Category Archives: Diet & Health

High cholesterol low heart disease – The Sami

(Of course, it is a paradox…. Paradox number 112, or thereabouts)

As a nod to a regular contributor to this blog, who lives not far from the area, I thought I should write about the Sami. When I was younger we would probably have called the Sami ‘Eskimos’ – because anyone who lived north of the Arctic circle and dressed in fur was, clearly, an Eskimo. This term is now, I believe, a dread insult. A bit like calling a Scotsman an Englishman, or an Austrian a German. Or, I believe, a Canadian an American. Wars have been fought over less.

The Sami, unlike the Inuit, who reside mainly in North America, live in the North of Scandinavia: Northern Sweden, Norway and Finland and suchlike. In what used to be called Lapland. However, we now call the Lapps, the Sami (please keep up), so do they live in Samiland?

What I know about the Sami is that they obviously enjoy the cold, eating reindeer and smoking. They must do other things too, but I am not entirely sure what. This makes them very similar to the Inuit, who also enjoy: the cold, eating seals, caribou, and smoking. Neither the Sami, nor the Inuit, have the least interest in eating vegetables. I suppose there may be the occasional frozen carrot – or suchlike – from Iceland (that is a UK based joke).

Apart from not eating vegetables, smoking, and eating lots of fat, the Inuit and the Sami have one other thing in common. You can probably guess what it is. Yes, they both – those that live a traditional lifestyle anyway – have a very low rate of death from heart disease.

This came to my attention during an e-mail discussion I was having about whether the human brain required any glucose – at all. Those taking part were the usual suspects, Richard Feinman, Gary Fettke, Nina Teicholz, Jimmy Moore, Jason Fung, Tim Noakes etc. [Yes, good bit of name dropping there].

The consensus was that the human brain could use Ketone bodies for much of its energy requirement. However, there was an absolute need for about forty grams of glucose per day. The final statement on this matter, the one everyone seemed to agree on anyway, was as follows:

1)     The brain requires no dietary glucose. It has a requisite use of 40 grams/day, but these grams can easily be provided from glycerol, and normal ingestion of not particularly high amounts of protein in a high fat, zero carbohydrate diet.

2)     But this is a time dependent situation. Short term fasting will not be a problem for most otherwise healthy people. However, more prolonged starvation will eventually kill you as the brain will pirate 40 grams of glucose/day from protein and lipid, until you have neither fat stores, nor adequate diaphragm or heart muscle left to survive.

Don’t worry, there were about a thousand papers quoted in creating these statements, so the science seems robust. This discussion started because I had an interest in how hunter gatherers, who ate no carbohydrates, kept their brains going. What was the mechanism by which the Massai, Inuit and Sami, power their brains with glucose, if they don’t eat any carbohydrates?

Well, it seems that you can get a certain amount of glucose from fat. Fat is made up of triglycerides, and each triglyceride contains three fatty acids and one glycerol molecule. Two glycerol molecules stuck together (by the liver) makes one glucose molecule.

In short, pure fat does contain some glucose, which can be used to power the brain. However – assuming you are eating no carbs – the brain requires more glucose than can be provided by the glycerol held in triglycerides. Thus, you still need to convert some dietary protein into glucose. If you are not eating any food at all, the body will need to break down muscle to get at the protein required to synthesize glucose.

To cut a very long story short, the end point of the discussion was an agreement that you do not actually need to eat any carbohydrates to remain heathy. The body, and the brain, can get all the glucose it requires from glycerol and dietary protein.

The reason why I was interested in this issue was that ‘the absolute need for carbohydrates’ is a ‘fact’ that is thrown at me from time to time by ‘experts.’ I have always known they were wrong, because there are people e.g. the Massai, who never eat any carbohydrates, and remain far healthier than any expert I have ever cast my eyes upon. However, I wanted to be sure of the facts.

Anyway, time to return to the Sami. For, during this lively discussion, someone posted up two papers on the Sami that I had not seen before. Both papers noted that the Sami, despite having very high cholesterol levels, a high level of smoking, a high fat diet and almost zero carbohydrate intake – and suchlike – had a very low rate of cardiovascular disease.

This was particularly interesting for a couple of reasons. Firstly, most of the Sami live in Finland, and the Finns – at one time – had the highest rate of heart disease in the world. Not only that, but the Sami live in an area of Finland, North Karelia, which had the highest rate of heart disease in Finland. The worst of the worst.

In addition, the Sami had considerably worse ‘traditional’ risk factors for heart disease than the surrounding population. Higher cholesterol and LDL, high fat diet, far more smoking etc.

‘The finding of high cholesterol and high prevalence of smoking the Sami area are compared with the reference rate, and high cholesterol in the Samis and Finns in the north, conforms with similar observations. in studies performed previously. As the classic risk factors indicate a high risk of CHD in the north, other factors, possibly the antioxidants, are important in the low CHD mortality there.’1

[Antioxidants and their impact on CHD were studied in the Heart Protection Study (HPS), and found to have no effect on CHD whatsoever. Whilst this study was done by Rory Collins, and has many issues, the data on the lack of impact of antioxidants on CHD appear robust].

Other researchers have also tried to establish why the Sami have such a low rate of CHD/IHD. As noted in the paper ‘‘Low mortality from ischaemic heart disease in the Sami district of Finland’:

An exceptionally low mortality from IHD was found here in the Sami district of Finland and an exceptionally high mortality in a neighbouring Finnish area, a 2-3-fold contrast or even wider, depending on age and time. No difference in IHD of this magnitude between areas located so close to each other has previously been described in the literature.’2

Of course, they looked for the reasons.

‘Reasons for the rarity of IHD in the Sami district of Finland

Our current knowledge of cardiovascular risk factors cannot explain the low mortality from IHD in the Sami district of Finland. Serum cholesterol is, in fact, relatively high in the far north of Finland, and it is higher in the Sami than the Finns, the same being true of the prevalence of smoking, while the low blood pressure frequently found in the far north and among the Sami would be insufficient to cause any substantial reduction in the risk of IHD. Similar differences in serum cholesterol, blood pressure and smoking have also been found between Norwegian Sami and Norwegians of Finnish ancestry. Serum high density lipoprotein cholesterol (HDL)is usually similar in both ethnic groups, although a Finnish study found even lower HDL-total cholesterol ratios in the Sami, which would indicate an elevated risk of IHD… The high serum cholesterol in the Sami can be attributed to their fatty diet.’

In short, the Sami live in area of Finland that had the highest rate of heart disease in the world. Their risk factors were worse than the surrounding population (LDL 4.45mol/l on average), yet their heart disease rate remained very low. It was postulated that this was due to a high intake of antioxidants, but the impact of antioxidants on heart disease has been subjected to large double blind placebo controlled trial, and antioxidants were found to have no impact on heart disease.

At this point you may cry, enough of finding populations that eat a high fat diet, have high LDL levels and low rates of heart disease. It is like shooting fish in a barrel. Not that the experts pay the slightest attention to such contradictory facts. They merely label such findings a ‘paradox’ and move on. But I thought it was interesting. Another nice shiny nail in the cholesterol hypothesis. ‘You call it a paradox, I call it a contradiction… let’s call the whole things off.’

Next, my series on what truly does cause heart disease continues.

1: ‘High serum alpha-tocopherol, albumin, selenium and cholesterol, and low mortality from coronary heart disease in northern Finland’: P. V. LUOMA, S. NAYHA, K. SIKKILA & J. HASSI. Journal of lnternal Medicine 1995; 237: 49-54

2: Simo Nayha: ‘Low mortality from ischaemic heart disease in the Sami district of Finland.’ Soc. Sci. Med. Vol. 44 No. 1, pp. 123-131, 1997

P.S. I am feeling much better, thanks for those who were concerned over my welfare.

Those who promote a high fat low carbohydrate diet are silenced around the world

For various reasons, including a chest infection that just will not clear, I have been quiet recently. (When you are physically unwell, your brain doesn’t work. At least mine doesn’t). I have coughed more in the last six weeks than in the rest of my life put together x 10.

Anyway, my brain cleared enough to read an e-mail by Gary Fettke, who has promoted the high fat low carb lifestyle for a long time. He, like many others has been ruthlessly attacked for doing this. Professor Tim Noakes was accused of exactly the same thing, and the South African authorities dragged him to court in order to silence him (not yet sure of the verdict).

Gary Fettke is an Australian orthopedic surgeon who has suffered the same fate as Tim Noakes. However, in Australia it seems you can be accused, tried and found guilty without having any chance to defend yourself in person. This is not a court of law, but the Australian Medical Board (AHPRA) who can – as with the General Medical Council (GMC) – strike you off being a doctor. Which for a doctor is a gigantic punishment.

Previously, Gary had been told that he could not comment on any area of nutrition for advocating a reduction in sugar intake (to what are now WHO guidelines). Of course, as with all such cases the ‘authorities’ changed the goalposts from a discussion on low carb high fat (LCHF) and turned the discussion into something else.

Namely, that Gary Fettke, as an orthopaedic surgeon should never give advice on dietary matters. “The fundamental fact ‘is’ that you are not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic as a medical practitioner.”

This of course allows the AHPRA to silence him, without discussion any of the science, and no chance of any appeal. So, his suspension about discussing any matters of diet has now been turned into a lifelong ban. Please read Gary’s e-mail:

Hi everyone,

It is with frustration that I write to inform you that I have been ‘silenced’, forever, by the Australian Medical Board, known as AHPRA.

We have a draconian system here in Australia where anonymous notifications can go in and they are investigated for public safety. The accused can only submit material but never have right of reply. It is a star chamber.

I recently got to present that ‘opinion’ of the process and the fabricated evidence at a Senate Inquiry. My evidence on the failings of AHPRA was granted parliamentary privilege which allowed a tell all opportunity. Within a few hours I received an email final determination of the 2 ½ year investigation. Coincidence or just another kick in the guts?

