoleic acid in mitochondria also generate more ROS (inflammation), hence every cell with mitochondria is affected and every tissue and organ can be damaged. Another piece of the puzzle.
      Substituting PUFA for saturated fat reduces LDL-C and makes people sick. Time to update dietary guidelines.

    3. Anna

      What an excellent post! These are the kinds of questions I want to ask. Because the simple LCHF paradigm isn’t quite convincing to me, even though I try to adopt it and it does me good. Something just isn’t right and I side somewhat with Sasha on this.

      Are we not omnivores? Are we not opportunists? And let’s not have the Euro bias about only tart fruit and berries! Much of the human race (India) lives in areas where very sweet fruit grows freely available.

      To be sure, all carbohydrates break down into simple sugars, but that is not ALL they contain. It must be very different to present to the body straight, stripped white sugar, perhaps in the form of a doughnut with white GMO flour deep fried at high temps in rancid PUFA oil versus, say, hearty lentil soup with carrots, onions and celery.

      I can tell you one thing – you can store that white flour and sugar for years on end and there is NO deterioration because everything from fungus to bacteria to bugs have zero interest in it.

      The context of those sugars must make a difference. I hear that certain nutrients help the body cope with insulin and sugar, such as chromium. What if the depleted diets of modern junk don’t have enough chromium, for just one example? Yes, all carbs break down into sugar – and yes, perhaps we humans do better in fat burning mode than carb burning mode, but does that mean we cannot handle any sugar? Sugar is a food source throughout nature and various animals eat more or less of it depending on species.

      So I also agree with Dr. K here that what’s tipping the balance for people is the perfect storm of excess calories, way too many of them junk, wrong oils and fats, stress, pollution, (antibiotics? vaccines?) lack of exercise, pesticides, GMO, etc. I understand glyphosate may damage digestion.

    4. chris c

      Wow! Colour me amazed!

      Back when his blog was worth reading, before he had his brain removed in order to work for Michael Schwartz and started arguing with Gary Taubes that insulin made you thin, Stephan Guyenet had an excellent post suggesting that below a certain level Omega 6s were toxic (see Rose Corn Oil Trial) but once they reached above a certain percentage adding more became less bad than adding other fats to the mix, and that threshold was crossed long ago – or so I seem to recall. I’ll read this paper with great interest, tomorrow.

  23. chris c

    “my brain was turned inside-out at birth by a careless midwife, and I can never see things the same way as everyone else.”

    I had her too!

    Could have been worse, I was such an ugly baby that half the time they put the dummy in the wrong end (Les Dawson I think)

    “They tell us we must eat a high carb low fat diet. This is completely bonkers. It makes no sense from any aspect of human physiology, or science, or logic.”

    Didn’t you know??? Diabetes is caused by eating meat. The Vegan Attack Hordes say so.

    More seriously I’ve seen the logic explained: most diabetics are fat, and die from CVD. Therefore it is crucial to avoid fat. Many diabetics get kidney disease which is caused by too much protein, so it is crucial to avoid that too. That only leaves carbs.

    Total and utter nutribollocks of course, to steal a phrase. Of course another factor is profit. The ADA used to have a page called “Eat More Starch!” where they helpfully explained that this was important but might require an adjustment (read increase) in meds. Look at their list of sponsors for a more realistic reason as to why they came to this conclusion. DUK and all other worldwide diabetes “charities” and for that matter most other “health charities” are sponsored by the same cartel of drug companies, carbohydrate processors and margarine manufacturers, strange that.

    You’re on a roll recently (not a bread one), will take a while to catch up.

  24. foodnstuff

    Will buy the book if only just to support Noakes and his ideas. I already have books by Jason Fung and Nina Teicholz and follow all the well-known LCHF blogs. Not diabetic or insulin resistant (to my knowledge), but don’t want to go anywhere down that road. Grow 50% of my own fruit and vegetables and have cut out most carbs. Eating more fat AND losing weight. Thanks for the heads up about the book Dr K.

    1. Goutboy

      Good one. Maybe it answers MK’s question – see above on what nutrients we get from carbs we can’t get from meat. I was going to suggest resistant starch and fibre to feed the
      Microbiome. Interestingly I think Z Harcombe doesn’t think much about fibre. Maybe the recent interest in the gut and bacteria will produce some enlightenment.

      1. Anne

        I eat low carb/high fat/paleo. Have eaten that way for ten years. My diet is VERY high fibre – the high fibre has been commented on by a gastroenterologist – but not one grain/piece of wheat or rye or oats or rice or starchy carbs etc have passed through my colon in all these past ten years. My high fibre comes from leafy green veggies which I eat three times a day as an accompaniment to the meat/fish/eggs/nuts I eat – oh nuts are high in fibre too.

        I remember a programme on telly many years ago where an experiment was done on what ‘fed’ the bacteria, the microbiome, best in our colon. The long and short of it was green veggies, particularly leeks and dandelion leaves if my memory serves me right. The experimenters fed groups of people diets with those foods and another group got given probiotic drinks – the gut bacteria preferred the veggies – their poo was tested at the start of the experiment and again after a couple of weeks !

      2. Martin Back

        I think we forget our gut is a farm, not a landfill. We can’t just dump any old rubbish into it, we have to consider the nutritional needs of our 100 trillion bacteria that work in crappy conditions to keep us healthy.

      3. Anne

        PS the green veggies I eat everyday with meat, fish, etc which give me my “high fibre” are broccoli, kale, cabbage, spring greens, cauliflower, asparagus and any others that happen to be available. I always sauté the veggies in fat (coconut oil).

      4. BobM

        There are no nutrients we need to survive you can’t get from meat. None. Seven years, all meat diet:


        There are many other “zero carb” (also called “carnivory”) people who have not eaten plant matter for years.

        See also:


        Also, saw a study saying 99.99% of pesticides are natural, from plants themselves.

        While I still eat plants, I don’t feel there is a need to eat plants. As for the “microbiome”, we know so little about that, that it’s useless. Until there’s an RCT comparing people who don’t eat plants to people who do, we’ll never know.

      5. Craig E

        @BobM can we get Vit C from meat? I agree meat is the king of nutrients but didn’t know that Vit C was among them

      6. chris c

        Naiman’s Law

        Personally I’m not fond of eggs, my version is meat and greens (including fish, poultry and especially game) to which I add other coloured veggies, herbs, spices and berries along with non-Omega 6 fats. Oh yes, nuts and a few other things too.

        ps/ don’t forget RUNNER BEANS! I eat a lot of seasonal things – and marrows are on my coming shortly list

        oh and frozen spinach, that’s not very processed, and sometimes frozen peas, ditto.

  25. Bill In Oz

    Dr Kendrick, something off topic which may interest you. It concerns a fellow Scottish Doctor, Dr. Normal Swann who hosts the Health Report on the ABCs Radio National, here in Oz.
    Last night he did a 15 minute interview with one of our local academics about obesity in children & teenagers..And no mention of high carbs of processed foods as a cause… No mention either that a low carb diet can solve the problem..

    I once listened in awe, religiously every week to the wonderful Dr Norman Swan. Now hardly ever. ..Oh that we had a different Scottish doctor here – such as yourself :-).

  26. Jan B

    Hurrah! My lovely new book arrived – ALREADY. Happy me. I shall look forward to a good long immersion in it; and all the comments on the blog. Such a treat.

  27. joanne mccormack

    In case it is useful this is a letter I devised to share with your clinician if you are following a low carbohydrate, healthy fat way of eating.

    Open letter for your family doctor, hospital doctor and/or dietitian

    I am an NHS GP who qualified in 1986.
    I won a Mersey faculty RCGP award in 2016 for my work in diabetes and obesity. I ran a General Practice 1992-2015, and have worked for the local Clinical Commissioning Group and 2 practices since then.

    I have a small professional website http://www.fatismyfriend.co.uk for my patients which is read by patients from the UK and a few in the wider world.

    3 years ago I realized that numerous doctors in various countries were advocating a way of eating for people who did not get the results they wanted with the Eatwell plate. These doctors seemed to be getting better results with their diabetic and overweight patients than I was.

    Your patient has probably been following this method, or hopes to start. I encourage people to chart their progress with standard metrics like HBa1c, weight, waist circumference, thyroid, liver function, FBC and lipids, so they may ask you for some blood tests.

    As an example of what can be done, a patient of mine who was diagnosed with T2 diabetes in February 2017 with an HBa1c of 116. By June 2017 his HBa1c was 39, a 66% drop. You can see how he did it by following my website http://www.fatismyfriend.co.uk or visiting http://www.diabetes.co.uk or http://www.dietdoctor.com

    Many of us have followed these methods for years now, and some like Dr David Unwin have published their results, and won awards for their work. The methods are known to help people with diabetes, overweight, fatty liver and epilepsy (the latter if they go as far as a ketogenic diet)


    “Hyperinsulinaemia and Insulin Resistance” Google group


  28. Bill

    In the discussion about carbohydrate consumption in other cultures let us not forget that; for the most part, at least historically, these nations, tribes or whatever group we are considering were operating at subsistence levels and having to endure periods of shortage. This is in no way equivalent to the modern day western setting. Perhaps we could consider the fact that, for example, in modern China, people are more affluent even at the lowest levels of society and ergo eat more of their traditional carbohydrate based diets + Chorley Wood bread, this may go some way to explain the increased instance of “Western” disease. In Europe the subsitence food was/is bread, If we go back 100 years the working mans diet was bread, fat (if he was lucky),tea and beer but it came in limited quantities and he laboured hard for probably 10 hours a day 6 days a week. In the modern setting citing ancient cultures as good example of how a high carbohydrate diet works is, may I suggest, flawed.

    1. Martin Back

      Years ago I heard an interview with a retired farm worker who said in his youth he could work the whole day on bread, but the bread of today didn’t give the same nutrition. Having made my own bread from flour ground the old-fashioned way in a historic windmill, I can believe it. These days they chemically strip the germ from the wheat, and mechanically remove the bran, leaving pure carbohydrate. It’s not nearly as satisfying to eat as bread made from flour milled with the germ and bran intact.

      Something I’ve pondered for a while — workers on building sites have their breakfast around 9:30 am. So they’ve put in an hour or two of hard manual work on an empty stomach. And they are pretty fit with good physiques.

      That pre-breakfast exertion must burn up any residual sugar in their bodies, effectively rebooting their digestive system so they don’t chronically overload it. It’s one of the reasons I myself practice intermittent fasting, with no calories before 12 noon, just water and black tea or coffee.

      1. Bill

        Red Bull, sweet tea and coffee, followed by some food at 9.30 or thereabouts as you say.

  29. John Collis

    According to a BBC programme that looked at Victorian lifestyles, manual workers required 6000 calories per day and this was invariably obtained from bread, meat was too expensive and other sources of nutrition were rare. Against this, I doubt that the flour used was that refined, and would have contained more of the chaff than our modern equivalent.

    1. Goutboy

      Never believe the BBC on anything you probably saw a children’s programme designed for adults. Which ‘Victorian’ period. I think it’s recognised that there was a period of 20 years mid Victorian which was healthiest, they had access to meat, potatoes and veg but there was a seasonality to it, btw beeer was only 1.2 0/0. Don’t believe food was better then,some of the toxic substances they put in food was horrendous.
      In reply to Anne above,greens are carbs! As are all veg. Albeit they also contain veg protein but it’s obviously different than meat based protein.

      1. Bill

        Just a note on beer. Since you couldn’t trust the water beer was the best thing for hydration, very low alc/vol, no more than 2%. Same reason the French used to drink dilute wine I guess. It was called breakfast beer here in the UK and most anyone could brew and sell it. Interestingly I worked in Sweden and Germany for a number of years and they had low alcohol beer that could be drunk at anytime. In Germany (Bavaria) you could get it out of a vending machine, my US colleagues used to became apoplectic!

      2. Anne

        Hi Goutboy – yes greens are carbs, but they are VERY LOW CARBS, around 2g carbs per 100g of veggies. A LCHF diet is low carb high fat, not no carb high fat ! I probably get around 30 to 50g carbs per day which is extremely low !

      3. John Collis

        Hi goutboy, first of all I’d appreciate it if you didn’t patronise me, I am fully aware that flour was adulterated, the programme did mention this, which, by the way, was aimed at adults and each covered a part of the reign of Victoria, the food prepared was baked goods made by modern professional bakers using Victorian equipment. http://www.bbc.co.uk/programmes/b06vn7sq IIRC it was the beginning section that made this assertion, prior to widespread mechanisation. 6000 calories would probably be about right, modern army personnel consume approximately 5000 calories per day. Bread was the staple of the slums, those slightly higher socially did have a better diet. Read Michael Mosley, another physician, at http://www.bbc.co.uk/news/magazine-37654373 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672390/, but it all depended on who you were and where you lived https://victorianchildren.org/victorian-food/. In response to the availability of beer in Bavaria, this is because it is classed as a food, and it is not restricted to low alcohol levels (or at least it wasn’t when I worked there a good few years ago).

      4. Dr. Göran Sjöberg

        Since I today drink regularly considerably more alkohol than prior to my serious MI 1999, when I really seldom had a drink, it is driven by my conviction that moderat consumption is “good for your health and longevity (five years?)”.

        But why?

        What is the physiological mechanism?