My verbal submission and the whole issue of bullying and harassment in the hospital system is linked from http://www.nofructose.com/introduction/senate-inquiry-into-medical-complaints-process-in-australia/

My first notification in 2014 was from an anonymous dietitian for me advocating cutting back sugar intake to what is now the WHO recommendations. Behind closed doors, with no right of reply or appeal, the goal posts shifted and I was investigated for the whole LCHF concept, for being disrespectful to health professionals (the Dietitians Association of Australia and the Heart Foundation, but never an individual) on social media and for failing to disclose a conflict of interest (COI) in our Nutrition for Life Centre, whilst on social media.

The good news is that AHPRA have decided NOT to argue the LCHF concept. I submitted enough material for a thesis and they have accepted that LCHF may be that the benefits of the LCHF lifestyle become the accepted best medical practice.

The central issue for my silencing has been that my primary medical degree and my further qualifications as an Orthopaedic Surgeon are not satisfactory to give nutritional advice. “The fundamental fact ‘is’ that you are not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic as a medical practitioner.”

If it wasn’t so serious it would be farcical. This decision is non-appealable under National Law. The determination is life long and by its wording, does not allow me to even do research in the area or gain further qualification because that would involve me communicating in the area of nutrition. The only thing I have not clarified is if it affects international boundaries.

We have put up the post this morning re the AHPRA decision and the launch of our community fund to keep the LCHF message going

The web page is

http://www.nofructose.com/introduction/help-be-a-voice-for-lchf-after-gary-is-silenced/

and the Facebook one is off Belinda Fettke No Fructose

https://www.facebook.com/belindanofructose/posts/1175659919195124

The other parts of the AHPRA decision I can live with.

I will not force anyone to eat LCHF, not that I ever did or ever could.

I will show respect to the medical profession (doesn’t stop me from thinking otherwise).

The COI allegation is unproven as I do declare my vested interest for all patients that I send to Nutrition for Life. I admit guilt for not doing that in social media but the doctor/patient relationship is not defined in that context. I pointed out to AHPRA that they shouldn’t be applying jurisdiction in an area that is undefined. That went down like a lead balloon.

I also pointed out that AHPRA don’t govern nutritional advice in Australia. Another lead balloon.

I had a recent notification, again from an anonymous dietitian, and have been investigated for ‘inappropriate’ reversal of someone’s Type 2 Diabetes and was also reported for what I was ‘about to say’ at a hospital food national conference. AHPRA actually asked me for a copy of my speech BEFORE I gave the talk. I refused as it was an infringement of the right of free speech.

AHPRA have just this week decided to close that investigation but have warned me that they will be observing me to see if a ‘pattern of behaviour’ continues, presumably in relation to reversing more patients’ diabetes.

I hear rumours that I have ‘attacked’ health professionals at a personal level – that is simply unfounded and I think started by some naysayers. Alas, I am having some sh!t thrown at me at times. If you hear something, then let me know please.

If this sounds like a horror story, it is. I honestly thought that this would just fade away but strange things do happen when you upset the ‘industry’. Just see what’s happening with Tim Noakes. The only thing in Tim’s favour is that it has gone to court. Mine is a closed process with no right of appeal, unless I can continue to have politicians assist.

My next step is to challenge the process via more closed groups and that will be years of tying me up. I am going the public awareness path as the finding lacks the common-sense conclusion. We are liaising with some media channels and politicians. It’s all we can do.

Any support would be appreciated. Happy to liaise. Feel free to forward this email as it is.

Cheers.

Gary

Gary Fettke
Orthopaedic Surgeon
M.B.,B.S.(University NSW), F.R.A.C.S.(Orthopaedic Surgery), F.A.Orth.A.

Science evolves by being challenged. Not by being followed. @thegaryscience

If you think this is all completely ridiculous, then please circulate widely, and make as much noise as possible.

What causes heart disease part XVIIII

Diet?

As I have written this series of blogs I have noted with interest the comments that people have come up with, and the discussions that have followed. It is interesting, though not unexpected, that almost everyone has focussed, almost entirely, on diet, and little else.

There are those who are utterly convinced that the cause of cardiovascular disease is a high carbohydrate diet. There are others who argue that this is not the case. There are also many who promote various dietary supplements, and vitamins and suchlike.

Within the mainstream, the discussions also seem to focus almost entirely on diet [and the effect diet has on cholesterol levels in the blood]. Over the years the ‘experts’ have moved on from cholesterol in the diet to saturated fat, to saturated/polyunsaturated ratios, to Omega-6 to Omega-3, to even or odd chained saturated and polyunsaturated fats… and on and on and on.

Sixty years ago Ancel Keys proposed the diet-heart hypothesis of cardiovascular disease. He started by stating that cholesterol in the diet raised cholesterol levels, which then cause cardiovascular disease. He ended up stating that saturated fat raised cholesterol levels and, well, you know that last bit. At least he only changed direction once.

Juhn Yudkin was Keys’ main rival in the diet-heart stakes. He stated that is was sugar in the diet that was the culprit. Unfortunately, Ancel Keys was a far better political operator and self-publicist. So he crushed Yudkin and won the argument. At least he won it for a while. Now, more and more people are saying that Yudkin was right all along.

Whatever you may think of Ancel Keys, and my thoughts should never be put down on paper without significant filtering out of swear words, he certainly managed to set the agenda for all discussions that followed. The agenda being that cardiovascular disease is caused by ‘something’ in the diet. Thus, diet has become playing field, and almost everyone fights here. It is this in the diet, not that. It is that, not this.

The problem I have here is that I do not believe that diet has much of a role to play in cardiovascular disease. There is evidence that vegetarians can live long, long and healthy lives. There is evidence that meat eater live long, long and healthy lives. In the West, we are eating more and more sugar and carbohydrate and the rate of cardiovascular disease falling. France maintains a very high saturated fat diet, and their rate of cardiovascular disease also falling.

I read the Blue Zones, which looked at people who live the longest, and I can see nothing whatsoever in the diet that links them together. Although the authors made various attempt to suggest that a vegetarian diet was healthy, the evidence does not stack up to support their assertions.

Of course I will be told that is not a simple as this. We need to look at sub-fractions of monounsaturated fats, or the glycaemic index, or grass fed this, or grain fed that or the specific impact of fructose on lipogenesis and insulin production…. On and on it goes. I sometimes feel that a complexity bomb has been thrown at CVD the purpose of which is to fractalise the debate.

Big fleas have little fleas,

Upon their backs to bite ’em,

And little fleas have lesser fleas,

and so, ad infinitum.

If there is anything, powerfully linking diet to cardiovascular disease, then I cannot see it. The only link that I can see is that people who eat a higher carbohydrate diet are more likely to become obese and develop diabetes. Or, perhaps I should say, develop diabetes and become obese. [A comment I may have to explain at some point].

As people who have diabetes are more likely to die of CVD then it seems highly sensible for those with diabetes to reduce carbohydrate consumption. This is also true of those who seem to be relatively intolerant to carbohydrates. Perhaps I should rephrase this as ‘people who tend to produce more insulin in response to diabetes.’

Blast, again here I am finding myself dragged into the diet debate. It seems impossible to release the discussion from this intellectual black hole. The meme is firmly entrenched. CVD is primarily to do with diet. Ancel Keys may be, posthumously, about to lose the argument on saturated fat However, he certainly succeeded in anchoring almost all discussions within the wider hypothesis that CVD is primarily due to diet.

It is not.

A Swiss Investment Bank gets it completely one hundred per cent right

[Yes, that’s right, a Swiss Investment Bank!]

A kind reader of my blog pointed me at a report by Credit Suisse entitled ‘Fat, the New Health Paradigm.’ I suppose I half expected the usual. Saturated fat causes heart disease, cholesterol causes heart disease. ‘We are a respected bank, what the hell did you expect – that we would rock the boat in some way. Don’t be daft.

What seems to have happened is that they actually looked at the evidence in this area and came to the conclusion that the current dietary advice is utter bollocks and is not based on anything at all. I shall start with a few key points from the Introduction:

‘Saturated fat has not been a driver of obesity: fat does not make you fat. At current levels of consumption the most likely culprit behind growing obesity level of the world population is carbohydrates. A second potential factor is solvent-extracted vegetable oils (canola, corn oil, soybean oil, sunflower oil, cottonseed oil). Globally consumption per capita of these oils increased by 214% between 1961 and 2011 and 169% in the U.S. Increased calories intake—if we use the U.S. as an example—played a role, but please note that carbohydrates and vegetable oils accounted for over 90% of the increase in calorie intake in this period.

A proper review of the so called “fat paradoxes” (France, Israel and Japan) suggests that saturated fats are actually healthy and omega-6 fats, at current levels of consumption in the developed world, are not.

The big concern regarding eating cholesterol-rich foods (e.g. eggs) is completely without foundation. There is basically no link between the cholesterol we eat and the level of cholesterol in our blood. This was already known thirty years ago and has been confirmed time and time again. Eating cholesterol rich foods has no negative effect on health in general or on risk of cardiovascular diseases (CVDs), in particular.

Doctors and patients’ focus on “bad” and “good” cholesterol is superficial at best and most likely misleading. The most mentioned factors that doctors use to assess the risk of CVDs—total blood cholesterol (TC) and LDL cholesterol (the “bad” cholesterol)—are poor indicators of CVD risk. In women in particular, TC has zero predictive value if we look at all causes of death. Low blood cholesterol in men could be as bad as very high cholesterol1.’

At one point they go on to say…

Here is our final hypothesis on why health authorities have remained so certain of their position and unwilling to change their view on saturated fats, omega-6 or carbohydrates:

  1. Health authorities advance very slowly and are afraid to change the market’s status quo (not a wise medical posture).

We have known since the 1960-70s that dietary cholesterol has no influence on blood cholesterol. Yet it took more than fifty years for the USDA/USDHHS to lift recommended upper limits of fat consumption. It took close to 20 years in the U.S.—that was quick—to ban transfats. So we should not look at public health authorities as leading indicators of potential health hazards, but rather as lagging behind.

Bureaucracy tends to move slowly, but when the health risks tied to “incorrect” information are so high, one would hope for swift action and the courage to reverse past mistakes. There was no fundamental reason to move from butter to solvent extracted vegetable oils. If we assume that research was the main reason—as it was claimed at that time—the health authorities now have enough information to change their recommendations, or if still in doubt issue no recommendations.

All quite extraordinary. This report is about as scathing as an organisation like Credit Suisse could possibly be. They have stripped apart the evidence on eating fats and saturated fats. They have come to exactly the same conclusions as I, and many others, have done. When they say:

There was no fundamental reason to move from butter to solvent extracted vegetable oils

That means, there was not one single scrap of evidence. Nothing, zip, nada, zero. So when you see various flower-like margarine manufactures promoting their products as super-healthy…. You know it is just the most complete nonsense. Even a Swiss Investment Bank says so.

And what do they have to say on raised cholesterol levels? Well they have many things to say, mainly that it does not cause heart disease. The shortest summary of their conclusions would be the following:

We can draw the following conclusions:

  1. High cholesterol (above 240mg/dl) (this is 6.2mmol/l) is only a marker of higher cardiovascular death for men. Please note that high cholesterol does not cause heart attacks, it is just a marker.
  2. For all other illnesses, higher cholesterol levels pointed to lower death levels. Why? Because cholesterol helps support, or is a marker of, a better immune system.

I know that this report will be ruthlessly attacked and vilified. Mainly on the basis that it was written by a Bank! And what can bankers possibly know of medical research? How very dare they? My own view on this is that, you know, anyone can read medical research, and if you are in possession of a functioning brain you can also work out what that research is saying.

Indeed, in my opinion, the best placed people to review any form of research are those who do not have a dog in the fight. The authors of this report have no reputations to maintain in medical research. They have no reason to support one side or the other. These people represent an investment bank, and all they are interest in doing is advising their ‘customers’ on what is really true, and what is likely to happen. They are a bit like bookmakers. No emotions involved just ‘what are the odds.’

As they say that odds are, as follows

‘The bottom line of these assumptions is that fat consumption per capita is likely to soar by 23% from now until 2030, protein by 12%, and carbohydrates will likely decline by 2%. This implies annual compound growth of 1.3% for fat consumption, compared to 0.9% over the last fifty years. Total demand for fat will be much higher—43% up for fat or 1.9% a year— given the 16% growth in the global population expected over the next fifteen years.’

Pork bellies are a ‘buy.’ How strange to find myself on the same side of an argument as a Swiss Investment Bank. I would have given you bloody good odds on that yesterday.

1: https://doc.research-and-analytics.csfb.com/docView?language=ENG&source=ulg&format=PDF&document_id=1053247551&serialid=MFT6JQWS%2b4FvvuMDBUQ7v9g4cGa84%2fgpv8mURvaRWdQ%3d

Tranny fats ha ha ha

[An apology. Some people have objected to the work Tranny, as this is considered offensive to trans-gendered individuals. I was attempting a play on words from Roddy Doyle’s well known book Paddy Clarke ha ha ha. I had not the slightest intention of causing offense in this way, and I apologise if I have done so. I hope the title can be taken in the ‘innocent’ way that it was meant]

Many years ago a man, who they say, had an ego the size of a planet decided that he just knew what caused heart disease. It was cholesterol consumption in the diet that raised blood cholesterol and killed us all. Unfortunately, for him, he did some research that however much cholesterol you ate, it had no effect on the cholesterol level in the blood.

No matter.’ He laughed gaily. ‘What is the point of a good hypothesis if you cannot change it upon a whim?

So he then decided that it was dietary fat that raised cholesterol levels in the blood and caused us all to die of heart disease. Only it wasn’t that one either. So then he thought it was animal fat (wrong again!) and finally settled upon saturated fat.

Then, through a combination of his forceful personality, and a good bit of merciless bullying anyone who disagreed, Ancel Keys promoted his message far and wide, and those in power decided he was right.

This set in chain a whole series of seemingly disconnected phenomena. The first of these was to start telling everyone that they should not be eating saturated fats, assumed to be animal fats, or else they would die. Thus, recommendations about what was healthy to eat became moved away from those horrible, unhealthy fats, and focussed entirely on eating carbohydrates.

At which point the obesity epidemic began- as you would expect. This was closely followed by the epidemic of diabetes – as you would expect. If you know anything about human physiology.

Then it was realised that diabetics, who were more likely to develop heart disease than anyone else really, really, should not eat any sort of fat. Saturated or otherwise. They were all advised to switch to eating carbohydrates. This of course, makes perfect sense. We have a group of people who cannot control their blood sugar levels, so we tell them to eat almost nothing but sugar.

We now spend more on medication for diabetes than any other form of medicine in the world. Why, because no-one can get their blood sugar levels under control any more. Quelle surprise?

In parallel with this nonsense it was decided that we should replace saturated fats with ‘healthy’ polyunsaturated fats and suchlike. Which inevitably included trans-fatty acids. These were first discovered many years ago, when oils were turned into margarine. The margarine was, at first, coloured pink – as it was considered unfit for human consumption, and was only fed to animals.

Gradually trans-fats, which are also polyunsaturated fats, found their way into almost everything anyone ate – including of course margarine (no longer coloured pink, instead with pretty coloured flowers on the tub). MacDonald’s were virtually forced into cooking their fries in vegetable fat, so that no-one would be exposed to the deadly, evil saturated fats. Hey ho, what happens to vegetable fats at high temperatures? Well, they turn into trans-fatty acids, of course. Who knew? Apart from all chemists in the world.

More recently we find that trans-fatty acids are uniquely unhealthy substances that should be banned, and excluded from human consumption. What a surprise, a range of chemical compounds almost unknown to nature may not be healthy….well, who’d a thunk? This morning I was listening to a debate on the radio about whether the UK should ban all trans-fatty acids. [Well, you can’t ban them all, because some are found in natural foodstuffs.]

I just sat and listened, and thought that the entire world of nutrition was bonkers, and remains bonkers. An egocentric megalomaniac called Ancel Keys decided that ‘HE KNEW’ what caused heart disease, and would brook no dissent. His legacy is that we now force carbohydrates into diabetics, and almost everyone else. We also forced manufacturers to stop selling saturated fat and, instead, switch to super-healthy trans-fats. We made MacDonald’s French fries uniquely unhealthy. A perfect and delicious irony. Accuse MacDonald’s of selling unhealthy food, then make them do it.

God knows how many have died prematurely because of this complete and utter nonsense. Tranny fats, ha ha ha.

The Augean Stables – part II

It has become clear that much of medical research is flawed, and so inherently biased that much of it/most of it simply cannot be relied upon. One of the strongest critics of this current situation is a brilliant statistician, Professor John P Ionnadis. His seminal paper on the subject of medical research, which is nearly ten years old now, was entitled ‘Why Most Published Research Findings Are False ‘. I include the abstract here:

‘There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias1.’

Has his work been contradicted by anyone? The answer would be a resounding… no. In fact, all that has happened over the last ten years is more and more confirmation that medical research has become worse.

This is an incredibly worrying situation, yet very few people seem in the slightest bothered. The status quo remains in status. When new medical studies come out the press continue to regurgitate the findings as though they are unquestioned gospel. Experts have maintained their status as demi-gods, to be fawned upon as though their work is beyond any possible reproach.

Guidelines, the ones that instruct doctors on how to treat various conditions, are still published without any provisos. Guidelines which are based on evidence that… ‘may often be simply accurate measures of the prevailing bias.’ But woe betide any doctor that fails to follow said guidelines, for they may well be struck off the medical register. In the US, you could end up in jail.

All of these things are bad enough, and there are many other problems. However, in this blog, I want to focus on another issue. Namely, what about placebo controlled studies? Just to make it clear, for those who know a great deal about this area, I am not looking at the issue of ‘what the hell is in placebos anyway, cos it sure as hell ain’t inert substances.’ Whilst the fact that you cannot find out what manufacturers actually put in placebos, which should be inert ‘sugar pills’, but most certainly are not, is extremely important, that is an issue for another day.

Today’s issue is as follows. We have reached a situation in medical research where it may never be possible to find out if certain treatments actually work. Sub-header… ‘And in which case we are all doomed.

Here is the context. Once a treatment has been found to be superior to a placebo, it will be deemed unethical ever to carry out a placebo controlled study ever again. That may not mean much to many people, so I shall expand – using a concrete example (yes, statins again).

If placebo controlled studies have shown that statins reduce the risk of heart disease, and for the sake of argument let us accept that this is true, where does this leave us? It leaves us in the position whereby, if anyone wanted to set up a study to try and disprove that statins are no better than placebo, they will never be given permission to do so.

Why not? Well, before you are allowed to carry out a clinical study, you have to present it to an ethics committee. This committee will look at the proposal and decide if it is indeed ‘ethical.’ Exactly what this means is up for debate. However, if you decided to study the speed at which cars need to run into children, to result in a fifty per cent mortality rate, I imagine you would be turned down by the ethics committee.

More prosaically, if you have found that statins reduce the risk of dying of heart disease vs placebo, then you will no longer be allowed to do a placebo controlled statin trial ever again. The reason for this is that you have already ‘proved’ that statins are superior to placebo. So it will argued that any volunteer placed in the placebo arm of your study would be suffering avoidable harm. Bong! Ethics committee says no. We know statins work, so it is unethical not to give them.

The only studies the ethics committees will allow would be statins vs. statins and a new drug. Equally you would not be allowed to study a new drug vs. placebo, at least not for an indication where statins had shown a benefit. Because everyone ‘at risk’ should be on a statin already.

Now, I have some sympathy for pharmaceutical companies in this situation. If statins reduced the risk of heart disease by 50% (made up figure), then any new drug can only provide an incremental benefit over statins – there is only 50% possible benefit left. So you need to study more people, over a longer period, to demonstrate superiority over statins. A higher hurdle than statins had to get over to be approved.