        Someone has any idea?

  30. Sue Richardson

    Blow me down, I’ve missed all these comments. I saw the article as soon as you wrote it Dr K – ordered the book (paperback) and it came this morning. I’ll be reading it soon. I then thought ‘hold on, I haven’t been notified of any comments” I know I ticked the appropriate boxes about notifying me of new comments, I always do. So I looked no found all these above! Now I have to catch up. I hope it’s just a blip. I’m ticking the boxes NOW.

  31. Craig E

    Dr K I have kept across the work of all the authors so I will be interested to read the book. I hope it answers a few of the remaining puzzling pieces for me. In particular:

    1) is the increase in prevelance of T2D simply due to a continual redefinition of what constitutes T2D, just as the levels of what constitutes high cholesterol keeps getting redefined to sell more statins. Perhaps T2 is over-diagnosed?

    2) Glucose can enter cells through non-insulin dependent Glut transporters so even if insulin resistance is a thing…glucose can still get into cells…albeit at a slower rate. I have read so many opinions about what insulin resistance is I can’t make sense of it…

    3) Fructose has been demonised but it has a lower glycemic index than glucose so doesn’t spike spike blood sugar as quickly as glucose. Also, with realistic doses of fructose most is converted to either glucose or glycogen in the liver. Isotopic tracer studies have confirmed this…so what role does fructose play in diabetes?

    4) In a previous post about ‘Turning diabetes upside down’ you mentioned the role of insulin putting the brakes on glucagon action. Indeed glucagon, cortisol and adrenaline all stimulate hepatic glycogenolysis and gluconeogenesis…so if fasting blood glucose is elevated wouldn’t these hormones be the suspects? I think most often people think fasting BG is high due to slow clearance of ingested carbs but surely in our stressed out world, with cortisol running riot…it should be considered.

    5) There are those that say that LCHF is anti thyroid and slows metabolism because apparently glucose is required for T3 production. Am interested in how this fits in to the picture or evidence to the contrary

    To me I think you are spot on with you dose comment about carbs and also exercise. And although exogenous carbs are not required I would be staggered if glucose was toxic in moderate amounts given that the body goes to extreme lengths to keep blood glucose from dropping too low (and many cells like red blood cells exclusively metabolise glucose for energy. That said I believe carbs are too easy to overconsume which IMO is THE problem…now where’s that coke? It’s such a complicated field that it’s hard to know what to believe. I shall get the kindle out and order the book!

    1. Dr. Malcolm Kendrick Post author

      Not sure if I can answer your excellent questions. First, I do not like a disease that is diagnosed through a blood sugar measurement. A high blood sugar has many possible different causes, but everything gets lumped within one diagnostic label – type II diabetes. This makes any discussion somewhat tricky. We need to start by asking the question – what is the pathology that causes the blood sugar to be high?

      What is insulin resistance? I do not think there is any such thing. It is a silly term, but we seem to be stuck with it.

      Fructose can have no effect on the glycaemic index, because the gylceamic index measures the rise in blood glucose – not fructose. Ergo, fructose has a GI index of zero. You may find this paper interesting on the impact of frucrose. It is called Fructose, insulin resistance, and metabolic dyslipidemia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC552336/

      You cannot understand the metabolism without factoring in GH, cortisol and glucagon. Glucagon is the primary hormone in glucose metabolism, insulin is the secondary player. See this presentation by Roger Ungar https://www.youtube.com/watch?v=VjQkqFSdDOc

      As to the thyroid issues. Not sure I can add anything here

      1. Dr. Göran Sjöberg


        Thank you for linking to Prof. Unger’s price lecture – one of my favorites.

        To me this is a very profound scientific take on this issue which turned most things in my world upside down. He, though, spent a life of research on that!

      2. Craig E

        Thanks for the response. I suspect that like you with heart disease I could be in for a 30 year journey! 26 to go!

      3. Anna

        “What is insulin resistance? I do not think there is any such thing.”

        Whaaa??? Now I’m lost again.

        As to the thyroid thing, I suspect it’s a red herring. If the thyroid needs glucose, well so do other bodily processes, and the body will maintain an adequate glucose level.

      4. Martin Back

        I finally got to watch the Unger video. In this field, jargon presents a severe obstacle to understanding for the layman. I had to keep searching the internet to find out what he was talking about. But I think I got the gist.

        In the pancreas, the Islets of Langerhans consist of a ball of beta cells surrounded by a rind of alpha and delta cells. The alpha cells secrete glucagon, which stimulates the liver to produce glucose from fat and thus prevents blood sugar from falling dangerously low. If blood sugar rises, the beta cells secrete insulin into the bloodstream, and also secrete paracrine insulin (i.e. insulin in the immediate vicinity of the beta cell) which bathes the alpha cells in highly concentrated insulin and stops them producing glucagon, which stops the liver producing more glucose than required.

        Unger suggested that injected insulin in Type 1 diabetics does not prevent the alpha cells from producing glucagon because it is not concentrated enough, so the liver keeps producing unwanted glucose. It was not enough to control insulin, glucagon needed to be controlled as well.

        Insulin and Glucagon: Partners for Life reports on a conference which carries on where the Unger lecture left off and gives a nice summary of the state of play. It then discusses the most recent findings and I got lost in the jargon again.

        This subject is not like science with nice simple models. It’s more like sociology, trying to sort out what happens in a remote region with several different competing tribes where you don’t speak the language and don’t understand the allegiances and kin relationships and who influences who.

        What about the delta cells in the Islands of Langerhans? They emit somatostatin which has an inhibitory effect on insulin, glucagon, and other hormones, and is produced at many sites in the body. And glucagon produced by alpha cells in the stomach wall? That doesn’t get bathed in concentrated insulin. I give up trying to understand it all. I’ll leave it to the experts.

        Two things I did get from the article:

        “These and other studies provided further impetus to develop glucagon receptor antagonists, and several pharmaceutical companies became engaged in the hunt… On the basis of the lack of severe hypoglycemia, the lesson learned was that glucagon antagonism appears relatively safe and therefore a potential therapy for type 2 diabetes… The appearance of unexpected side effects halted development of some but not all of these molecules. Importantly, the clinical results with the antagonists demonstrated unequivocally that inappropriate secretion of glucagon is responsible for a major part of the hyperglycemia of type 2 diabetes.”

        – As a result of the work Unger reports in his lecture, “These findings provided new fuel to the old hypothesis that glucagon is responsible for diabetic hyperglycemia, and the old debate flared up again: What is more important—lack of insulin or excess of glucagon?” Hence the conference.

      5. Andy S

        Martin Back, I am a layman as well who needs to understand what dietary path to follow. Scientific research seems to be geared towards developing new medications, that is where the payoff is for the researchers. The consumer has to figure out on his own how to avoid being medicated.
        I am still in the glucose camp. When in doubt i google ” effect of hyperglycaemia on…..” to find a connection.The next step is to simplify the complex in order not to get bogged down by science. My understanding of diabetes2: hyperglycaemia initiates destruction of beta cells but not alpha cells, insulin production reduced, blood glucose levels rise, medical problems develop
        To avoid risk of diabetes: LCHF to prevent hyperglyceamia
        Insulin Resistance: blaming muscle and fat cells for the problem
        Medical intervention: metformin and insulin injections
        Other interventions: beta cell function can be restored by fasting+LCHF (Dr. Jason Fung protocol)
        Possibly other factors involved as well, but must not get distracted.

      6. gollum

        Fructose is processed by the liver and must be exported afterwards as lipoprotein. Things can go wrong, namely if the patient lacks protein.

        As to the glucagon, I understand that the beta cells signal via GABA to shut glucagon off. Has anybody ever looked at the effect of oral GABA on glucagon and glucose levels? GABA powder is a somewhat not-uncommon supplement (no, it is not Synthohol, curse the brain barrier).

      7. chris c

        IMO “insulin resistance” evolved as an important mechanism for nutrient disposition and rapid storage of a glut of food. This only works when it is dynamic, takes on different values at different tissues and can be switched off when no longer required, so the food stored as fat can then be metabolised.

        Much like “inflammation” it only becomes a danger when it is locked on chronically and inhibits “metabolic flexibility” (as per J Stanton at gnolls.org) so under conditions of high insulin we metabolise only glucose and store fat, and when the glucose supply runs low the body demands more carbs – which we provide – and not only dietary fat but stored fat never gets metabolised, only added to.

        A long time back I read a paper on Sedge Warblers. These fuel a trans-Saharan migration by doubling their body weight, which they achieve by switching to high carb insects – plum reed aphids which are basically little protein bags of sugar from plant sap, then they metabolise the fats to drive the prolonged flight.

        I predicted that if anyone studied this they would find they switched on insulin resistance for the storage process, then switched it off so insulin levels dropped to where the stored fat could be metabolised.

        Tim Noakes recently posted this


        Garden Warblers have a similar though perhaps less extreme process.

        Interesting eh?

  32. Errett

    Eur J Clin Invest. 2017 Jul 19. doi: 10.1111/eci.12781. [Epub ahead of print]
    Anti-inflammatory effects of exercise: role in diabetes and cardiovascular disease.

    Pedersen BK1.
    Author information

    Persistent inflammation is involved in the pathogenesis of chronic diseases such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).

    The aim of this review was to provide the reader with an update of the mechanisms whereby exercise-induced cytokines may impact cardiometabolic diseases.

    Evidence exists that interleukin (IL)-1β is involved in pancreatic β-cell damage, whereas TNF-α is a key molecule in peripheral insulin resistance. In addition, TNF-α appears to be involved in the pathogenesis of atherosclerosis and heart failure. A marked increase in IL-6 and IL-10 is provoked by exercise and exerts direct anti-inflammatory effects by an inhibition of TNF-α and by stimulating IL-1ra, thereby limiting IL-1β signalling. Moreover, muscle-derived IL-6 appears to have direct anti-inflammatory effects and serves as a mechanism to improve glucose tolerance. In addition, indirect anti-inflammatory effects of long-term exercise are mediated via improvements in body composition.

    Physical activity represents a natural, strong anti-inflammatory strategy with minor side effects and should be integrated in the management of patients with cardiometabolic diseases.

    © 2017 Stichting European Society for Clinical Investigation Journal Foundation.
    Cardiovascular disease; cytokines; diabetes; exercise; heart failure; inflammation
    PMID: 28722106 DOI: 10.1111/eci.12781

  33. JDPatten

    “Medication disutility”. That translates as “pill burden”. Euphemisms. Obfuscations.

    I’m tossing this statin article in here so that attention will be paid.
    An “analysis” with three scenarios for primary prevention:
    More people on a statin; many more people on a statin: almost everybody on a statin. Lives saved!
    I thought people here might want to go there and comment:

    1. joanne mccormack

      I have read it and commented on the site, thanks.
      Until all the data is published we do not know the true extent of the benefits or the extent of the risks, but we do know that many parties are making statins out to be more effective, and less harmful than they actually are, by the clever use of statistics.
      A colleague told me last week that they benefits of statins are undisputed and very clear.(No they are not imho). The fact he was so vehement about it shows how well he had been brainwashed. So were we all (apart from Dr Kendrick)

      1. Anna


        Carl Jung thought that people who even reject all religious belief will take on other beliefs religiously, such as politics. But could also be scientism.

      2. sasha

        I think atheism is as much of a belief system as all the religious beliefs it rejects. Since it’s not possible to disprove existence of God, all one can hope for is agnosticism…

  34. Andy S

    Errett, exercise is good, but can we do something else to attenuate the need for exercise?

    “In summary, our findings point to hyperglycemia as the trigger and to the vascular endothelium as the origin of the initial increase of IL-1b expression in the diabetic retina, and to IL-1b itself, via autocrine/paracrine autostimulation in endothelial and glial cells, as the mechanism of sustained retinal upregulation of this cytokine.”

    “Elevated levels of glucose have also been shown to impair b-cell function by a mechanism associated with the intra- islet production of IL-1, and b-cell may be the source of this cytokine (12,13). These studies suggest that the local production of IL-1 in islets may be a common mechanism associated with the loss of b-cell function in the context of type 1 and 2 diabetes. ”

    “Our results suggest that hyperglycemia down-regulates CD33 expression and triggers the spontaneous secretion of TNF-α by peripheral monocytes. This phenomenon involves the generation of ROS and the up-regulation of SOCS-3. These observations support the importance of blood glucose control for maintaining innate immune function and suggest the participation of CD33 in the inflammatory profile associated with type 2 diabetes.”