In another way, obviously, I have less sympathy. Let us suggest that all of the statin trials were biased. Let us further suggest that statins do not have any benefit over placebo. Is there any evidence for this? Well, the only major non pharmaceutical funded study on statins vs placebo was ALLHAT-LLP. Which was run by the National Institutes for Health (NIH). It was reported thus:

‘Washington, DC – Surprising results of an unblinded but randomized comparison of pravastatin (Pravachol® – Bristol-Myers Squibb) vs “usual care” in patients with hypertension and moderate hypercholesterolemia enrolled in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT) show that pravastatin did not significantly reduce either all-cause mortality or fatal or nonfatal coronary heart disease (CHD) in these patients.’

So, no benefit at all. This study was immediately attacked by all the ‘experts’ and dismissed as being useless, not enough LDL lowering, not enough difference from standard care blah, blah. Nothing to see here, move along.

However, I find it interesting that the only statin study which was not funded by the pharmaceutical industry was completely negative. You may even believe that this would give people pause for thought. If so, silly you.

Where does this leave us though? Well, as already stated, you can never, ever, do another statin vs placebo study. For it would be unethical to do so. You can never do a cholesterol lowering study on any other drug vs placebo either, for it would be unethical to do so. If the statin trials were all correct and unbiased and without the slightest doubt attached to them….fine. If, however, these trials were simply accurate measures of the prevailing bias then we are completely screwed.

This leaves us in a situation whereby if we test other drugs against statins, we are testing a drug against a drug that we cannot be certain has any benefits at all. So, what can we prove? Nothing. Which means that the very foundations of all future research in this area have been built on a bog.

So, what can we do? Carry on believing that all the research done is correct and above any suspicion of bias and manipulation. If so, fine, but you may have trouble sleeping at night. If not, you are going to have to tear apart all of the research that has been done, and do it again. I think that makes the task of Hercules look pretty easy.

1: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124

2: http://www.medscape.com/viewarticle/785851

What happens to the carbs – part II

My interest in nutrition began many years ago as part of my over-riding interest in cardiovascular disease. This means that, unlike many other people, I backed into this area with no great interest in the effect of food on health. For most doctors nutrition takes up about an hour of the medical degree course. We are pretty much given to understand that it is of little medical significance. Eat a balanced diet…end of. I also paid nutrition about that much heed.

However, because of the power and influence of the diet/heart hypothesis I felt the need to understand more about this whole area, and how the system of digestion and metabolism actually worked. At first my interest was purely to find out if there was any clear and consistent association between diet and cardiovascular disease (which I shall call heart disease from now on, as it is simplest to do so).

Like many others, before and since, I could not find any such association. Nor could I find any biochemical or physiological reason why saturated fat, in particular, could cause heart disease. That issue, of course, represents a long and winding road that I am not going down here.

However it did not take long before I became side tracked by the very powerful and consistent association between heart disease and diabetes. People with diabetes have far higher rates of heart disease than people who do not. In the case of women with diabetes, the increase in risk hovers around five times the rate of non-diabetics. So it became clear that I would need to understand diabetes, if I was going to fully understand heart disease.

This led me into the looking at the underlying causes of diabetes (type II). At first it seemed blatantly obvious that type II diabetes was primarily due to insulin resistance (it is far less clear now). In its simplest form, insulin resistance means that you need a higher level of insulin to drive down blood sugar levels, because something is ‘resisting’ its effects. Of course, like everything else, it is rather more complex than this, but I will leave it at that for now.

It also became clear that you can have mild/moderate insulin resistance for many years before you develop frank diabetes. Confronted with resistance to its effects, the body simply increases insulin production to keep blood sugar within the normal range. In this state, sometimes called ‘pre-diabetes’ you do not actually have a high blood sugar, especially not in the fasting state. This, of course was when most blood sugar level measurements were taken. Yes guys, look for a metabolic condition when it isn’t actually visible …very sensible.

However, mild to moderate insulin resistance, even if blood sugar levels are not consistently raised, is not benign. It is associated with a whole series of other metabolic abnormalities such as: central obesity, raised VLDL/triglycerides, low HDL, high blood pressure, high levels of blood clotting factors – to name but a few. In addition you can also find higher sugar levels, and higher insulin levels in the post-prandial state (after eating). Most importantly, to my mind, mild to moderate insulin resistance is also associated with a far higher rate of heart disease.

In the early days, ‘pre-diabetes’ came under many different monikers. Just to give you four:

  • Reaven’s syndrome
  • Syndrome X
  • Insulin resistance syndrome
  • Metabolic syndrome

This caused a lot of initial confusion, but once I chased them all down, it because clear that these different names were simply describing the same phenomenon, which is probably best described as insulin resistance syndrome. Although this title carries its own problems.

The next question, of course, is what causes the insulin resistance? The wisdom was, and remains, that it is caused primarily by obesity. This was based on the observation that, as people got fatter, the risk of diabetes increased almost exponentially. One paper I read many years ago stated that younger obese women had around forty times the risk of diabetes, compared to women of normal weight. That is what you call a strong association. Perhaps causation may even be whispered?

In short, if you added together what was clear about diabetes and insulin resistance, you got a model of type II diabetes which looked pretty much like this:

  • You eat too much food
  • You put on weight
  • As you put on weight you become more and more insulin resistant
  • At first you will develop insulin resistance syndrome
  • If you keep putting on weight you will become so insulin resistant that you will develop frank type II diabetes

I call this the ‘blowing up a balloon’ theory of diabetes. As a balloon expands you have to blow harder and harder to overcome the resistance. As you get fatter and fatter you need more and more insulin to force fats into fat cells. As with many things in medicine this is a nice simple story. It is also very easy to understand, and it is tantalisingly close to being correct

As always, however, when presented with a model like this, my immediate reaction is to try and smash it to bits with contradictory evidence. I figure that any theory that can withstand repeated assault is likely to be correct. On the other hand.

I started by looking at the extremes, as I always do. Beginning with the most obese group people on the planet earth, namely Sumo wrestlers. I wanted to know how many of them have diabetes, and it did not take long to discover that, whilst in training, none of them have diabetes.

I then searched for the opposite end of the spectrum. Were there people with no adipose tissue, and how many of them had diabetes? Surprisingly, there is one such group, the least obese people on earth. They are those with Beradinelli-Siep lipodystrophy. This is a genetic abnormality which means that these poor unfortunates have almost no fat cells. How many of them have type II diabetes? Well, all of them actually.

I then looked for the population with the highest rate of diabetes in the world. This happens to be the Pima Indians of North Mexico/Southern US. I have seen figures reporting that over 80% of adult males Pima Indians have type II diabetes. It may even be more. And yes, they are very obese.

However, there are two other very interesting facts about the Pima Indians. First, they have a very low rate of heart disease. Or they did last time I looked. Perhaps most importantly, in their youth, when they are not obese, they produce far more insulin in response to food than ‘normal’ populations. Or, to put this another way, they are hyper-insulinaemic before they are obese, and long before they become diabetic. So their excess insulin production is not a result of becoming fatter. The causal chain is the other way around.

I have found that if you speak to most doctors about these facts, a look of complete incomprehension passes over their faces. ‘That cannot be right.’ Of course if you believe in the ‘blowing up a balloon’ model of diabetes, then the Pima Indians, Sumo Wrestlers and those with Beradinalli-Siep lipodystrophy do not make any sense. However, in science, when observations do not fit your hypothesis, it is the hypothesis that needs to change, not the facts.

Just to summarize these ‘paradoxical’ facts:

  • You do not need any fat cells to develop diabetes/if you have no fat cells there is a 100% probability that you will be diabetic
  • You can be very , very, obese and not have diabetes
  • You can have increased insulin production long before you become obese (and/or insulin resistant). You become obese later

Just to remind you of the current model.

  • You eat too much
  • You get fat
  • As you get fat you become more insulin resistant
  • In order to overcome this resistance you produce more insulin
  • Eventually you cannot produce enough insulin, the system ‘burns out’ and you develop type II diabetes

Where and how can the paradoxical facts be fitted? The answer is that they cannot. Ergo, the model is wrong. However, luckily, there is another model that fits all the facts. One that I prepared earlier:

  • You produce too much insulin
  • This forces your body to store fat
  • You become obese
  • At a certain point insulin resistance develops to block further weight gain
  • This resistance becomes more and more severe until…
  • You become diabetic

This model explains the Pima Indians. Can Sumo wrestlers be fitted into this model? Yes, with a couple of addendums. Sumo Wrestlers eat to become fat, because added mass provides a competitive advantage if you are trying to shove someone else out of a small ring, before they do it to you.

To achieve super-obesity, they wake up, train for two hours, then eat as much as they can of a high carbohydrate, low fat, broth. They then lie about for a few hours allowing the high insulin levels created by the high carbohydrate diet to convert excess sugars to fat, storing this in adipose tissue. Later on they train very hard again, then eat, then sleep. Rpt.

The reason why they do not become diabetic is on this regime is simply because they exercise very, very, hard. They burn up all the sugar/glycogen stores in the liver and muscle whilst exercising, which means that when they eat, the sugar(s) can – at least at first – be easily stored in muscle and liver (so there is no insulin resistance to overcome). However, once these guys stop training, things do not look so good. Diabetes lurks..

Those with Beradinelli-Siep lipodystrophy have the reverse problem to Sumo Wrestlers. Because they have no fat cells there is nowhere to store excess energy to go. If they eat carbohydrate/sugar, the first 1,500 calories can be stored as glycogen – after that there is nowhere left. If the liver converts sugar to fat, there is nowhere for that to go either. So, you get ‘back-pressure’ through the system. It doesn’t matter how high the insulin level gets, if you have nowhere to store energy you have nowhere to store energy. End of.

Whilst those with lipodystrophy cannot tell us much about diabetes and obesity in ‘normal’ people. This condition does make it very clear that diabetes – insulin resistance, high insulin and high sugar levels – is primarily an issue with energy storage and how the body goes about this storage, and the role that insulin plays. If there is somewhere for excess energy to go easily, insulin levels will not go up, and nor will blood sugar levels.

But what of ‘normal’ people. Can normal people be fitted into the updated model of type II diabetes? Well, of course, they can. But you need another step in the new model, the first step. Which means we have a new causal chain, and it looks something like this ‘You eat too much carbohydrate.’ Adding in this step gives us the new model:

  • You eat too much carbohydrate/sugar
  • You produce too much insulin
  • This forces your body to store fat
  • You become obese
  • At a certain point insulin resistance develops to block further weight gain
  • This resistance becomes more and more severe until…
  • You become diabetic

The best thing about this model is that it works. It is not contradicted by Sumo Wrestlers, Pima Indians of those with lipodystrophy. It explains the association between obesity and diabetes, and how insulin resistance develops. It may not be perfect, but it is a bloody site better than the simplistic model we have got. The one that says, if you eat fat, you will get fatter, then diabetic…. Bong! If you are diabetic you should eat carbohydrate and sugar, not fat…Bong!

How long before mainstream medicine rejects this mainstream model? Another fitty years or so, I would guess

What happens to the carbs?

I have found a strange thing happens when I talk to nutritionists about the fate of carbohydrates in the human body. Professors, who shall be nameless, appear unable to admit how basic human physiology works. For example, they may concede a few steps here and there, but they will never, ever, admit to the following chain that I have described below.

1: Carbohydrates, such as fruit and vegetables, bread, pasta… and, of course, less complex sugars – such as the stuff we sprinkle on cornflakes, that we call ‘sugar’, are all turned into simple sugars in the human digestive tract before entering the bloodstream.

2: If you keep eating carbohydrate the resultant simple sugars will, at first, be stored. The human body can pack away around 1,500 calories of sugar. However, once this limit is reached, the liver will turn the rest into fat.

3: The fat that is made in the liver is palmitic acid

4: The next step is that three palmitic acid molecules are attached to a glycerol molecule, to form a triglyceride.

5: These triglycerides will then be packed into Very Low Density Lipoproteins (VLDL) and released into the bloodstream. [Beware of confusion here. For VLDLs are also called triglycerides although, of course, they are not. VLDLs contain triglycerides but they are not the same thing – even if they are called the same thing].

6: When VLDLs reach fat cells (adipose tissue), the triglyceride is stripped out and absorbed into fat cells. Which means that VLDLs gradually shrink.

7: Once a VLDL has lost a large amount of triglyceride it becomes a new, smaller, lipoprotein, which is often referred to as ‘bad cholesterol’ a.k.a. LDL (Low Density Lipoprotein).

8: LDL is taken out of the circulation, primarily, by the liver. Some LDLs are removed from the circulation by other cells around the body that need the cholesterol contained in them.

9: As can be seen, the only source of LDL is VLDL.

Here a couple of quotes from Wikipedia to confirm at least a couple of these steps:

Lipogenesis is the process by which acetyl-CoA is converted to fatty acids. The former is an intermediate stage in metabolism of simple sugars, such as glucose, a source of energy of living organisms. Through lipogenesis and subsequent triglyceride synthesis, the energy can be efficiently stored in the form of fats.

Lipogenesis encompasses both the process of fatty acid synthesis and triglyceride synthesis (where fatty acids are esterified with glycerol to form fats). The products are secreted from the liver in the form of very-low-density lipoproteins (VLDL). VLDL are secreted directly into blood, where they mature and function to deliver the endogenously derived lipids to peripheral tissues. https://en.wikipedia.org/wiki/Lipogenesis

Excess carbohydrates in the body are converted to palmitic acid. Palmitic acid is the first fatty acid produced during fatty acid synthesis and the precursor to longer fatty acids. As a consequence, palmitic acid is a major body component of animals. In humans, one analysis found it to comprise 21–30% (molar) of human depot fat and it is a major, but highly variable, lipid component of human breast milk. https://en.wikipedia.org/wiki/Palmitic_acid

I am half tempted to leave the blog here and let you think about what all of that means for a while. However, I feel the need to make a couple of other points, in no particular order. First, I would like you to think about this fact. The form of fatty acid that the liver chooses to synthesize from sugar(s) is palmitic acid, a saturated fat. Palmitic acid is also the major component of breast milk.

Yet, despite this, we are told that saturated fats are uniquely unhealthy, and eating them leads to heart disease. Indeed, within to the very same Wikipedia article on palmitic acid we learn that: ‘According to the World Health Organization, evidence is “convincing” that consumption of palmitic acid increases risk of developing cardiovascular diseases.’

It seems that we are being asked to believe that the body naturally synthesizes a substance, palmitic acid, that actively damages our health. Not only that, but mothers choose to synthesize exactly the same form of fatty acid in their breast milk, which then increase the chances of their offspring developing cardiovascular disease.

Now just how likely does this seem…exactly? We have evolved to kill ourselves from heart disease? As Spock may have said, ‘its evolution Jim, but not as we know it.’ You would think that if polyunsaturated fats were healthy, this is what the human body might choose to make. But no, we eat super healthy fruit and vegetables and then our body, in a unique and ironic twist of fate, converts them into death dealing saturated fatty acids.

Not only that, but just to rub salt into the wounds, once the liver has synthesized these death dealing fatty acid molecules it then chooses to pack them into VLDLs which have the cheek to shrink down into LDL a.k.a. ‘cholesterol’ and these also kill us with heart disease (allegedly).

Of course, if you actually eat saturated fat, this gets nowhere near the liver. It is digested, packed into chylomicrons, and these very large lipoproteins enter the bloodstream directly through the thoracic duct. Which is a secret passage from the gut that opens out in one of the veins in your neck. When chylomicrons encounter fat cells, the fats/triglycerides are sucked out, and the chylomicron shrinks down to virtually nothing. Chylomicrons, however, do not convert to LDL and have nothing whatsoever to do with heart disease – even according to those who think saturated fat in the diet is deadly.

Yet, despite this knowledge we are continuously told, in all seriousness, that eating saturated fat raises our LDL levels and causes us to die prematurely of heart disease. [You may have noticed that cholesterol has hardly entered this discussion at any point.] When people ask me why I don’t believe in the diet/heart hypothesis, I tend to shrug and move the conversation on.

However, if I am feeling a bit stroppy I tend to reply that ‘Even if you were to believe that a raised LDL levels causes heart disease, the current diet/heart hypothesis does not, and cannot make any sense from a biological or physiological perspective.’ If you were actually looking for a substance that really could raise LDL/cholesterol levels it would have to be carbohydrates a.k.a. sugars. After all the only source of LDL is VLDL, and it is eating too much sugar that raises VLDL levels.

In short, how can it not be that carbohydrates raise LDL levels? This is what a basic understanding of lipid physiology tells us must be true. Yet, people write papers on this phenomenon in a tone of almost stunned surprise. Here for example is a paper called ‘The Effect of Dietary Carbohydrate on Triglyceride Metabolism in Humans’:

When the content of dietary carbohydrate is elevated above the level typically consumed (>55% of energy), blood concentrations of triglycerides rise. This phenomenon, known as carbohydrate-induced hypertriglyceridemia, is paradoxical because the increase in dietary carbohydrate usually comes at the expense of dietary fat. Thus, when the content of the carbohydrate in the diet is increased, fat in the diet is reduced, but the content of fat (triglycerides) in the blood rises. http://jn.nutrition.org/content/131/10/2772S.full#fn-1

This author, writing for the Journal of Nutrition, finds it paradoxical that… increased dietary carbohydrate usually comes at the expense of dietary fat….but the content of fat (triglycerides) in the blood rises. Well, what did they think would happen? That carbohydrates would turn into fairies at the bottom of the garden?

Once the liver and muscles are full of sugar (stored as glycogen – a polymer of glucose) the body can do absolutely nothing else with it, but turn it into fat – through the processes I have described earlier. This is basic, incontrovertible science.

Most people who are interested in the potential benefits of the low carb high fat diet (LCHF), have tended to look at it from the perspective of helping with controlling diabetes, and promoting weight loss. I came at the LCHF diet from my own perspective, which is heart disease.

When you understand the science you find yourself looking at the diet heart hypothesis (fat in the diet raises LDL levels, which causes heart disease) and thinking. This does not make any sense at all. Yet, such is the determination of the nutritional experts to defend their position that they never, ever, talk about ‘what happens to the carbs?’

What happens to the carbs is that they are all turned into saturated fat. This then raises VLDL levels and these, in turn becomes LDL. Yet eating carbs is supposed to be healthy, and eating saturated fat is unhealthy. Go figure.

The world of nutrition is, I am afraid, nuts.

Sorry seems to be the hardest word

I think that the four words ‘I told you so’ should only be thought, and never written down. No-one likes a smart arse. But sometimes it is impossible to resist….just impossible. In this case I have failed. ‘Father forgive me, for I am weak.’ So, here goes…’I told you so.’

Some of you may be aware that the US dietary guidelines are going to be changed. For some reason it is required that the full report is suppressed for about a year. Presumably so that everyone can pile high their defences when the attacks begin. ‘I think you will find that I have always, ahem, supported these ideas.’ Cough, shuffle of papers….cough. ‘Sorry, no time to take questions.’ Exit left.

The entire report, I believe, stretches to about a bazillion pages. However, here are four of the highlights.

  • Cholesterol is to be dropped from the ‘nutrients of concern’ list. [I love that phrase ‘nutrient of concern’].
  • Saturated fat will be… ‘de-emphasized’ from nutrients of concern, given the lack of evidence connecting it with cardiovascular disease.’ [Whatever de-emphasizing may be. Pretending you never said it in the first place, I suppose].
  • There is concern over blanket sodium restriction given the… ‘growing body of research suggesting that the low sodium intake levels recommended by the DGAC (Dietary Guidelines Advisory Committee) are actually associated with increased mortality for healthy individuals.’
  • And…’ The identification and recognition of the specific health risks posed by added sugars represents an important step forward for public health.’

In short. Cholesterol is healthy, saturated fat is healthy, salt is healthy and sugar is unhealthy. I have pulled those four points out of a press release by the Academy of Nutrition and Dietetics, which I reproduce in full, below.