  35. Marguerite Harris

    I’m learning about type 2 diabetes, because my husband is “pre-diabetic” and has been very careful with his diet since the diagnosis a few years ago (does not take medication of any sort), although his morning fasting blood sugar has crept up somewhat. So I am very interested in learning more about the low carb/high fat diet. I guess he would have to give up his breakfast oats!
    I’m also interested in the topic of diabetes as a result of statins, because lately I’ve been very concerned about my 64 year old brother, who had chest pains about a year and a half ago, and had a stent put in and blockage cleared out of a valve in his heart (sorry, this is not an topic I know much about!)…and then was put on 80 mg of Atorvastatin (Lipitor) “for life”. But over the past year or so, his health has declined dramatically. He used to be fit, and positive, and he seems like an old man now, which surely cannot be due to the heart operation? He has terrible anxiety and depression, insomnia, and is really not himself. He turned down invitations to 3 conferences recently, which is unheard-of for him. His wife told me that he cries quite often now, and we have never seen that before. I’ve learned about statins now, and finally managed to convince him to go to his GP, who agreed to test his cholesterol levels, (his cholesterol was not high when he had the heart problems, and they said the cause of heart problems was stress from work etc.), which he just found out are: “total” cholesterol 2.99, LDL 1.13, HDL 1.22, triglycerides 1.39, NON-HDL chol. 1.77, and a ratio (?) of 2.5.
    His GP said he can try cutting the Atorvastatin dose in half (to 40 mg), and should go see his cardiologist, although he won’t be able to see the cardiologist for a couple of months probably. I don’t think the GP knows much about this topic, but he must think it’s safe to cut the dose in half. I am a little nervous because I convinced my brother to look into all this! I don’t understand what is happening with our (Canadian) medical system, when lay people must do all their own research and then tell the doctor what they, the patient, should do! Who knows if we are right! It is a scary scenario.
    Anyway, I know Dr. Kendrick cannot give medical advice on this site, but if any of you lovely folks have an opinion about my sad story, and whether or not I should be concerned about my brother, I would appreciate it very much!

    1. joanne mccormack

      That is so sad to hear. I am one of a group of doctors who use LCHF diets to help health. Most of our patients get normal lipids when they do this, and if they don’t they can think again. You can see what we do at my website http://www.fatismyfriend.co.uk. There is a link there to various helpful resources on lipids and statins. Your brother could suggest stopping his statin for a few weeks and seeing if he gets better? The extra risk from that is negligible- ask Dr Aseem Malhotra the UK cardiologist.

      1. Marguerite Harris

        Thank you Joanne, I’ll check out your website. Also will look up Dr. Malhotra. One thing totally baffles me, and I haven’t seen any info on this: seeing as my brother’s cholesterol levels were not high when he had the stent put in, (by the way, he did not actually have a heart attack) and now are what I think, from what I’ve read, very low, why would he be put on the statin in the first place, especially such a high dose?? The cardiologist must have had some reason, one would think, and that is what I would want to know if it were me. I must be missing something, but I look at this and think it seems crazy to use a statin if your cholesterol levels are already low. Or maybe cholesterol lowering is not the only purpose of a statin? The more I read, the more I feel I am living in upside-down land, and it is quite disconcerting.

      2. Jan B

        Might it be called a knee jerk reaction? Everyone seems to be prescribed a statin of varying strengths whatever their Cholesterol level.

    2. Clathrate

      Hello Marguerite, as per Stephen T’s reply about his brother, my dad also suffered serious muscle pain and memory problems when on statins (sorry don’t know which one). Short story is that I got him to give them up and the pains went away and his memory returned to ‘normal’ (in his middish-70’s at the time). Late 70’s, he was put on them again (I think he’d jump off a cliff if a Doctor told him to) – he had took them for 1 day when I found out on a visit by checking the medicine cupboard (I went nuts and he binned them). I do not know what his cholesterol levels are, I do not want to know, nor do I care what they are. I echo and second ST’s advice.

      2.99 is a precise figure (don’t you love accurately imprecise vs precisely inaccurate). Assume the units that go along with this value are mmol/litre. My personal opinion is that I would not want a total cholesterol figure of 3 mmol/litre – it is low (and I think it would be crazy to want to lower a total cholesterol figure of 3 mmol/litre).

      1. Marguerite Harris

        Clathrate, thanks, I thought 2.99 mmol/litre (3!) was low! But it seems difficult to find info on what is too low, only what is too high.
        Your dad is lucky to have you to look out for him.

    3. Clathrate

      The ‘bath-tub’ curve for cholesterol is tricky. A total of 3 mmol/l, in my opinion, is too far to the left of the steep edge. There is a lot of literature out there but if you were to ask for a recommendation of a good read up of blood lipids, I’d recommend the Paul Jaminet book ‘Perfect Health Diet’ (shame it has ‘Diet’ in the title as it might put people off, but, as a PhD myself, I appreciate it – I don’t think that it is heavy reading but recommendations to family and friends might show otherwise) [further aside, shame PJ is not blogging anymore].

      The PHD ideal serum lipid profile ‘looks like this’ [US units in book (mg/dl), converted to UK in brackets]:
      Total cholesterol level between 200-260 mg/dl [5.2-6.7 mmol/l]
      LDL cholesterol level above 100 mg/dl [2.6]
      HDL cholesterol level above 60 mg/dl [1.5]
      Triglyceride level around 50-60 mg/dl [0.5-0.7]

      [In terms of looking out for my dad, he has ‘waterworks’ problems and I found out earlier this weekend that he is on some ‘new’ tablets. My first question – do these make you light headed. A – yes. Me – bang head against wall.]

      1. Marguerite Harris

        Thanks Clathrate, I will look up Perfect Health Diet. Great info on cholesterol levels, too. I am going to get a few books on cholesterol, statins etc. and give them to my brother.
        You looking out for your dad… wish I had known more when my dad was alive — he was on SO many drugs at the nursing home. Don’t bang your head too hard against that wall!

  36. Nigella P

    Diabetes and its exponential increase fascinates me. I’m sure in 100 years time, scientists will look back on the 1980s onwards and wonder what the hell medical professionals were doing advocating high carb diets.

    My mother is type 1 apparently. However, I often wonder about this & would be interested in what others think. She was diagnosed back in the late 1960s, when diabetic diagnosis was still fairly rudimentary. When she tells her story, it often sounds to me like she was type 2 that went undiagnosed for so long that eventually her whole system was shot to pieces & in those days the only solution they had was insulin injections. My mother has a phenomenally sweet tooth, along with the rest of her family and everything they ate was heavily loaded with sugar. They drank tea with several spoonfuls of sugar and I’ve never known anyone add so much sugar to a bowl of strawberries to make them “palatable”. She says that for years, she used to suffer from terrible thirst and my father always said that it was best never to go anywhere with her without a sugary snack in his bag. She was very sporty & active, which I’m guessing must have helped to some extent but gradually over a decade she slowly got worse & worse & eventually ended up with type 1 symptoms of weightloss, constant thirst, yeast overload etc. Finally in 1969 at the age of 36 she was diagnosed with diabetes, which back in those days meant Type 1 and you injected for the rest of your life. She thinks she is terribly lucky to have type 1 not type 2 because “you can still eat all the sweet things but just give yourself a bigger injection”!!!!!

    I don’t know how untreated Type 2 ends up – would it be like that?

    1. chris c

      Quite plausible. Cynics have said there’s “no point” in diagnosing or treating Type 2 early as “you are going to end up on insulin anyway”.

      Used to be the diagnostics were c-peptide which showed insulin output and was initially high in Type 2 and only decreased later, but dropped off rapidly in Type 1, and GAD-65 which showed the autoimmune process in Type 1 but this seems to have become deprecated, not sure why.

      Also used to be that Type 1s had high HDL and few signs of “metabolic syndrome” and also that Type 2 drugs were ineffective but insulin worked at much lower doses than in Type 2 but all this is being confounded by sticking Type 1s on HCLF diets and more insulin to cover the carbs, leading to them also becoming insulin resistant and requiring higher doses and also the addition of Type 2 meds.

      Some insulin dependent Type 2s require insulin doses that would kill a Type 1 stone dead. Anatomically correct insulin levels are around 20 – 50 units/day depending on size, activity level etc.

      But then there are also strongly genetic syndromes, not only the MODYs. Unkown then and probably still underdiagnosed today.

  37. Stephen T

    Marguerite, my brother was losing his memory on statins and suffering serious muscle pain. He stopped the statins and he got his memory back.

    I’m sorry to say that your brother is unlikely to hear any sense about statins from most GPs or cardiologists. There are many exceptions, but most of the medical profession have been trained in the standard pharmaceutical driven paradigm that cholesterol is a risk for heart disease. It just so happens that the countries in the world with the highest rates of cholesterol have the lowest rates of heart disease. Yes, the exact opposite of what we’re still told. Low cholesterol is a particular risk in the elderly. Please see the attached paper.

    If, as I believe, statins are harmful and have only minute benefit, halving the dose makes little sense. Less harm is still more harm on top of what’s already happened. Perhaps you could get your brother to give them up for a couple of months and hopefully he will see the difference. People, including Dr Kendrick, have written books on this subject and there is no shortage of information out there. Personally, I ignore anything funded by pharma, because their track record for producing convenient results and finding a way to hide the inconvenient is legendary. Google Vioxx Scandal for just one of many examples.

    As for you diabetic husband, LCHF is the way to go. Look up Dr Jason Fung and Dr Michael Mosley’s talks on YouTube. Or Dr Unwin, who is winning awards treating diabetics in the UK by this method. Or Dr Sarah Hallberg in the US.

    I’ve attached a simple and directly relevant paper, and also a talk from a very engaging doctor on cholesterol, and statins feature prominently.

    Best wishes.


    1. Marguerite Harris

      Thank you, Stephen.
      I’ll look at all this information. I must say I feel a sense of relief, coming to this site. It could be that I am not crazy after all!
      I don’t think my brother will go off the Lipitor completely right now, although he will cut back to 40 mg., until he looks into it more. He is, however, a strong person and I believe he has turned a corner now, and will be open to learning about this issue. It is a huge shock for many people, especially older people I think, to come to the cold realisation that they cannot trust their doctor or the medical profession to do what is right for them. Once we start to learn, we make excuses, but ultimately there is no getting around it… we need to educate ourselves, and take responsibility for our own health.

      1. Bill In Oz

        Marguerrite, back in November I was referred to a cardiologist here in South Oz. My symptom ? Chest pain when I over exerted myself such as walking or going up hill. He immediately with no dat put me in low dose statins..Just 10 mg a day..
        Later on my GP (who had also requested blood tests) discovered I was anemic. and that as the cause of the chest pain. His solution : a blood transfusion, 2 units. My solution stop taking the daily aspirin which I had been taking for years as part of my own anti-aging program and some iron tablets for a while.
        But the cardiologist had his grip and wanted further tests and so on.. His ‘solution’ was three medications for high LDL=C, ( big does of statins ), High BP ( 160 / 90 )and hypertrophy ( ?) of the heart. No explanation or reasoning, just scripts !
        I did some research. I discovered that in us older folk high LDL-C is protective not dangerous. I discovered that statins have side affects, illustrated in my younger brother who has muscle pains and type 2 diabetes and feels sleepy all the time from statins prescribed 10 years ago for no reason he can remember.

        So armed with this I went again to the cardiologist. When I declined all of his prescriptions & and said I wanted a better way to deal with the issue, he sacked me as his patient. He is and remains a Cardiogamist’. ( A word I have just invented from merging Cardiologist and Dogmatist. Nice ! )

        A part of me was glad as I would be responsible for my own health. But a part of me was extremely annoyed by his arrogant and dogmatic attitude that he alone knew what to do. I am not sure if this is typical of cardiologists here or not. He is not Australian, in fact a Bangldeshi who has migrated here to Adelaide…

        Anyway, I have these past 5 months been exclusively responsible for my own health. I have discovered that losing weight by cutting down carbs is good. So too is intermittent fasting. So too are Vitamin D3 and K2. So too is fish oil -6 grams a day; so too is Ubiquinol ( = CoQ10 ). And so too is lots of over the counter Chondroitin sulfate . Ten grams a day initially, as per the program designed by Dr. Lester Morrison in the 1960’s. He discovered that heart patients who took CS recovered their health.

        I have had no loss of memory issues nor muscle pains nor developed Type 2 diabetes..

        As for my younger brother after 10 years of statins, he has given them the flick. Gradually the side affects are diminishing.. No energy and sleepy is the last one still hanging about. But I think he is better off.

        Maybe all this will help your brother.

      2. Dr. Göran Sjöberg


        I can fully appreciate your story from my own experience with cardiologists. When you as a patient questions their belief system and having done your “homework” you turn into being a threat. In my case I sacked the arrogant ‘cardiogamist’ (I liked that!) and solved my angina problem with research of my own.

        I guess that the arrogance is an understandable defense mechanism in any profession being challenged from the outside. But it must be worse for those heretics who are inside the “medical church”.

      3. Bill In Oz

        Goran, after I found out courtesy of my GP that the problem was anemia due to daily aspirin, I wrote a detailed letter to the ‘Cardiogmatist’ telling ( actually reminding rather ) what the blood tests had shown.I did not get any response. Ummmm !

        I also discussed this situation with my GP. His response was that he would like me to take the scripts prescribed by the cardiogmatist..Having done my research i declined. But I have been seeing this GP for 17 years and seems a decent person. ( We bump into each other in other contexts occasionally. ) So I have taken on myself the task of educating him about the modern research on these issues. I go armed with print outs of peer reviewed journal articles. On the next occasion in a week or so it will be a new, recently ordered copy of Dr Kendrick’s “Cholesterol Con”. As my GP is English & trained at Oxford in the late 1970’s, I have some hopes of opening his eyes to the wisdom in it. .

  38. JDPatten

    Dr Malcolm,
    You’ve said that you do not prefer the label “insulin resistance”.
    What, in your view, is the actual phenomenon that is referred to this way? Why do you dislike the term?
    This is a hint?: “You are more prone to release excess insulin in response to carbohydrates ”

    It’s currently being suggested that too much insulin – as OPPOSED to elevated blood sugar – is the culprit in all manner of health problems.
    Elucidate your view??