Academy of Nutrition and Dietetics Commends Strong, Evidence-Based Dietary Guidelines Report

The Academy of Nutrition and Dietetics, the world’s largest organization of food and nutrition professionals, commends the 2015 Dietary Guidelines Advisory Committee for drafting a strong, evidence-based Scientific Report outlining recommendations and rational for the forthcoming 2015 Dietary Guidelines for Americans. The Academy supports these recommendations that will improve how and what Americans eat.

“The Academy applauds the evidence-based systematic review of the literature, which is vital to the DGAC’s assessment of the science,” said registered dietitian nutritionist and Academy President Sonja L. Connor. “We commend the Department of Health and Human Services and the Department of Agriculture for their commitment to the Nutrition Evidence Library and their ongoing efforts to strengthen the evidence-based approach for assessing the scientific literature for future dietary recommendations.”

In comments recently submitted to USDA and HHS, the Academy supports the DGAC in its decision to drop dietary cholesterol from the nutrients of concern list and recommends it deemphasize saturated fat from nutrients of concern, given the lack of evidence connecting it with cardiovascular disease.

“Despite some criticism suggesting that changed recommendations illustrate concerns about the validity of the nutrition science upon which the Dietary Guidelines are based, the DGAC should change its recommendations to be consistent with the best available science and to abide by its statutory mandate,” Connor said.

The Academy also expresses concern over blanket sodium restriction recommendations in light of recent evidence of potential harm to the overall population. “There is a distinct and growing lack of scientific consensus on making a single sodium consumption recommendation for all Americans, owing to a growing body of research suggesting that the low sodium intake levels recommended by the DGAC are actually associated with increased mortality for healthy individuals,” Connor said.

The Academy supports an increased focus on reduction of added sugars as a key public health concern. “Among the identified cross-cutting issues, the evidence is strongest that a reduction in the intake of added sugars will improve the health of the American public. The identification and recognition of the specific health risks posed by added sugars represents an important step forward for public health,” Connor said.

In its comments, Academy also emphasizes that enhanced nutrition education is imperative to any effective implementation. “It is critical to ensure that individuals making diet and behavior changes in accordance with the Dietary Guidelines have access to the resources and support necessary to succeed. HHS and USDA must have sufficient resources to commit to improving a number of initiatives,” Connor said.

“The Academy appreciates the opportunity to comment on the Scientific Report and to serve as a resource to HHS and USDA as they finalize the 2015 Dietary Guidelines and develop resources to implement and promote their use,” Connor said.1

In one way, I commend this press release. At least it has made no real attempt to fudge what is now going to be said. These are the facts.

But you know what. Organisations like this have been haranguing the entire population of the world about the dangers of cholesterol, saturated fat, and salt for the last thirty years. Foodstuffs which they now seem happy to admit, cause no harm, indeed they are almost certainly good for you.

At the same time, they have bombarded us with messages to consume sugar(s). They usually call them carbohydrates, which is disingenuous in the extreme. Carbohydrates are all just sugars in disguise. A disguise that the digestive system can strip off in a few minutes.

Yes, all those healthy fruit and vegetables are simply extended chains of simple sugar(s). And once they enter your digestive system, your body cares not whether or not you ate a carrot or a sugar cube. It delivers them into your bloodstream as sugar [primarily glucose and fructose].

Now there have been a number of people, including me, who have been saying for years that cholesterol and saturated fat are perfectly healthy, salt is good for you and sugar (in large amounts) is bad. We have all been dismissed as cranks and idiots who would have caused the deaths of thousands of people, if they had ever dared to listen to what we had to say.

It turns out the cranks and the mavericks were right. The experts were wrong. Completely and utterly wrong. Damagingly wrong. Whilst the words ‘I told you so’ are temptingly easy to say; and saying them should be resisted. There is another, single word, that appears impossible to say.

Sorry.

1: http://www.newswise.com/articles/academy-of-nutrition-and-dietetics-commends-strong-evidence-based-dietary-guidelines-report

Medicine – science or religion?

[Never admit that you are wrong]

Medicine has always occupied an often uncomfortable space between science and belief. I remember when I started medical school the Dean of the medical school welcomed us to the main lecture hall. He told us how wonderful it was that we had chosen to become doctors, and waffled on for a bit about how we were the chosen few. He finished his speech with these words, which etched themselves into my brain… ‘Welcome to the brotherhood.’

Of course the parallels between medicine and religion have always been obvious to anyone who has eyes to see. The patient consultation as confessional. The use of long latin words that the patient cannot understand. The rituals and incantations of medicine have clear parallels with religion. Or would that be the other way round. You could go on and on.

It is easy to understand why many aspects of medicine and religion mirror each other. Particularly if we look at one very important aspect of religion. Namely, protection against terrible things happening to you. Humans, once they became aware of their mortality, very rapidly felt the need for protection against an unpredictable and dangerous world. Earthquakes, storms, crop failures, plagues, early death… that type of thing.

Very early on, religious leaders realised the power and status you could command if you claimed to be able to understand why such terrible things happened. And, more importantly, how to stop them. Build a big temple, pray to a god, don’t shave your hair, sacrifice a pig, don’t eat pigs…. give the priests lots of money, and suchlike. The people, in turn, were extremely eager to do these ‘right’ things in order to feel a sense of protection, a removal of fear.

Of course, none of this actually stopped anything. But when terrible things still occurred it was because you (you sinner) didn’t pray in the right way, or someone else (a heretic) was deliberately praying the wrong way and causing bad things to happen. ‘Find the heretic in our midst and burn them.’ Or whatever. A good idea not to have ginger hair or a club foot at such times.

Over time, a million and one reasons were developed by clever priests to explain why, despite all the incantations, gifts, temples built, and sacrifices, bad things were not prevented. However, there was one reason that could never be countenanced. Namely that the priests were completely wrong, and had no idea what they were talking about. For, if the priests were wrong then…well then, terrible things just happened and there was nothing you could do to stop them.

How frightening is that. Thus, it was not just were the priests desperate to keep their power that kept their religion going, the people were equally desperate to believe that the priests knew what they were doing. It could be described as a conspiracy of the willing. ‘I will protect you. Yes, you will protect me.

It was usually only when plagues and earthquakes and lack of rain and suchlike went on for a prolonged period of time that the people rose up against the priesthood and bashed their skulls in. Usually to be replaced by the ‘new model priesthood’, with another bunch of newly discovered incantations. ‘The absolutely new true truth is revealed,’ rpt.

Then, luckily, along came science and we started to learn what caused bad things to happen in the first place. Earthquakes weren’t due to the displeasure of Gods. Infections were caused by viruses and bacteria and suchlike. More and more that used to be unknown, and terrifying, became explained and, at least in some cases, controlled.

As science advanced, and became the best way to explain the physical world medicine, which used to be a branch of the priesthood, moved towards becoming more scientific. However, one of the primary social drivers behind medicine remained ‘this is how the world works, and we can protect you from it’.

Thus, although in many ways, medicine became more scientific, it maintained of the key social functions previously carried out by religion. ‘We can stop bad things happening to you. You do not need to be frightened. If you do as we say’

This form of mutual dependency works extremely well when the medical profession really does know how to stop things happening, and the medical leaders know exactly what they are doing. However, there is a heavy price to be paid for establishing yourself in the position of ‘certainty’. A position of belief requirement.

Primarily, it becomes extremely difficult for you, or the rest of the brotherhood, to admit that you don’t know something? Or that things you have been telling people, or doing, are in fact useless or wrong. Because if you start doing that, you fear you may lose your hard won authority, control and respect. Equally, if patients no longer believe, or trust in you, or your advice, what then? Fear stalks the land. Metaphorical skull crushing looms.

This is why, if you are a patient who feels that your treatment has not worked as you were told it would, or should, you will not find an eager audience for your complaints within the medical profession. Equally if you question or refuse the sacrament, sorry treatment, your doctor is likely to become very angry with you.

Additionally, if a doctor cannot discover what is causing your symptoms, or they have no tests to diagnose you, you are likely to be told that there is nothing actually wrong with you. The medical profession cannot easily admit to ignorance. In such situations, the only explanation that can be countenanced is that ‘you are making it up.’ Unexplained symptoms become ‘somatisation’. Side effects from drugs, such as statins, are due to ‘nocebo’ effects.

A million reasons will be found as to why the treatment has not worked in your case. Or why you got worse. The only explanation that cannot be allowed is that the doctors are completely wrong, and do not know what they are talking about.

If you find a whole group of patients who feel that their condition is not being treated well, and you band together to get the medical profession to think again, you will run up against a brick wall. You will simply be written off as cranks, and dismissed. The priesthood does not take kindly to being exposed as wrong.

See under, treating thyroid patients like children.

Treating Thyroid patients like children

Here is an imagined, but not far off the truth, conversation between a doctor and a patient.

‘Why can’t I have T3 doctor? I feel so much better when I do?’

‘Because I say so, now go away.’

Nowadays doctors, at least when they are in training, are repeatedly told that they must NEVER be paternalistic. To do so will result in immediate censure. In the UK it is also a very rapid way of failing the GP entrance exams. We are told that we must explore the patients’ expectations, listen to their worries and fears, and work with them in partnership to lead to a therapeutic partnership…. or some such left wing bollocks. [Joke]

How exactly that fits within the National Institute of Health and Care Excellence (NICE) guidelines is up for grabs. For those who don’t know, NICE decide on which drugs and interventions can be prescribed, or paid for, within the NHS. So you can explore expectations with your patient till the cows come home, only to find that you cannot prescribe what the patient wants, even requires. Even if it makes them feel much better and costs very little. Would you call this paternalism? Oxford entrance exam, discuss.

Don’t get me wrong, I think rationing is increasingly vital for healthcare provision, and at one point I supported NICE. I now realise how naïve and misguided I was…but that is a discussion for another day.

Where was I? Oh yes, T3. Most people have never heard of it. But I am willing to bet that if you have heard of it, and you are a patient, you will certainly know all about this particular hormone. You will definitely know about a thousand times as much as your GP, who may nod sagely when you mention T3. But frankly they are unlikely to have any idea what it is, or does.