    1. Dr. Malcolm Kendrick Post author

      I cannot fully elucidate my view, because I do not feel that I fully understand what is going on.

      I do not like the term insulin resistance because it focuses the entire debate on insulin and sugar. A trap that all thinking fell into in 1922, a trap we seem incapable of escaping from. The trap being insulin = good: sugar = bad. True in type I diabetes, a barrier to thought in all the other conditions where blood sugar may be raised.

      I am more in the insulin = bad: sugar = not quite sure, but probably not as bad as most people seem to think – camp. (A camp that appears to contain one member currently… that would be me). In my camp there is also a tendency to consider that many other hormones and systems are involved, in highly complicated ways. I am still to get my head around visceral fat: what it is, what it does and why it does it – and why do insulin and cortisol have the opposite effect on visceral fat to subcutaneous fat – and suchlike. I am waiting for the light bulb moment. But no sign of it yet.

      1. Bill In Oz

        I am glad to read this. There is wisdom there in what you say. T2 Diabetes is a huge problem but despite the medical knowledge and opinions it is getting worse in many countries. So maybe our understanding of it ‘mis thought’….I hope you can find the switch to that light bulb moment soon-ish !

      2. John Collis

        Please may I join you in your camp? I also think that there are many other factors involved in ways that aren’t cut and dried.

      3. Anna

        The way I heard it explained by Dr. Mercola, is that you want insulin to jump in when needed, do its job, and disappear. But if you have insulin resistance, it can’t do its job quickly and disappear. So…maybe insulin resistance should be understood within the context of the whole system of hormones and visceral fat and you don’t like over simplification?

      4. xtronics

        What is most important to realize is that insulin-sensitivity is just as important for glucose regulation as insulin. And it is also important to realize there is not one insulin-sensitivity – muscles, liver, and adipose tissue react differently.

        A couple of notes..

        Liver becomes insulin resistant first, muscles second, adipocyres last.
        Insulin levels in the obese remain about 10 times those of a normal person even under complete starvation.

        And you HAVE to be a bit insulin resistant to lose weight.

        So how to get insulin resistance in adipose tissue with-out having high BG? low-carb diet – and avoiding PUFA’s

  39. Sylvia

    I do think that for the last 30 years or so, people think they can eat exactly what they want and damn the consequences because the doctor will have a pill to make it better. We are to an extent preaching to the converted. My dear sister, type 2D, metformin, so she eats what she wants, sweet things, loves bread. I persuaded her to go low carb, lost weight, no metformin needed, she has more energy, walks well now. But she does still have a treat of her sinful things, and so she should, treats are allowed in my view. I think we probably all know people who smoke, drink and misbehave who live long lives; what is their secret.

      1. Errett

        There is a Chinese saying that goes: “If you want happiness for an hour, take a nap. If you want happiness for a day, go fishing. If you want happiness for a year, inherit a fortune. If you want happiness for a lifetime, help somebody.”

      2. Marguerite Harris

        About positive mental attitude… this is just based on my observations over the past couple of years, but I’m convinced that mood has a huge influence on my “pre-diabetic” husband’s blood sugar levels. Not really talking about stress exactly, but a happy vs unhappy mood. When he is happy and engaged in lots of activities, his blood sugar levels are usually pretty good, vs when he is down and unhappy.
        By the way, I always feel the need to put “pre-diabetic” in quotes, because ever since I learned that the levels for diagnosing type 2 diabetes and pre- diabetes have been made lower and lower, I have started to feel sceptical about the whole issue. Uh oh, soon I’ll be sceptical about everything! But seriously, I do get the feeling that so much health info and advice we are given now is intended to make us view ourselves as unhealthy and in need of help (and lots of drugs…).

      3. chris c

        Nothing at all to say that causality can’t work in both directions at once. Sorry, I’m not helping much am I?

  40. Martin Back

    Tim Noakes was interviewed on local radio this afternoon, together with a mother with a diabetic daughter. They discussed how to treat people with diabetes.


    WATCH: Tim Noakes explains how diet affects children’s odds of diabetes
    21 July 2017 2:52 PM

    Professor Tim Noakes, a scientist, author and Banting diet advocate, has urged parents to take preventative measures to protect their children from diabetes.

    The professor explains that diet plays a crucial role in the odds of children getting diagnosed with diabetes and says carbohydrates have a negative impact.

    I made an edited transcript of the video that I planned to post here, but it’s far too long. It’s on Dropbox at this link for those interested: https://www.dropbox.com/s/h1iohzmahcyy4h4/Tim%20Noakes%20interview%2021%20July%202017%20–%20edited%20transcript.doc?dl=0

    Some excerpts:

    TN: Diabetes is going to kill the medical services in South Africa, as in the world. Type 2 diabetes, but the same principles apply to Type 1 and Type 2 diabetes. As far as nutrition goes, they’re identical.

    TN: [Children] develop T2D because mothers eat too much carbohydrate during their own pregnancies, they become diabetic during pregnancy, gestational diabetes, and wean the children, not on to breast milk, or they don’t use breast milk but they use the substitute milks which are full of sugar. They then wean onto cereals, which is high carbohydrates, and they make the children insulin resistant. And it’s the insulin resistance which then exposed to high carbohydrate diets, which is what we expose our children to — we feed them breakfast, it’s cereals and grains, high carbohydrates, sugars, bananas, etc, orange juice — we just load the children with carbohydrates and they become diabetic.

    So you’re quite right. There might well be a T1D epidemic. But the number of Type 2 diabetics is frightening as well. So we need to address both of them.

    Mother: [American parents] do not look at the diet. They look at how to bolus for whatever the kids want to eat. And you’ve got kids there who are eating 120 grams of carbs in one meal. And then you are putting in 15 units of insulin, which is a lot, and then you are putting yourself at risk for severe hypoglycaemia if you get it wrong. You are talking of major, major health issues that they are bringing on board when it’s not necessary.

    TN: Insulin damages your health. It may lower your glucose, but ultimately it damages your health. It damages your arteries. It gives you fatty liver. It gives you all the abnormal cholesterols that damage the arteries.

    Presenter: Some doctors say carbs are needed for children’s growth, even if they are diabetic.

    TN: That’s fake news. We’ve got to realise that medicine is being driven by fake news for too long and it’s time to change. There is no essential requirement for carbohydrate, not one gram of carbohydrate is required by any human being.

    The key for diabetes, before insulin became available in 1921, was a high fat diet, but it was 70% fat. And the evidence to me is that that still remains our best diet for a diabetic Type 1. A 70% diet with a trivial amount of carbohydrate and the balance is protein.

  41. Charles Gale

    Vit C and meat

    Yep – vit C is in meat…but I wouldn’t think it present in your well cooked meat such as crispy bacon or slow cooked lamb (3 hrs plus). Or any veg which has been cooked for too long.

    I used to be an amateur enthusiast for the Heroic Age of Polar Exploration (e.g. Nansen, Amundsen, Scott and Shackleton) and they found that fresh meat e.g. seal and penguin meat cured and prevented their scurvy but the cuts were not cooked too long. Primarily, they didn’t have the fuel to over cook their meat. If memory serves, vitamin c was identified until the 1920’s, about a decade of Scott’s death.

    Steffanson did his year long meat only diet and if memory serves again the fatty meat was not overdone and Steffanson and his colleague enjoyed good health.

    1. Dr. Malcolm Kendrick Post author

      I believe the Inuit made sure they ate the adrenal gland – I think it was the adrenal gland – where there is a greater concentration of vitamin C. My memory on this may be wrong.

      1. AH Notepad

        I think your memory is correct about the adrenal gland. Weston Price related similar in a story of when he enquired of a North American indian if they ever had scurvy. The reply was that scurvy was a white man’s disease. Weston then asked how they avoided scurvy, and the indian said he would have to speak to the chief to see if he was allowed to say. The chief said that as Weston was trying to help them keep away from white man’s food he could be told. The reason was when an animal was killed, they cut out the two hard lumps near the kidneys (adrenals) and cut them up and everyone had a small piece.

        I think the animals had large glands or they killed many animals, as I can’t see an adequate supply of vitamin C otherwise.

      2. Andy S

        “Muktuk is the traditional Inuit/Eskimo and Chukchi meal of frozen whale skin and blubber.
        Muktuk is most often made from the skin and blubber of the bowhead whale, although the beluga and the narwhal are also used.
        Muktuk has been found to be a good source of vitamin C, the epidermis containing up to 38 mg per 100 grams (3.5 oz).”

      3. chris c

        Interesting! Also I always believed liver.

        Another factor is that not eating excess carbs allows the same glucose transporters to syphon the vitamin C into the cells, thus you are using more of it and can eat less for the same effect.

        Also some micronutrients (don’t ask me which, I forget) help recycle vitamin C, thus further reducing the primary demand.

    2. gollum

      Ascorbic acid is a common ingredient in sausages, Pollmer used to have field days with that fact.

      Of course, if you consider that a source, you can reach for the trusty 100 g can of the stuff as well.

      1. Martin Back

        L-ascorbic acid is vitamin C. D-ascorbic acid is a preservative, although their chemical formula is identical. Ascorbic acid manufactured in a purely chemical process is a mix of L- and D- forms. Vitamin C for human consumption has a biological fermentation stage in its manufacture, so it is all L-ascorbic acid, as required. I don’t know if the preservative sold as ascorbic acid is the pure D- form or a mixture of both.

  42. sasha

    I came across a very interesting lecture by Dr. Bruce Ames: Triage Theory, Longevity Vitamins and Micronutrients. He does touch on the subject of what in his opinion are essential micronutrients and whether the currently accepted list is complete.

  43. Bill In Oz

    All in all , an interesting discussion ! I am no advocate for the USA ‘way of medicine’. It is an especially high cost system. But some MD’s are doing interesting work. One is Dr Peter Attia is San Diego. He manages a blog similar to this one. Over the years he has posted on many issues related to heart disease, Type 2 diabetes, high carb & ketogenic diets.
    Here is one recent post on reversing type 2 diabetes.

    1. Marguerite Harris

      It is an interesting blog, thanks Bill, and also for advice about managing one’s own health and supplements…will pass on to my brother who is on statins.

  44. Martin Back

    Tim Noakes was interviewed on local radio yesterday, together with a mother with a diabetic daughter. They discussed how to treat people with diabetes.


    WATCH: Tim Noakes explains how diet affects children’s odds of diabetes
    21 July 2017 2:52 PM

    Professor Tim Noakes, a scientist, author and Banting diet advocate, has urged parents to take preventative measures to protect their children from diabetes.

    The professor explains that diet plays a crucial role in the odds of children getting diagnosed with diabetes and says carbohydrates have a negative impact.

    I made an edited transcript of the video I planned to post here, but it’s too long. It’s on Dropbox at this link for those interested: https://www.dropbox.com/s/h1iohzmahcyy4h4/Tim%20Noakes%20interview%2021%20July%202017%20–%20edited%20transcript.doc?dl=0


    Tim Noakes: Diabetes is going to kill the medical services in South Africa, as in the world. Type 2 diabetes, but the same principles apply to Type 1 and Type 2 diabetes. As far as nutrition goes, they’re identical.

    Tim Noakes: [Children] develop T2D because mothers eat too much carbohydrate during their own pregnancies, they become diabetic during pregnancy, gestational diabetes, and wean the children, not onto breast milk, or they don’t use breast milk but they use the substitute milks which are full of sugar. They then wean onto cereals, which is high carbohydrates, and they make the children insulin resistant. And it’s the insulin resistance which then exposed to high carbohydrate diets, which is what we expose our children to — we feed them breakfast, it’s cereals and grains, high carbohydrates, sugars, bananas, etc, orange juice — we just load the children with carbohydrates and they become diabetic.

    So you’re quite right. There might well be a T1D epidemic. But the number of Type 2 diabetics is frightening as well. So we need to address both of them.

    Mother: [American parents] do not look at the diet. They look at how to bolus for whatever the kids want to eat. And you’ve got kids there who are eating 120 grams of carbs in one meal. And then you are putting in 15 units of insulin, which is a lot, and then you are putting yourself at risk for severe hypoglycaemia if you get it wrong. You are talking of major, major health issues that they are bringing on board when it’s not necessary.

    Tim Noakes: Insulin damages your health. It may lower your glucose, but ultimately it damages your health. It damages your arteries. It gives you fatty liver. It gives you all the abnormal cholesterols that damage the arteries.

    Presenter: Some doctors say carbs are needed for children’s growth, even if they are diabetic.

    Tim Noakes: That’s fake news. We’ve got to realise that medicine is being driven by fake news for too long and it’s time to change. There is no essential requirement for carbohydrate, not one gram of carbohydrate is required by any human being.

    We can reverse, or put T2D into remission, if we cut the carbohydrates low enough. The problem is, that puts six pharmaceutical companies out of business who are producing insulin, and that’s the reason why all those children are chasing the pizza with insulin. It’s because the industry is driving the advice that the America Diabetes Association gives, that the American Dietetics Association gives. It is driven by industry because they want patients, they don’t want cures.

    The key for diabetes, before insulin became available in 1921, was a high fat diet, but it was 70% fat. And the evidence to me is that that still remains our best diet for a diabetic Type 1. A 70% diet with a trivial amount of carbohydrate and the balance is protein.

    1. chris c


      A thought experiment – if a doctor was found to be giving his patients three glucose tolerance tests a day, every day, how long do you think he would last before facing disciplinary action?

      The UK Government’s recommended RDA is for 230 – 300g carbs including 70 – 90g “sugar”. Some dieticians recommend up to 450g/day carbs, including to diabetics.

      Theoretically any doctor failing to abide by these recommendations could face disciplinary action.

      Can anyone spot the difference?

  45. Sue Richardson

    Sorry to be a nuisance but I am still not getting alerts that there are new comments. I’m getting the news posts obviously, but although I’ve ticked the boxes that say ‘notify me of new comments via email’ i’m not getting any at all. Any suggestions from someone who knows?

    1. Craig E

      Hi Sue….check that the notifications aren’t accidentally turning up in your junk or spam section?

      1. Sue Richardson

        Hi Craig. Just popped in to see if there were any more comments – and there were! I popped out again to look in my trash box and the junk box and No, nothing whatsoever. I haven’t changed any settings so I can’t understand what’s happening. I did notice though, that usually with a new post, when I tick the box to follow the comments I then receive an email asking me to confirm that I want to follow – and I didn’t get one of those this time. Always have done before. I’ll tick the boxes again and see what happens.

        I am now reading the book this blog post is about ‘Diabetes Unpacked’ and am enjoying it. Well worth getting.

  46. Dr. Göran Sjöberg

    It is for me today interesting to note how many people, including myself and my wife, start “thinking” first when we have been metabolically “carb trapped” in our middle ages and when we also have experienced serious health problems of different kinds, e.g. obesity/overweight, DT2 and CVD. For sure this revelation is also true for prominent people like Prof. Noakes and Gary Taubes to name just two more of us.

    When one has “opened the eyes” for what I now consider to be science in nutrition (and medicine) one, all of a sudden, see “the light” and also how utterly fooled we have been by the “establishment” during the larger part of our lives.

    Then it is understandable that one wants the fellows citizen to see the same “light”. In essence one then tend to jump on a “religious” bandwagon to convert and save “the whole world”. I have tried this for a couple of years now with limited success though it is a comfort to know that I have not been alone. The whole thing also tends to be a moral issue but as always business is stronger than moral when it is about addictions of various kinds.

    Yesterday I was participating at a birthday party of an old time friend of mine among people of my own age (70 +) and as Gary Taubes recently stated I also noted how difficult it is abstain from the sweet “traps” presented at such a party. However I am today a “hard-core” LCHF-guy and mostly stayed with the Highland Park whisky trap offered and away from the sweet traps.

    To my enjoyment the host who offered the party and whom I successfully converted into the LCHF way of life about twenty years ago is still, at 81, on the track though with a few carb sidesteps along the track, this time on his own party and bringing me along off road on this occasion. In his garden, where the party was held, in the now gorgeous weather, he had grown potatoes which we now collectively harvested and was served as the essential part of the typical Swedish pickled herring dish with the sour cream and which is always served at Swedish festivities where also strong liquids are consumed in abundance – a true party!

    I now guess that the omega-3 fat of the herring and especially the Highland Park together clean my arteries up from the potato residues 🙂 And the workout in my garden which I am planning for today will probably not hurt me.

    1. Andy S

      Dr. Goran, occasionally I eat potatoes as well mostly homegrown, with plenty of butter and high fat sour cream. Next time will check post prandial glucose reaction. Like your habit of working off a carby meal, the glucose has to go somewhere.

      1. Dr. Göran Sjöberg


        I once did that post potato prandial glucose test and it was not encouraging if you believe in such numbers.

        Work outs may work but I have no consistent view on how this works on card which are seldom a part of my eating habits.

        I am though working with a pulse meter attached around my chest and trying to reach my upper pulse limit a couple of times (I have read that this is enough and that you don’t need to work for extended periods of time to improve your heart health) – this time by shuffling 14 tons of makadam around my garden.

      2. Andy S

        Dr. Goran, eating according to LCHF removes much of the concern about blood glucose. My interest is what glucose does to ageing bodies. Everyone has glycated hemoglobin even at perfect blood sugar levels. Do AGE’s accumulate faster later in life due to reduced excretion?

        From Wikipedia:
        “Glucosepane is a lysine-arginine protein cross-linking product and advanced glycation end product (AGE) derived from D-glucose.[1] It is an irreversible, covalent cross-link product that has been found to make intermolecular and intramolecular cross-links in the collagen of the extracellular matrix (ECM) and crystallin of the eyes.[2] Covalent protein cross-links irreversibly link proteins together in the ECM of tissues. Glucosepane is present in human tissues at levels 10 to 1000 times higher than any other cross-linking AGE, and is currently considered to be the most important cross-linking AGE.[3]

        Aging leads to progressive loss of elasticity and stiffening of tissues rich in the ECM such as joints, cartilage, arteries, lungs and skin.[4] It has been shown that these effects are brought about by the accumulation of cross-links in the ECM on long-lived proteins.”

    2. Martin Back

      Did you open a bulging can of rotten fish?

      “This is the time of year when Swedes crack open tins of fermented Baltic herring called surströmming (sour herring) – a stinky culinary tradition that dates back several centuries and is often likened to the smell of eggs rotting in open sewage drains. …surströmming is often eaten outdoors at garden or balcony parties — because like skunk spray, its stench will linger on for days.”

      1. Dr. Göran Sjöberg


        Yes, these “surströmmingsparties” are true tough Viking parties where I myself have serious hesitations and have only participated in one of them. Well you can get used to the smell (the taste is not that bad) as it was in the tradition of my wife’s relatives and ancestors (the Sami people) in northern Sweden when they preserved the big catches by fermentation actually in big holes dug out in the ground. The process could be noticed by the kilometers.

        Still surströmming is about the most healthy thing you can eat together with most fermented foods.

      2. Dr. Göran Sjöberg


        “Did you open a bulging can of rotten fish?”

        No – but I killed one extremely bulging can that had been anticipating my opening for too many years (10 + ?) with my shotgun in the garden. To my surprise it didn’t smell very much any more.

        This though reminds me of a party with a couple of Americans visitor to our company and they were very keen in participating when being invited to the surströmming party. The host though had taken the precaution of opening the can under a shower due to the danger with the overpressure in the bulging can but one of the visitors unfortunately felt safe to stand too close.

        To the astonishment of all present the can didn’t bother about the precautions and the jet hit all over his suit. Well, he obviously had to step out of his suit to replace the can in shower cabin while his suit was put in the washing machine. During the party he was then wrapped in a big towel to participate in a party he never forgot.

      3. Martin Back

        Goran, LOL!

        Do you hear the drumming
        Warning of the coming
        Of a Swedish man
        With a bulging can
        Of rotten fish — surströmming.

      4. Dr. Göran Sjöberg


        I like your comments – very apt!

        Here is a little more.

        You can get used to awkward smells of different kind and find them appealing when they have been associated with pleasant eating experiences. It is a little about Pavlov’s salivating dogs getting used to a ringing bell and for that matter the ducklings in my pond which are rapidly approaching when I am shouting “DINNER” before serving them their daily treat of oats – a shout that will certainly chase away “normal ducks”. Scientific experiment have also shown that by training you can get people to salivate at the smell of petrol so why not by the smell of surströmming when you are used to it.

        I read about such an accustomed Sami man who, in the “old days” brought a big open bucket (no bulging can there) of surströmming onboard a bus where though not all people were accustomed and as I understand there was some controversy but he was allowed to fulfill his trip anyway since it took place in the land of surströmming and people knew what it was all about.

        I wonder if you are allowed to bring such bulging cans onboard on flights.

      5. chris c

        “No – but I killed one extremely bulging can that had been anticipating my opening for too many years (10 + ?) with my shotgun in the garden. To my surprise it didn’t smell very much any more.”

        Haha I literally laughed out loud at that one!

        It brought to mind a similar story from one of my late father’s plant collecting books (Reginald Farrer?) set in China, where the guest was presented with a long buried fermented egg, a similar local delicacy. The egg chose that very moment to explode.

  47. TS

    Since type 1 diabetes is said to be autoimmune, doesn’t it suggest that stress and the HPA axis are frequently involved? Is this stating the obvious or not?

      1. Andy S

        Hi Sasha, there is a possible connection via effect of cortisol on immune function, and raised blood glucose level. Type 1 is considered an adolescent disease, do they have more stress than adults?

      2. Sasha

        Hi Andy, I don’t know but I don’t think so. Why would a 10 year old have so much stress? Or why would incidence of diabetes grow in developed countries? It’s not like 10 year olds in 2017 Finland are more stressed out than 10 year olds in 2007 Finland. Also, prevalence of T1D in Finland, for example, is 30 times that of rural China. I doubt that Finnish adolescents are that much more stressed out than rural Chinese.

        If stress plays a role in T1D, it may be secondary to bigger issues going on with immune system.

      3. Andy S

        Hi Sasha, you are correct that stress does not cause juvenile onset diabetes according to study mentioned elsewhere. Complete loss of beta cell function later in life is another story.

    1. Andy S

      Hi TS, some more ideas on type-1
      “It takes a long time (usually several years) for the T cells to destroy the majority of the beta cells, but that original viral infection is what is thought to trigger the development of type 1 diabetes.

      Not every virus can trigger the T cells to turn against the beta cells. The virus must have antigens that are similar enough to the antigens in beta cells, and those viruses include:
      • B4 strain of the coxsackie B virus (which can cause a range of illnesses from gastrointestinal problems to myocarditis—inflammation of the muscle part of the heart)
      • German measles
      • Mumps
      • Rotavirus (which generally causes diarrhea)
      There have also been some controversial studies into the connection between drinking cow’s milk as an infant and the development of type 1 diabetes. Researchers don’t all agree on this, but some believe that the proteins in cow’s milk are similar to a protein that controls T cell production called glycodelin1. The baby’s body attacks the foreign protein—the cow’s milk protein—but then also attacks glycodelin, leading to an overproduction of T cells. And too many T cells in the body can lead to those T cells destroying the beta cells.”

      1. chris c

        I’ve also read of a potential link between Type 1 (and sometimes other autoimmune diseases) and celiac. Interesting but little known facts – Type 1 was always considered to be childhood-onset, and the victim would go from “normal” to “die without insulin” in a matter of days, or at most weeks.

        In recent years- and I don’t know if this is still true – rate of INCREASE in incidence of Type 1 has exceeded the rate of increase in incidence of Type 2, though it remains at around 10% of diabetes cases in total. Not only that but a major part of the increase has been in adults and even old folks, which at the time I read this was outnumbering childhood-onset by about 2:1.

        The confounding factor is that adult onset/LADA may be much slower to onset and may take months or even years to progress to “die without insulin” – some forms of Type 2 may progress faster, which can confuse the diagnosis. GAD used to be used as a diagnostic but now seldom seems to be mentioned, I wonder why not.

        I recently read a Type 1 who claimed she was one of 5 cases diagnosed in the same town at the same time. This set me thinking – one of my father’s brothers was the only Type 1 known to me anywhere in my history. Although we believed one of my mother’s uncles was Type 1 as he was skinny and on insulin. genealogical research revealed a string of other skinny diabetics almost certainly some genetic form of Type 2/MODY, and a whole bunch of predominantly males who died prematurely from CVD, almost certainly undiagnosed diabetics.

        Now my father developed Graves and my mother Crohn’s all while living in the same village, all supposedly autoimmune. I wish I could dig them up and ask if these diseases also all developed at the same time, which would point to some environmental factor triggering the autoimmune attacks.

        I know other families where everyone has one and most have more than one autoimmune condition, which is blamed on some HLA variant, and again where different family members developed different diseases at the same time, often following some seemingly trivial viral infection. The waters here are quite muddy.

    2. Andy S

      Hi TS, should we worry about stress?

      “Do stressful life events cause type 1 diabetes?
      The link between psychological stresses and deteriorating diabetes control is well known. However, people who develop type 1 diabetes sometimes ascribe the onset of diabetes to a recent stressful event.
      To perform a systematic review of the literature to assess whether stressful life events can cause type 1 diabetes.
      Electronic and manual literature search using appropriate key words.
      Older literature provides anecdotal links between stressful life events and diabetes. The difficulty in interpreting these papers is the small numbers under study and the lack of distinction between type 1 and type 2 diabetes. More recent studies, in particular from Scandinavia, demonstrate that there is no link between either the number or the severity of life events in the year up to the diagnosis and the onset of the condition.
      Given the progress in understanding the molecular biology of diabetes, the concept that stress causes type 1 diabetes is no longer plausible. There is no evidence from large well-controlled trials that type 1 diabetes is caused by stressful life events.”

      1. chris c

        Similarly I’ve known a few Type 2s who suggest its onset was related to highly stressful events.

        Also steroids (prescribed or not) may produce temporary Type 2 diabetes, and theoretically this becomes permanent if the steroids are continued for long enough. In some cases (not proven just observed) steroid-induced diabetes may be prolonged and then suddenly remit completely.