To be honest, until about a year ago I had no real idea what T3 was either, but I have learned quite a lot since. Wikipedia states that: ‘The thyroid hormones, triiodothyronine (T3) and its prohormone, thyroxine (T4), are tyrosine-based hormones produced by the thyroid gland that are primarily responsible for regulation of metabolism.’ I would like to draw your attention to the fact that, in Wikipedia, at least, T3 is mentioned before T4 – which makes it more important?

In reality, in a physiological sense at least, T4 comes before T3, in that T4 is produced almost exclusively by the thyroid gland in a ratio of about 17:1 T4 to T3. Once inside various tissues and organs T4 is then converted to T3, where it becomes the biologically active hormone.

Whichever does come first, it can be argued that T3 that is the key thyroid hormone, because T4 is basically a ‘prohormone.’ From Wikipedia again: ‘A prohormone refers to a committed precursor of a hormone, usually having minimal hormonal effect by itself. The term has been used in medical science since the middle of the 20th century. Though not hormones themselves, prohormones amplify the effects of existing hormones.’ Although the figures are not absolutely clear cut, it is usually stated that T3 is five times more biologically active than T4.

Therefore, if someone is hypothyroid, which is normally taken to mean that the thyroid gland is not producing a sufficient quantity of thyroid hormone, you would want to prescribe the active hormone T3, would you not?

This is a rather rhetorical question because what doctors do, at least since the 1960s, is to prescribe synthetic T4 (levothyroxine). Once T4 is in the body it is converted to T3 (through the kidneys, liver, spleen and brain – and numerous other thyroid hormone receptors throughout the body) and does its thing. In most cases this is a perfectly good treatment. However, there is a kicker, which I will get to.

At this point I feel I need to add that hypothyroidism is a very, very common condition. By the age of 60, 10% of people have ‘lab’ test abnormalities that would define them as having subclinical hypothyroidism. At least 2% of the population has overt, clinical, symptoms. Which means that we are talking about millions of people in the UK, possibly tens of millions in the EU and US.[It affects women ten times as much as men].

TSH

I now need to bring in another player called Thyroid Stimulating Hormone (TSH). As with all systems in the human body, a negative feedback loop controls the function of the thyroid gland, and it works something like this:

If you have a high T4 level, this is detected by the pituitary gland, which sits deep within your brain. At which point the pituitary gland reduces the production of Thyroid Stimulating Hormone. As TSH is the hormone that instructs the thyroid gland to produce T4/T3, production of T4/T3 falls. [There are actually a couple of other steps, but this is essentially what happens].

If T4 falls too far, the pituitary gland swings into action to produce more TSH. In turn stimulating the thyroid gland to manufacture more T4…and so it goes. Up and down, up and down, up and down. Endlessly until, of course, you get too old and drop dead. And there ain’t no feedback loop for that.

TSH is also important in that it is usually the substance you measure to decide whether or not someone is hypothyroid. If TSH is very high this means it is trying to ‘drive’ the thyroid gland into action – and failing. You also use the TSH level to determine the dose of T4 that is required as replacement therapy. If the level of TSH is low, this suggests you may be giving too much T4. If the level of TSH is high, this suggests you may be giving too little.

As you may have noticed, at this point I have slipped into talking about TSH and T4, with T3 getting very little mention. That is because this is where the medical profession now stands. Hypothyroidism means high TSH and low T4. You are getting adequate thyroid replacement hormone if TSH in the ‘normal’ range. End of.

Here is what the Royal College of Physicians (RCP) and the British Thyroid Association (BTA) have to say on the matter. Key points only

  • The only validated method of testing thyroid function is on blood, which must include serum TSH and a measure of free thyroxine (T4).
  • Overwhelming evidence supports the use of Thyroxine (T4) alone in the treatment of hypothyroidism. Thyroxine is usually prescribed as levothyroxine. We do not recommend the prescribing of additional Tri-iodothyronine (T3) in any presently available formulation, including Armour thyroid, as it is inconsistent with normal physiology, has not been scientifically proven to be of any benefit to patients, and may be harmful. [Then again, it may not be – harmful, that is]

An aside – (Additional information, as provided to me)

I should mention here that I have been told that the RCP has been asked on numerous occasions to cite references to research/studies showing “overwhelming evidence supports the use of thyroxine (T4 alone)”, but to date, they have provided none. A Freedom of Information (FOI) request that the RCP provide such evidence – again met with no response. A request was made via the ‘Ask for Evidence’ website, run in association with ‘Sense About Science’ asking for evidence on the safety and efficacy of L-T4 as a treatment for hypothyroidism. This request was directed to the RCP who eventually responded stating “The RCP’s guidance is based on the opinion of an expert panel which was temporarily formed for this purpose. The evidence they used to form their individual opinions has not been collated and therefore the RCP cannot provide any evidence list”1 (Jolly, as they say, good)

Restricting the diagnosis and treatment of hypothyroidism to measuring T4 and TSH, and nothing else, is the approach that seems to be used by conventional medicine in the rest of the World. I recently received an e-mail from someone in Singapore telling me that their doctor was about to be struck off for prescribing T3 to patients- against Singaporean medical rules. In the UK, T3 testing is virtually banned, and the medical authorities are making it virtually impossible to prescribe T3 in any form.

In the UK, a doctor called Gordon Skinner was repeatedly dragged in front of the General Medical Council (GMC) for prescribing thyroxine to patients whose T4 and TSH levels were in the ‘normal range’. He was also attacked for prescribing natural thyroid extract (NDT) (a combination of T4 and T3) to his patients – who he felt would benefit. He is now dead. It has been suggested that constant and repeated efforts to strike him off the medical register may have had an impact on his health. I couldn’t possibly say.

Now, there is no doubt that this area is highly complex and for those who know this area, you will be aware that I am keeping things as simple as possible. But I think it is important to make a few points:

The lab tests, especially for TSH, are far from 100% reliable, to say the very least. In fact the man who developed the test in the UK, at Amersham International in Wales, has told me that the test is virtually worthless in many cases (especially continuous testing when patients are taking thyroid hormone replacement).

The conversion of T4 into T3 can be significantly reduced in some people. So these individuals can have normal T4 and TSH, but they are still effectively hypothyroid. For those who are interested in a bit more detail, there is a population with a defective DIO2 gene. This blocks T4 to T3 conversion, and results (amongst other things) in reduced T3 levels in the brain, which can lead to mood disorders2. I mention this single example to make it clear that there is solid scientific evidence to back up the conjecture that it is possible to be functionally ‘hypothyroid’ with normal blood tests.

A lot of people have reported significant improvements in their health through taking thyroxine, with normal blood tests, and also natural thyroid extract when their laboratory tests were ‘normal’. Please look at this article in the Daily Telegraph3…then look at the comments section – which is very, very telling. A cry of despair!

I am not going into further detail of how T4 binding and conversion in various organs can be affected by stress hormones, inflammation, trauma, adrenal insufficiency, lack of converting enzymes in tissues, and infection of various sorts. I shall just keep this simple by stating that it is possible to have enough T4, even T3 in your bloodstream, but these hormones have reduced ‘bioavailability’. This is not crank ‘woowoo’ stuff. This is real and measurable and you can find studies on this in peer-reviewed medical journals.

Far more telling, from my point of view, is the fact that hundreds, indeed thousands of patients report that, although their blood tests were normal, they felt terrible, and that they have felt so much better when they have been given ‘excess’ T4 and/T3, or NDT (natural desiccated thyroid). Whilst there is no doubt that some of them are, to quote a medical colleague, ‘not tightly wrapped.’ I have spoken to many, many, people who are calm, rational and reasonable, and their stories are compelling. A hellish existence that was ‘cured’ by Dr Skinner and his like. I refuse to believe that all of these patients are ‘somatising’ fruitcakes.

Comparing the use of SSRIs and ‘Unconventional’ Treatments for Hypothyroidism

At this point I will change tack slightly. For I think it is fascinating to compare and contrast the treatment of depression using SSRIs, with hypothyroid patients who complain that they are unwell, despite ‘normal’ T4 and TSH tests.

Today, almost all doctors you speak to believe that depression is due to a low level of serotonin in the brain. This is why they prescribe SSRIs (Selective Serotonin Reuptake Inhibitors) by the lorry-load. Drugs such as Prozac, Zoloft, Paxil etc.To quote from a recent article in the BMJ ‘Serotonin and depression, the marketing of a myth’4.

‘…the number of antidepressant prescriptions a year is slightly more than the number of people in the Western World.’

This all happens despite the fact that:
‘There was no correlation between serotonin reuptake inhibiting potency and antidepressant efficacy. No one knew if SSRIs raised or lowered; they still don’t know. There was no evidence that treatment corrected anything.’

In short, with depression, there is no lab test, no way of measuring the impact of anti-depressants. They are prescribed purely and simply on the basis of the patient history. Equally, there is no doubt at all that SSRIs have significant side-effects, some of which are very, very serious e.g. increased suicidal tendency. They are also addictive and patients can end up stuck on them for years. So, they do cause harm.

Equally, as you may be aware, clinical trial data in this area have been horribly distorted….

“…That said, the fact that the class of antidepressants known as the selective serotonin reuptake inhibitors (SSRIs), are basically useless in treating depression in children and adults is not news to the FDA. Back on September 23, 2004, during testimony at a hearing before the House Oversight and Investigations Committee on Energy and Commerce, Dr Robert Temple, the FDA’s Director of the Office of Medical Policy, discussed the agency’s review on the efficacy of SSRIs with the children.”

He noted that it was important in a risk-benefit equation to understand the benefit side. “Of the seven products studied in pediatric MDD (Prozac, Zoloft, Paxil, Celexa, Effexor, Serzone and Remeron),” he testified, “FDA’s reviews of the effectiveness data resulted in only one approval (Prozac) for pediatric MDD.”

“Overall,” Dr Temple said, “the efficacy results from 15 studies in pediatric MDD do not support the effectiveness of these drugs in pediatric populations.”