  48. Marguerite Harris

    One other thing I’ve been wondering, about blood sugar. Maybe this is nuts, but could it be possible that some people just naturally have slightly higher blood sugar levels than average, and that’s ok for them? Maybe different races have different “normal levels”? Like how some people have lower or higher blood pressure, or are naturally thin or naturally chubbier? I see so many variations on what is healthy in my animals. A thin healthy thoroughbred horse, a chubby healthy Fjord horse, fat cat, thin cat, one dog active, one lazy, on and on. All different, all healthy and all old now and still doing fine. Couldn’t humans be the same? We seem to have such narrow guidelines now for what is considered acceptable.

  49. John Collis

    David Bailey, your raised blood sugar could have been entirely due to the statin, despite pulished articles that refute this (the fact that the authors were sponsored by the sole manufacturer of one of the statins (Lipitor IIRC) is purely coincidental (Waters et al 2011). )

    I, too, have a problem of what is junk food, is it just a convenient catch all for fast food like McDonald’s or KFC? Where does fish and chips fit into this?

    Every food additive has an e-number:
    Vitamin C is E300
    Antibiotics have numbers from E 701 (tetracycline) through to E717 (Avilamycin)
    Helium is E939 and Argon E938 (both inert gases)
    Ethanol is E 1510
    Even OXYGEN has an e-number it is E 948

    Fructose may be metabolised in the liver, but it is mainly to glucose (29-54%); 1% to triglycerides, 25% to lactate and 15-18% to replenish glycogen (apologies for referencing Wikipedia. https://en.wikipedia.org/wiki/Fructolysis).
    There has been a suggestion from myself that exposure to sweeter fruit may be involved in the increase in T2 DM seen in the UK over the past 30 years or so; someone argued that other countries have access to these types of fruit, citing the Indian sub-continent as one example; however, the risk of a 25 year old from the Indian sub-continent developing T2DM is approximately the same as the risk of a 40 year old caucasian developing the condition. I believe the risks to Afro-Caribbeans is similar. Also I think that these tropical fruits have been bred to be significantly sweeter than they used to be, although this is somewhat anecdotal and not concrete evidence.
    People have also been asking about the significance (or otherwise) of hypothyroidism, thyroxine is involved in the catabolism of protein and, perhaps significantly, carbohydrates; basal metabolic rate and increases sympathetic nervous system activity; how this may relate to the development of T2DM I’ll leave it to those cleverer than myself to ponder.

    1. Bill In Oz

      Hi John
      You wrote ” Also I think that these tropical fruits have been bred to be significantly sweeter than they used to be, although this is somewhat anecdotal and not concrete evidence.”

      This may be very wrong. Take a look at this article by Denise Minger at l: https://deniseminger.com/2011/05/31/wild-and-ancient-fruit/

      Denise’s article is quite detailed and sourced with lots of examples of fruits from the tropical and temperate areas of the world.

      The problem with fruit may not be it’s size but rather it’s universal availability now at any time of the year due to low temperature storage & supermarkets, rather than just at the season when the fruits are ripe.

  50. TS

    Thanks Andy and Marguerite.
    Yes, most people suffer stress. What I concluded from my work with children is that they express their tension in different ways and this expressed itself in different “conditions”. For example, a child whose tension is expressed by repeating sounds might develop a stammer – which then becomes conditioned and exists even when the tension has abated. Another child might express the same degree of tension in an entirely different way. This is where, alas in my not so humble opinion, genetic susceptibility comes in.
    Being no more tense or anxious than others is not a safeguard to a genetic susceptibility. Normality is not a safeguard. We all need a degree of tension to survive. But tension results in expression of some kind.
    Researchers dismiss tension as a cause of stammering (stuttering) because children who stammer are not generally more tense or anxious than his/her peers. The mistake could be made with class 1 diabetes.

  51. JDPatten

    Have you ever watched a toddler being transported by his first experience of ice cream?
    Have you wondered why “french fries” (or “chips”) is the world’s favorite food?
    The salivary enzyme ptyalin breaks starch down to simple sugars even as you’re still munching the potato. Yummy. Blood sugar spike.
    It took Nature a pack of millennia of eliminating mistakes to get the human blueprint as workable as it now is.
    So tell me, if carbs and sugars are as counterproductive as they now seem to be, how come we, now the final human product, are “designed” to be so in thrall to sweeties?

    1. Bill In Oz

      Because in nature they are so rare JD Patten. We stuffed up that pattern with our ability to subvert other carbohydrates by cooking them. And there’s your instant sugar.

      I suspect that if we stuck to eating only what we could eat raw, there would be no type 2 diabetes. But life would be soooo boring. So finding the happy safe & healthy balance is the key

      1. JDPatten

        Rarity doesn’t explain the inordinate attractiveness the carbie-sweeties hold for us. After all, sugar has no nutritive value, and the impression left us from the Sasha/Dr. Malcolm debate is that the nutritive value of the more complex carbs is anything but essential.
        All I can think of is that we’re “designed” to really like the lactose of mother’s milk as babies. Survival assurance.

      2. Anne

        Oh no, life wouldn’t be boring if we ate raw Bill in Oz ! My most favourite meal is beef carpaccio (raw fillet steak) which I make from a recipe that Prof Tim Noakes (one of the authors in the book ‘Diabetes Unpacked’) has in his cookery book ‘Real Meal Revolution’. I use organic, grass fed beef for this. I cannot explain how nice raw beef tastes, but it is amazing, it feels so wonderful to eat, and something I could happily eat every day if I were rich enough I crave it so !

      3. Anne

        PS – when I was a child I refused to eat meat, I stopped eating meat when I was 3. But one day when I was about 5 I was at a neighbour’s – she was cutting beef into chunks to make steak and kidney pie. I thought the beef looked nice and I asked her for a piece. She happily obliged and gave it to me – it was really yum ! So it seems I was happy to eat some raw beef as a child but not cooked – I never ate beef again until I was 53 !

      4. David Bailey

        Yes Bill, but my point is that unless those raw carbohydrates never get digested, then conventionally they still get converted to glucose! There really needs to be a reason why carbohydrates that break down slowly, are not so harmful!

    2. Andy S

      I doubt that we are the final human product. Urbanization, everyone on low fat diet, statins and daily aspirin: we need to evolve. There could be many casualties until the evolution is complete.

      1. JDPatten

        As far as you and I are concerned, this is as far as it goes. Virtually final. Of course, if the species survives our depredations, it will likely evolve further. But we’re talking about multiple orders of magnitude of lifespans for anything definitive to develop. Evolution is too slow for us, with our perspective, to see.

      2. JDPatten

        Right about statins and aspirin.
        Evolution doesn’t work through pressure, though. And whatever “adaptation” there may be is passive.
        Evolution is random. Whatever random change or addition happens to be easily passed along might be established, over generations, for good or bad. (“Good or bad” being values from the human perspective.)

      3. chris c

        We are going to have to evolve as a species even if the majority of individuals have to suffer and then die prematurely. Vegans and the Foodlike Substance Manufacturing Industry via the WHO have already planned for our future to be grain-based low fat vegan and are already fighting tooth and nail for this, see pretty much every low carb/Paleo/doctor’s/science blog or twitter feed for the trolling and the mainstream press and (most) dieticians for the dogma.

        Here the agenda is revealed

        oh I went back and corrected a typo – manufatcuring. In retrospect I should have left it.

      4. Andy S

        chris c, question is how long would it take to evolve back into a strictly plant eating species (soy, corn, wheat, beans, potatoes)? What would be the BMI, brain size, etc.? New genes are not required, epigenetic changes could be sufficient, humans are presently omnivores. A study of healthy vegans could give a clue of what to expect. A study over several generations, not the recently converted.

        Other organisms evolve quite rapidly to changing environment: super-weeds due to herbicides, drug resistant bacteria. Devastating effect initially but survivors will thrive, not just survive.

      5. AH Notepad

        Evolution will not solve this problem, it takes too long. The solution to the problem of overpopulation is a massive die-off by whatever mechanism. The longer the population grows, the worse will be the inevitable catastrophic corrective change.

      6. Dr. Göran Sjöberg


        I once produced a lecture about our evolution from the apes relating to food. The main point in my talk, if we now believe in Darwinian evolution, was that we have been totally “outsmarted” by the grains who have made humanity their slave. To get convince about that fact it is just to look around over the fields. I think, based on my own experience that there is an addiction element involved.

      7. chris c

        Andy S, great questions! Meanwhile a quote from someone with more sense “babies are marinated in insulin, starting in the womb” which IMNSHO results in epigenetic changes where each generation becomes fatter and more diabetic than its predecessors. Perhaps a third of the population or maybe less is immune to this process – so far.

        Goran, yes! I once described wheat as a vegetarian psychopath, it fills its children with opioid peptides to convince us to eat them, and gluten and other things to ensure the few survivors are sown into a convenient pile of manure. Since then we have automated the process – from combine harvesters to seed drills – and now wheat has spread from an obscure part of the Middle East to become one of the most widespread plants ever.

        Now it’s sucking people’s brains out. See recent PETA propaganda.

        Some of these people are too clueless to comprehend that there is a LOT of land where wheat simply cannot be grown yet animals can be grazed. Plus many of our farmers leave wild field margins, and even sow wildflowers and cover crops which give them a second crop of pheasants and partridges and encourage birds and predatory insects, which ,may reduce the yield but also reduces seed costs and diesel bills from the lack of need to cultivate, and pesticide costs as the predators eat the “bad” insects which attack the crops. Win all round.

        How will grain agriculture continue as the costs of diesel and agrochemicals continues to rise? Meanwhile ruminants *improve* the soil with minimal inputs.


      8. Andy S

        Chris, food availability can drive adaptation/evolution. My understanding is that humans are attempting to adapt, for the last 10k years since introduction of agriculture, from meat eaters to eating mainly carbohydrates. Today the popular/official diet consists of wheat, corn, soybeans,beans, potatoes, sugar and seed oils. Low fat and high carbohydrate for everyone assisted by government subsidies. The reality is a world populated by obese, diabetic and generally unhealthy people. Medical intervention for all. The beginning of evolutionary change, not a very good outcome in the short term i.e. the first few million years.
        High glucose/insulin influences gene expression and can explain how we respond to dietary choices.

      9. Martin Back

        I’ve been reading a lot about conservation agriculture. It turns out that soil is improved and grain yields increased by running animals and crops together. Plants need animals and vice versa. Pure grain monoculture is destroying the soil structure and water-holding capacity, and converting soil organic life into CO2 in massive quantities. (From 7% to 2% organic life in the Great Plains.)

      10. chris c

        I suspect at least in the near future the population will be dumber, angrier and wider. (Personal observation). After that, who knows? I won’t be around to notice, or care. Nor sadly is John Brunner who wrote a stunning series of dystopias back in the sixties and seventies – Stand On Zanzibar, The Sheep Look Up, Shockwave Rider and sever\al others – all based on projecting what were then current observations into the near future. He was right about cancer and antibiotic-resistant infections but more or less missed out completely on metabolic diseases, they weren’t even on the horizon back then. Nor were PCs – his version of the internet centred upon a giant computer accessed by keypads, although The Cloud is approaching this now. Pollution too, but not global warming. Door to door armament salesmen haven’t happened quite yet. Militant Islam has though. I’d love to see what he could come up with using today as a starting point.

        Martin yes, back when I was young there was “mixed farming”. Fields were rotated through various crops and then into a short term (maybe three year) ley – grass often sown with clover to fix nitrogen into the soil, and grazed by cows. Often not so successful as the cows would damage the soil structure, hence the old saying “the secret of a good ley is a firm bottom” and then back into crops. Nearest I’ve seen to that recently is sowing eg. turnip tops and rape into stubble and fetching in sheep from the hills to overwinter and graze them off along with the crop volunteers – and turn them into neatly pelleted manure which is ploughed in prior to sowing a spring crop.

        On a large scale there’s a lot of trade between the Big Arable farms and the animal guys – huge piles of stinky manure arrive about now and are ploughed into the stubbles, along with Limex. This includes digested food/garden/shop waste and digested human ordure, with strict regulations as to what crops the latter cannot be used on. After a while the soil smells almost sweet enough to be edible and contains masses of life which feed huge flocks of gulls that follow the cultivations, and continue to feed even huger flocks of rooks, jackdaws, more gulls, thrushes, lapwings, golden plovers etc. throughout the winter even as next year’s crops are coming through.

        A typical rotation might be two years wheat, one year oilseed rape, peas (usually profitable) or beans (sometimes not, but like the peas put nitrogen into the soil so are valuable for cutting down the fertiliser bill) then back into wheat. I remember when farmers could only dream of 10 tonnes/hectare, now that is commonplace and I think records are now around 16 – 18 tonnes/hectare. Of course twice as much crop from the same area with much the same sized roots suggests half the nutrition per tonne of starch, and grasses and annual crops are mainly shallow rooted. The old permanent meadows with perennial wildflowers in the grass have deeper and undisturbed roots which can pull up far more nutrients, which the cows and sheep are pleased to process into meat for us, and are less subject to damage by trampling and puddling. Because they are harvested during the winter, by heavy machines, sugar beet probably has by far the worst effect on soil structure. Like the spuds not grown here on the heavy clay, more on the lighter sands which require a lot of irrigation and fertiliser.

        Protein leverage is something worth a second look, and I suspect (though haven’t seen anything totally convincing as to mechanism) nutrient-poor foods may be another factor driving the overreating of carbs as the body tries to get enough of something that isn’t actually there, and conversely part of the benefit of LCHF may be higher levels of other nutrients along with the meat, unprocessed fats and veggies leading to less hunger and overreating. As someone said we are overfed and still malnourished.

    3. Jan B

      It’s not just humans. Watch chimps probing a bees nest with a stick to get honey. Our dogs loved sweet stuff – biscuits, cake, chocolate and cats too are rather partial. Of course, in the animal world sweetness is not so easily come by. I can’t actually call to mind the last time I probed a bees nest with a stick. It’s so much easier to buy it in a nice convenient jar.

      1. JDPatten

        Yeah. How about bees? They apparently need that sweet stuff for their own well being. Essential!?
        Makes me think that that vast amount of honey we take from them weakens them at large, making them susceptible to honey bee decline.

      2. Dr. Malcolm Kendrick Post author

        How about humming birds? They run blood sugar levels way up there – I had a look years ago, out of interest. Average blood sugar about three times that in humans. Wonder if they are all diabetic?

      3. JDPatten

        Three. Wow.
        When I’m stuck thinking something out, I like to look at the extremes. How about the other end? What’s the lowest blood sugar creature? The variously toed sloths? Tortoise?
        Another thought comes to mind. What’s it like to dine on diabetic poultry? Or beef? Sweet?

      4. Dr. Göran Sjöberg

        Jan, to my own experience the sweet tooth among dogs varies largely but among cats I have never heard about any cats attracted by sweets. Those who are visiting our garden are most certainly looking for rodents. Some of them we though give a treat of cream (sweet?) to encourage their presens.

      5. Jan B

        Hi Dr. Goran, Well, Benjamin was a Blue point Siamese so perhaps that made a diiference. He loved cake and peas of all things, perhaps because he like their sweetness. I always think Siamese are dogs manqué. He certainly was.

      6. chris c

        On the other hand dolphins, somewhere here I have a paper on dolphin metabolism which has them in an almost diabetic state, well insulin resistant anyway, not the broken pancreas part.

    4. Maureen H

      JD, it might be because in our distant past, we’d need to fatten up for winter, and the way to do it was to stuff ourselves with fruits and berries, honey too, in the fall. We wouldn’t have eaten them the rest of the year, they weren’t available.

      1. Jan B

        Maureen, I’m sure you’re right. I was thinking about this on my walk this morning, how we must all be evolved to eat whenever and whatever we can as hunger/food scarcity/famine was always lurking round the corner and anything sweet would stoke up the metabolic fires very readily.

      2. JDPatten

        Good! I like it. But not so distant past. I used to finish a large bag of corn crisps on my way home from shopping. Only in the late New England Autumn and winter. It can go to minus twenty-five Fahrenheit here.

      3. chris c

        Yes, the likes of thrushes which are mainly insectivorous, turn to berries in autumn and winter to gain body fat for migration, hard weather movements and just to maintain while the ground is frozen/snowed over.

        Conversely most seed-eating birds feed their young on insects as they need the fats and proteins for rapid growth. The species that still feed seeds to their young have far slower growing babies which spend far longer in the nest.

      1. Andy S

        Adult obesity predicted in almost all European countries by 2030
        Date:May 9, 2014
        European Society of Cardiology

        In reviewing the results, she said: “Our study presents a worrying picture of rising obesity across Europe. Policies to reverse this trend are urgently needed.”

        In almost all countries the proportion of overweight and obesity in males was projected to increase between 2010 and 2030 — to reach 75% in UK, 80% in Czech Republic, Spain and Poland, and 90% in Ireland, the highest level calculated.

  52. Marguerite Harris

    Hummingbirds… maybe exercise keeps them from getting diabetes?!
    They sure are hyper little critters. And in the wild, wouldn’t any animals with diabetes die out pretty fast, so not pass on those genes? Wild animals have to be so tough. Artificially bred dogs and cats get diabetes but I wonder if wolves and tigers do! I wonder if primitive man got diabetes, but I guess if so, those individuals would die fast and so not pass on the genes. Not sure if that fits.
    Not related really, but my grandma pretty much lived on “sweets”, Turkish Delight in particular, and lived well to 96, and wasn’t active! She was calm and happy, though.

    1. Jan B

      So many domestic cats and dogs eat junk pet food these days and never ending ‘treats.’ Dogs and cats need to “eat real food” too.

      1. HW

        I agree, Jan. Our cat came to us from neighbours who used to provide only cheap, grain-based food. She was thin, vomited frequently, had a poor appetite. In trying to work out what was wrong with her, we researched modern commercial cat foods and found they contain grain and soya fillers, PUFAs, and other processed nasties not naturally found in a feline diet. We have to buy pricier German brands of single protein, additive-free food. She supplements with mice and voles! Her lifelong digestive upsets resolved quickly.

    2. Gaetan

      Diabetes in wild life is a survival mechanism. For example, bears become diabetics before and during their slumber, when they wake up after a couple of months, the diabetes goes away.

      ”This insulin resistance allows the bears to break down their fat stores throughout hibernation, when they will not eat, drink or defecate for up to seven months. They survive on their fat before waking up, and begin to respond normally to insulin when they start to feed again.”


      1. Andy S

        “Why do humans respond differently when they put on weight to these bears?” asks Gwyn Gould at the University of Glasgow, UK. “If we can identify that, we could produce therapies for diabetes.”

        I believe humans and bears get fat for the same reasons, pack adipocytes full of TG. Humans could take a lesson from bears and practice intermittent hibernation, commonly called fasting. It is part of the Jason Fung protocol to reverse diabetes.

  53. chris c

    Overlooked point about this seemingly excellent book – Richard Bernstein wrote one of the best books on diabetes in general and there are a few recommended books on Type 1 by doctors.

    Most of the best books on Type 2 are by diabetics themselves – Gretchen Becker, Janet Ruhl, Alan Shanley et al. Unless anyone knows different, this is the first recommendable book on Type 2 actually written by doctors. Most of the others just peddle high carb low fat high drugs and inevitable decline – unless you go back half a century or more.

    I await the inevitable explosion of horror from dieticians and the Usual Suspects when this hits the market. Expect lynchings.

  54. Mick Smith

    it really goes to show how much of a strong choke-hold that big pharma has in both the UK and other countries whereby they allow bad advice to be pushed via the NHS just to allow the sale of their drugs. Rotton to the core.
    Much of the nonsense dietary advice of today came from the BS ancel keys report all of these years ago. John Yudkin wrote the correct data at the same time but was generally ignored. Even medical books from the 1920’s suggest eliminating carbs to cure diabetes.

  55. Martin Back

    The Kiatavans are famous for their good health on a starchy diet. It might be high-carb, but it is also quite varied. Here is a Kitavan on what he eats:

    “The common food that the Kitava islanders eat to stay alive for the next day are tuberous such as:
    Yams (teitu, kuvi, kasiwena, kwanadu, gorina(sweet potato), bisia, taro (uni and viya), including wild and domesticated greens like unonu, gayasu, yakumalasi, beans, nuweta, yakirodi, including fruit from pawpaw, pumpkin, water melon, lemon (kamokuku), natu, yaku, mango, breadfruit, gwadira, sasana, seida (okari-nuts), coconuts, plus with protein not always (daily basis) such as fish (main one), pork (pig — rarely), chicken — rarely), crabs and shell fish.
    Thank you,
    Kaigabu Kamnanaya (Kitava Island)”


    1. Gaetan

      This is not a high fat diet for sure.
      And yet the Kitavans still exist.
      69% of their calories come from carbohydrate, 21% from fat and 10% from protein.
      and have undetectable levels of cardiovascular disease (CVD)

    2. Dr. Göran Sjöberg


      The Kitavans are often used as a Popperian refutation of LCHF but I agree with Stephen here about the other “culprits” involved. As I remember the Kitavans had not developed any insulin resistance so they could handle all those carbs. Protein in moderation and preferably from seafood is what we LCHF-adherents also usually advocate.

      To my experience LCHF kicks in when one for whatever reason has been trapped in the metabolic syndrome where obesity for sure is one of the main signature. It is at this point you can not any longer “handle the carbs”.

      It is today hard to “reprogram” me and my DT2 wife from LCHF when after our “conversion” her vision was fully restored within a year (e.g. her glaucoma) and as her severe peripheral neuropathy is today only an unpleasant memory. As a “sidekick” we lost our overweight, myself 20 kg and my wife 12 kg within that year.

      With Hippocrates we are today, contrary to the medical establishment, convinced that “food is medicine”.

      1. Stephen T

        Goran, I agree.

        If Kitivans, or any other of distant people whose life and diet has no resemblance to ours, are eating their native diet, they are likely to be fine. They are well adapted to that diet, eat sparingly, have an overnight fast, and consume no western rubbish, such as sugar-laden junk, sugary drinks, wheat and vegetable oils. There’s room for broad agreement on most or all of this.

        We need to be careful with distant and very different peoples. The Okinawans are often held up as examples of the vegetarian way, yet they are known as “Pig eaters” in Japan and cook as much as possible in lard. They share many good habits with Kitivans.

        More instructive, I think, is to look at pacific islanders who have adopted sugary junk and all the other bad parts of the western diet. Look at the truly astonishing rates of obesity and diabetes in the Samoan islands. I saw a documentary recently where an obese Somoan woman was close to having one of her feet amputated, yet was given a burger, bread, chips and coke for her lunch.


      2. Martin Back

        The Kitavans are not overweight. This might have something to do with the surprising (to me) fact that potatoes are the food with the highest satiety index, and by quite a long way. I can’t find any official data on the satiety of yams and sweet potato, but unofficially a bodybuilding site rates sweet potato about as satiating as potato. So although their food is high carb, they are not tempted to consume more calories than necessary.

      3. Dr. Göran Sjöberg


        Talking potato I love it but it is not part of my lifestyle today. On occasions I eat a few but if I would go for my true “desire” I don’t see any “limit”. With butter it is a real treat though to be avoided in my present world.

      4. Gaetan

        i can maybe eat one normal sized potato after that i am full. So i agree with Martin on this.

        i am also incline to say HFCS and derivatives are the culprits mostly, along with all the pesticides and herbicides. They have to disturb our endocrines glands, how is our body supposed to deal with poison? Same with Soy and many vegetable oils, they all go thru factory processes that are disturbing to say the least, to make them “edible”.

      5. Martin Back

        I don’t have a problem with the LCHF diet; it influences the way I eat today. But in ten years’ time I fear it will be in the dustbin of history alongside Atkins, Pritikin, South Beach, Zone, and all the others. Already in South Africa I know more people who have stopped Noakes’s Banting diet than are starting it.

        The thing with a staple diet is we know that people stick with it for the long term. In fact, I would be interested to know what factors influence the development of a staple diet. Obviously, wide availability of the food is one factor, but there must be many more.

        By intelligently exploiting the factors it might be possible to nudge the majority of people in the direction of making healthier food choices.

      6. Andy S

        Martin, The reasonI I see people going LCHF is motivated by desire to avoid a looming medical problem, one is a desire to avoid insulin injections. Normally people tend to fall back into old bad eating habits and have to restart. Daily motivation like reading this blog helps until a healthy eating pattern is established. Science on “healthy diet” is advancing, have to keep up to date. General rules are good but effect of food choices on an individual is what counts.

      7. Andy S

        Dr. Goran, there could be a possible connection with Kitivans and “food is medicine” and that is the health of the soil. A healthy soil will produce healthy food. There is a trend to grow vegetables hydroponically (tomatoes, cucumbers, peppers, lettuce etc.). Glyphosate chelates soil minerals and affects life of microbes that live in soil and interact with plant nutrient uptake. GMO Bt corn can affect gut microbes. Pesticides and fungicides are universal. Adopting a Kitivan diet by sedentary people in an urban environment using commercially grown fruits and vegetables might not give the expected results.

      8. Dr. Göran Sjöberg


        I agree with Andy here.

        If you have tried LCHF as a diabetic for a while and be able to get off all medication and perhaps lost 20 kg or more there is a strong drive to continue. There are about 500 millions of diabetics worldwide so my guess is that some of them (10 % ? = 50 million) will catch on and stick with this LCHF life style even with the banning from the present hostile nutritional establishment.

        Some of us don’t want to be fooled by the authorities.

      9. Dr. Göran Sjöberg


        As far as I remember most (all?) indigenous peoples who have adopted the “western” high carb sugary diet have rapidly deteriorated metabolically – more rapidly than the “western” population. It has been speculated that they are more vulnerable due to evolutionary (questionable!) or epigenetic adoption (more probable!).

        Weston Price has shed fundamental light on this fact but also Gary Taubes.

      10. Bill In Oz

        Certainly this has been true of Australian Aboriginals when the last of isolated tribal groups came in from the desert in the 1980’s they were generally fir with no diabetes or CVD. Adopting a high carb. & sugar diet has had disasterous results…

      11. Martin Back

        Something I just learned about GMO crops. You probably know that plant roots are in a symbiotic relationship with mycorrhizal fungi in the soil — the plants feed leaf-generated sugars to the fungi, and the fungi feed minerals to the roots from far beyond where the roots can reach. Win-win.

        Well, it turns out that the toxin produced by the Bt gene in GMO foods affects the fungi, and GMO plants are unable to form the symbiotic relationship, which results in them being nutritionally poorer than conventional plants.

      12. chris c

        Insulin resistance can be reversed, or if you prefer, sensitivity regained, but once you have lost enough beta cells they don’t grow back.

        An undamaged pancreas can put out about five times as much insulin as normally required. Once diagnosed diabetic that would reduce to about 2 1/2 times, so your ability to deal with high carb loads and even temporarily increased IR is limited.

        If diagnosed late in the process, or if you continue to eat the carbs you are told to eat, you are doomed.

  56. Errett

    Lean RED MEAT and Resistance Training leads to improved health-related quality of life—1.3 grams/kg/day———–4 month training period—–

    Br J Nutr. 2017 Jun;117(11):1550-1559. doi: 10.1017/S0007114517001507.

    Effects of progressive resistance training combined with a protein-enriched lean red meat diet on health-related quality of life in elderly women: secondary analysis of a 4-month cluster randomised controlled trial.

    Torres SJ1, Robinson S2, Orellana L3, O’Connell SL1, Grimes CA1, Mundell NL1, Dunstan DW1, Nowson CA1, Daly RM1.
    Author information

    Resistance training (RT) and increased dietary protein are recommended to attenuate age-related muscle loss in the elderly. This study examined the effect of a lean red meat protein-enriched diet combined with progressive resistance training (RT+Meat) on health-related quality of life (HR-QoL) in elderly women. In this 4-month cluster randomised controlled trial, 100 women aged 60-90 years (mean 73 years) from self-care retirement villages participated in RT twice a week and were allocated either 160 g/d (cooked) lean red meat consumed across 2 meals/d, 6 d/week or ≥1 serving/d (25-30 g) carbohydrates (control group, CRT). HR-QoL (SF-36 Health Survey questionnaire), lower limb maximum muscle strength and lean tissue mass (LTM) (dual-energy X-ray absorptiometry) were assessed at baseline and 4 months. In all, ninety-one women (91 %) completed the study (RT+Meat (n 48); CRT (n 43)). Mean protein intake was greater in RT+Meat than CRT throughout the study (1·3 (sd 0·3) v. 1·1 (sd 0·3) g/kg per d, P<0·05). Exercise compliance (74 %) was not different between groups. After 4 months there was a significant net benefit in the RT+Meat compared with CRT group for overall HR-QoL and the physical component summary (PCS) score (P<0·01), but there were no changes in either group in the mental component summary (MCS) score. Changes in lower limb muscle strength, but not LTM, were positively associated with changes in overall HR-QoL (muscle strength, β: 2·2 (95 % CI 0·1, 4·3), P<0·05).

    In conclusion, a combination of RT and increased dietary protein led to greater net benefits in overall HR-QoL in elderly women compared with RT alone, which was because of greater improvements in PCS rather than MCS.

    CRT control resistance training; HR-QoL health-related quality of life; LTM lean tissue mass; MCS mental component summary; PCS physical component summary; PRT progressive resistance training; QoL quality of life; RT+Meat resistance training plus lean red meat; SF-36 SF-36 Health Survey; Dietary proteins; Elderly women; Interventions; Quality of life; Red meat; Resistance training
    PMID: 28721837 DOI: 10.1017/S0007114517001507

    1. AH Notepad

      Regrettably, even if true, these studies seem to require a regime which is too complex for everyday living, even for the bright people. For the less able it becomes a non-starter. When coupled with the usually tiny benefits, which have to be quoted in relative terms to make them attractive, it makes it yet more unlikely to be taken up.

    1. Andy S

      Errett, looks like mitochondria control ageing. Unfortunately statins affect bone marrow derived stem cell function and thereby accelerate ageing. Stem cells are needed to replace old and dying cells. Something to discuss with your health care provider.

      how statins inhibit stem cells google result:
      “The researchers were interested in the fact that macrophages (the body’s natural cellular “scrubbers”), which are responsible for the artery plaque rupture that leads to heart attacks, were less likely to be created by MSCs in the presence of statins. Since fewer macrophages could mean less plaque ruptures, this could be a potentially good thing to prevent heart disease. However, what other effects do statin drugs have on MSCs? Regrettably the researchers also found that the drugs hurt the MSC’s so that they could no longer differentiate into bone and cartilage cells. Statin drugs also increased the aging and death rate of MSCs and reduced DNA repair abilities of the stem cells. Basically, statin drugs were a kind of stem cell poison.”

      1. Bill In Oz

        Andy S, no doubt mitochondria play a role but have you seen this new s report a day or so ago ?

        It seems that scientists in New York delayed aging in mice by injecting miRNAs from embryo mice.

        This may also explain why the transfer of young blood to older mice in some trials a couple of years ago had a ‘youthing’ effect on older mice.


        This story was also published in New Scientist yesterday but I can no longer access it there. NS is suppressing this story. Nor very scientific.

  57. Jean Humphreys

    Slightly off topic and by the way. When my BG was found to be high, I was given a glucose tolerance test. But I was’t. I turned up, fasted and was presented with most of a bottle of Lucozade. So they had done the sum and I got the gluose, but what else? Certainly carbon dioxide and when I take a moment to have a look at label in the supermarket, I will surely find goodness-knows-what minerals.
    All history now since I stopped taking the thiazide that was failing to keep my BP down. GP looked at my BG readings and unticked the diabetes box on his system.
    Ignoring Nice Nursey and cutting down the carbs did lot of good, even before I stopped the offending medication.

  58. Richard

    I remain frustrated to read so frequently dietary recommendations that are universal. There is so much published evidence that one’s ABO blood type and secretor status affect one’s digestion. In particular, blood type A secretors have low Intestinal Alkaline Phosphatase, so handle high fat diets poorly. That’s why so many with type A have been reported to do poorly on the Atkins Diet.

  59. Errett

    Interesting that Vit. C had no positive effect on pulmonary capillary permeability resulting from Sepsis and exposure to LPS—-however when combined with Hydrocortisone they dramatically improved outcomes—-


    Chest. 2017 Jul 21. pii: S0012-3692(17)31276-X. doi: 10.1016/j.chest.2017.07.014. [Epub ahead of print]

    Hydrocortisone and Ascorbic Acid synergistically prevent and repair LPS- induced pulmonary endothelial barrier dysfunction.
    Barabutis N1, Khangoora V2, Marik PE2, Catravas JD3.
    Author information

    Sepsis refers the dysregulated host immune response elicited by microbial infections resulting in life-threatening organ dysfunction. Sepsis represents a medical challenge, since it is associated with a rate of death as high as 60%. Septic shock is strongly associated with vascular dysfunction and elevated pulmonary capillary permeability. We recently reported that the combination of hydrocortisone (HC), ascorbic acid (VitC) and thiamine dramatically improves outcomes and reduces mortality in septic patients. In the present study we provide experimental evidence in support of the hypothesis that the combination of HC and VitC enhances endothelial barrier function.

    Human lung microvascular endothelial cells were exposed to LPS in the absence or presence of HC and VitC.

    LPS alone induced profound hyperpermeability, as reflected in decreased values of transendothelial electrical resistance (TEER). VitC alone did not exhibit barrier enhancement properties nor affect the LPS-induced hyperpermeability. Similarly, HC alone exhibited only a minor barrier enhancing and protective effect. Conversely the combination of HC and VitC, either as pre- or post-treatment, dramatically reversed the LPS-induced barrier dysfunction. The barrier protective effects of HC+ VitC were associated with reversal of LPS-induced p53 and phospho-cofilin downregulation and LPS-induced RhoA activation and MLC phosphorylation.

    These data provide a novel mechanism of endothelial barrier protection and suggest one possible pathway that may contribute to the therapeutic effects of HC and VitC in septic patients.
    Copyright © 2017. Published by Elsevier Inc.
    PMID: 28739448 DOI: 10.1016/j.chest.2017.07.014

    1. AH Notepad

      Interesting. Though a study by Fowler et al, did find benefits usig vit C alone http://europepmc.org/articles/Pmc3937164 and Pubmed 24484547 2014. Suzanne Humphries commented in one of her videos that she would have used significantly higher doses of vitamin C and would have expected earlier recovery as a result. NICE do not recommend vit C treatment and so it is difficult to get a UK clinician to use the treatment. So much for Clinical Excellence.

      1. Bill In Oz

        I would like to hear more on Vitamin C. In the early 1970’s I heard of Linus Pauling and his work on Vitamin C. In fact I still have his book “The Healing Factor” published in 1972, on my library shelf. Since then I have always taken Vitamin C whenever a Cold tries to get a hold on me. – like this morning !
        But since then conflicting ‘stories’ about it’s role in Diabetes and in CVD and other diseases have emerged. Dr Kendrick, I wonder if you can point us at research papers, books or trials that are worthy of our attention ? There is so much which frankly is written in a way that simply cobnfuses or misinforms.

  60. David Bailey

    This study showing that alcohol (at least wine) protects against diabetes is interesting:


    Since wine always contains some sugar, this is particularly remarkable!

    As already discussed, moderate alcohol consumption seems to protect against a variety of illnesses. Is it possible that a lot of the effect is that taken in moderations – typically over the evening meal – it is pretty effective at reducing stress?

    Are there specific biochemical reasons why moderate alcohol might reduce diabetes?

  61. Randall

    Fructose raises insulin and blood sugar dramatically, but the effect is delayed by several dayshttp://www.wheatbellyblog.com/2017/07/high-fructose-corn-syrup-wolf-sheeps-clothing/

  62. Randall

    The major cause of CVD is atherosclerosis, which is a progressive chronic inflammatory disease This accumulation and oxidative or enzymatic modification of the cholesterol-rich lipoproteinsactivates endothelial cells to produce pro-inflammatory molecules such as adhesionmolecules and chemotactic proteins. the role of cholesterol crystals (CCs) in the development,progression and clinical outcome of atherosclerosis was underestimated for a long time Although a pathogenic role for crystalline cholesterol was already suggested in the 1980s, the potential contribution of CCs to atherosclerosis progression was largely ignored The answer to CC is cyclodextrins which are are included in the U.S. food and drug administration’s (FDA) “generally recognized as safe” (GRAS) list of compounds and are generally accepted as food additives. http://hss.ulb.uni-bonn.de/2016/4524/4524.pdf

    1. Martin Back

      Probably because drinkers don’t like sweet, sugary foods. They prefer salty and meaty or fatty foods. Check out the snacks on any bar counter.

      1. Gaetan

        it depends, i drink regularly, and dark brown beers made with flavors of caramel, chocolate, coffee, malts etc. are among my favorites. very sugary for a beer. but i like mostly all beers except the popular commercial ones, like bud, coors, don’t know how people drink that stuff.

        The results and explanations from drinking alcohol is a bit like the effect of the Sun on the human body, it dilates blood vessels and makes us relaxed.

  63. Jll

    Funny how – well, not really in view of the consequences – what goes around, comes around. As a newly qualified dietitian in the late 60s/early 70s, LCHF was exactly the advice that we gave our diabetic patients, tinkering it according to whether the patient was on medication or not and according to body weight. Diabetes was well controlled. Fast forward to the change to HCLF in the 80s in accordance with “expert advice” from the scientists – and we all know what happened. Disaster! Thanks for a brilliant blog.

    1. Jan B

      Agreed. In the 50s when I was diagnosed and even much earlier when my grandmother was diagnosed the standard advice was HFLC though it wasn’t called that, of course, though the basic principle was the same. What a disaster indeed.

    2. chris c

      Yes and how many of your diabetics failed to progress, fall apart and die prematurely compared to the present day ones? I know a few who are still around and in their eighties, and when they have fallen off the perch it has generally not been from “diabetic complications”

      1. Clathrate

        Robert, same here. The website still shows that ‘few left’ of the Limited Edition Hardback – has anyone received the Hardback yet?

      2. Robert Dyson

        Reply from publishers –
        Hello Robert,
        You should be receiving your book any day now as it was posted out over the weekend.
        Hopefully the wait will be worth it when it lands with you.
        Very best wishes

      3. Robert Dyson

        The Diabetes book arrived this morning, 17th.
        Opportune. I have a hospital panel meeting this afternoon. I will take it along and flash it! See if I can generate more sales.

      4. Robert Dyson

        I emailed the publishers this morning. I will post the reply I get. As far as I could see Amazon were only offering on Kindle today.

  64. Jennifer.

    Hardback arrived on 18th, and have completed reading it…once quietly to myself, and again to my husband so that we could discuss contents.
    It has given us both the encouragement to reduce carb intake a bit better than we have been doing lately….you know how it is….we get complacent, and before you know where you are…..the carbs are taking over again.
    It is an excellent read…..and would recommend it to diabetics and non-diabetics alike.
    Thanks to all concerned.

  65. Anne

    I still haven’t got mine – ordered Hardback edition 16th July. Publishers said sent out 1st class last week or maybe this Monday (not priority shipping unless that’s what 1st class means) and that some are taking as long as a week to arrive 😦

  66. Anne Lucas

    Still haven’t received my hardback copy and I know I was one of the first to order. I know Australia is in the sticks but this is ridiculously long. Now that I have posted this maybe it will arrive tomorrow. 🙂


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