Also in 2004, a study of previously hidden unpublished data as well as published studies on five SSRIs, was conducted by Tim Kendall, deputy director of the Royal College of Psychiatrists’ Research Unit in London, to help analyze research to draw up the clinical guidelines for British regulators, and published in the Lancet.

Following his evaluation, Mr Kendall stated: “This data confirms what we found in adults with mild to moderate depression: SSRIs are no better than placebo, and there is no point in using something that increases the risk of suicide.”

In 2005, the British Medical Journal published another study that concluded that SSRIs are no more effective than a placebo and do not reduce depression.

In December 2006, at the most recent FDA advisory committee meeting held to review studies on SSRI use with adults, SSRI expert, Dr David Healy, author of, “The Antidepressant Era,” told the panel that the efficacy of SSRIs has been greatly exaggerated, while the actual studies reveal that only one in ten patients responds specifically to an SSRI rather than a nonspecific factor or placebo.

In February 2008, Irving Kirsch’s study at the Department of Psychology at the University of Hull is the first to examine both published and unpublished evidence of the effectiveness of selective serotonin reuptake inhibitors (SSRIs), which account for 16 million NHS prescriptions a year. The largest study of its kind concluded that antidepressant drugs do not work. More than £291 million was spent on antidepressants in 2006, including nearly £120 million on SSRIs. 4

Critics complain that industry funded studies are presented in ways to exaggerate benefits and obscure side effects. “These include failure to publish negative results, the use of multiple outcome measures, and selective presentation of ones that are positive, multiple publication of positive study results, and the exclusion of subjects from the analysis,” according to the paper, “Is Psychiatry For Sale,” by Joanna Moncrieff, in People’s Voice.”5

So we have an interesting medical conundrum, do we not? On one hand, doctors are more than eager to prescribe antidepressants at the drop of a hat, based entirely on the patients reported symptoms. No need for any blood tests, and no evidence that they work for the vast majority of people.

On the other hand, if a patient dares to say that they feel better taking T4 when their blood tests are normal, or if they say they feel better taking a combination of T3 and T4/NDT, they are dismissed as ‘somatising.’ Which is a posh medical way of saying, you are making your symptoms up and we don’t believe you. Equally, if a patient complains of continuing symptoms and that they don’t feel better when they are taking T4 (or T3 and T4) and their blood test results show ‘normal’ they are again accused of ‘somatising’6

The world, my friends, has gone nuts and, in a bitter irony, the medical profession – at least in this area – has become institutionally paternalistic. ‘You cannot be feeling better, because your blood tests say you were never unwell. So you cannot have treatment. And you, Dr Skinner and your like. If you dare treat patient’ symptoms you will be attacked and struck off from medical practice.’ Now I have looked long and hard, and I have found no evidence, from anywhere, that giving T3, in the dose that’s needed, causes any significant medical problems, and I have listened to repeated testimony from people who feel they have greatly improved.

As for antidepressants, these mostly useless addictive drugs that can increase suicide risk. ‘Have as many as you like for as long as you like. Because we fully believe everything you say about your symptoms….’ No need for any silly tests, or anything like that.

Compare and contrast, then try to make some sense of the medical world that we now live in.

Sigh.

P.S. Because I am considered to have alternative views about medical matters, many people contact me to help promote their ‘alternative’ ideas. Some I believe to be completely whacko, I smile sweetly and move on. Some I cannot decide. Other issues, once I start looking into the evidence, I find the evidence compelling.

I certainly find the evidence that a large number of people are effectively hypothyroid, with ‘normal’ thyroid blood tests, to be virtually overwhelming. Both from a scientific/physiology basis, and also from a patient testimonial basis.

I now firmly believe that the medical profession is currently doing these people a great disservice, and that the guidelines on the treatment of ‘hypothyroidism’ are rigid, autocratic, and just plain wrong (for a significant minority).

As with all medical matters that I write about, I have no axe to grind, no horse in the race, no financial links to anyone or anything with regard to treating thyroid patients. I simply hope this article can have some positive impact. For it seems very clear to me that many thousands, hundreds of thousands, of people are suffering unnecessarily. And I would like it to stop.

References:

  1. http://www.scottish.parliament.uk/S4_PublicPetitionsCommittee/General%20Documents/PE1463_AAA_Petitioner_19.11.14.pdf
  2. “Common Variation in the DIO2 Gene Predicts Baseline Psychological Well-Being and Response to Combination Thyroxine Plus Triiodothyronine Therapy in Hypothyroid Patients”http://press.endocrine.org/doi/pdf/10.1210/jc.2008-1301
  3. http://www.telegraph.co.uk/news/health/alternative-medicine/10985192/Could-a-renegade-doctor-save-your-life.html
  4. Serotonin and Depression, the marketing of a myth.’ BMJ2015;350:h1771
  5. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration.” 2008, PLoS Med 5(2): e45 doi:10.1371/journal.pmed.0050045: Access full article at http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045
  6. http://www.lawyersandsettlements.com/articles/ssri_birth_defects/ssri-secret-00642.html#.VT-ycCG6eUk
  7. Professor A Weetman – http://www.medscape.com/viewarticle/524955

 

Further postscript

Malcolm – we need to clear up the fact regarding the definition of ‘hypothyroidism’ which is “underactivity of the thyroid gland” according to the RCP Policy Statement on the diagnosis and management of hypothyroidism. Hypothyroidism is easily diagnosed and more often than not, easily treated with L-thyroxine only. However, what is being missed by everybody is that over 300,000 UK citizens (15% of the thyroid community – millions worldwide) have a normally functioning thyroid GLAND, but the hormone it is secreting is not getting into the cells where it does its work. These are the folk who need T3, in combo. with T4, T3 alone or in NDT. The RCP teaching curriculum makes no mention of the possibility of a non-thyroidal condition where patients suffer the same symptoms and signs of hypothyroidism that may need to be treated with a different medication or hormone. When these patients complain of continuing symptoms when treated with L-T4 monotherapy, many are given an incorrect diagnosis of ME, CFS, FM, depression, functional somatoform disorder – or even old age blah, blah, blah – and sent on their way without further investigation or treatment. This is a serious business, which the RCP and BTA choose to ignore.

The NHS

[A slight divergence of theme]

As an election looms in the United Kingdom of Great Britain, the National Health Service has become the usual political football. All political parties now claim to love it and want to hug it, and squeeze it, and spend eye watering sum of money on it. Because, for the next three weeks or so, they truly ‘care’. Sincerity, once you can fake that, you’ve got it made.

A UK politician, Nigel Lawson, once called the NHS “the nearest thing the English have to a religion”. This, of course, rather pissed off the Scots, Welsh and Northern Irish. Forgetting that England is not the only country in the United Kingdom is something English politicians just, unconsciously, do. They now wonder wonder why the Scots are all going to vote for the Scottish National Party in a few weeks time. ‘But how could anyone possibly dislike us?’ Oh well.

But what is the NHS? It is, to state the bleeding obvious, a National Health Service. It is paid for out of taxes which are gathered with the usual threats of punishment and fines. The Government then hands it out, well over a hundred billion pounds (~$150Bn), through a mind-bogglingly complicated bureaucratic system, losing vast chunks as it goes.

What pitiful sum finally remains is spent on the healthcare of the people of the United Kingdom (including Scotland, Northern Ireland and Wales). Although Scotland would claim it now has its own NHS, sort of. As would Wales, and Northern Ireland, sort of.

Whatever country you are in, the key underlying principle of the NHS is that it is free at the point of use. If you turn up at a GP, or accident and emergency, or hospital, whatever is wrong with you, you are charged, not a penny. Yes, it is free.

Actually this is not quite true. Dentistry used to be part of the NHS, but most people now pay for dentistry. Many people also pay for prescriptions, and it is eye-watering expensive to get a decent hearing aid. Also you cannot get medical equipment for free, e.g. a nebuliser. So the NHS is mainly free, but this concept is being sneakily eroded.

I know that many Americans believe the NHS to be some terrible ‘communist’ system where you queue forever, cannot get expensive treatments, and people wither and death in dimly lit hospital corridors whilst uncaring staff blow their noses on your sheets and cackle as they stride past in their jackboots. The NHS, at least as reported over here, seems to be held up as the poster child of an ‘evil’ system by those on the right wing of American politics.

I would just like to point out that it costs less than a half (as a percentage of GDP) of American healthcare. Yet, almost all measurable outcomes for health in the UK are better than in the US. Looking at the single most important outcome, which is overall life expectancy; people in the UK live longer than in the US. As do, it should be added, the French, Germans, Italians, Danish, Swedish, Spanish… Indeed, in virtually every way you choose to measure it, US healthcare comes last of all developed countries in the Western World. Just saying. So, the NHS may not be perfect, but please, please, let us not drift into US style healthcare provision.

However, having said all this, I still have a huge problem with the NHS. In that, it is no longer a ‘free at the point of access healthcare delivery system paid for out of taxes’. It has become ‘The NHS.’ Sounds of trumpets and a celestial choir. A kindly bearded figure sits on a throne in the clouds, beaming, surrounded by angels. Hallelujah, hallelujah.

Many years ago, the one thing that Margaret Thatcher said which, more than anything else, marked her out as an evil witch (in the eyes of many) was when she said that ‘there is no such thing as society.’ This is all that most people remember her saying, and they still hate her for it.

It marked her out as an uncaring monster, which is why they song ‘The witch is dead’, from the Wizard of Oz, got to number on in the UK charts shortly after she died. Not, perhaps, the UK’s finest hour.

In fact, the full quote was as follows:

“I think we’ve been through a period where too many people have been given to understand that if they have a problem, it’s the government’s job to cope with it. ‘I have a problem, I’ll get a grant.’ ‘I’m homeless, the government must house me.’ They’re casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It’s our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There’s no such thing as entitlement, unless someone has first met an obligation.” http://briandeer.com/social/thatcher-society.htm

As for me, I don’t really believe that there is such a thing as ‘society’ either. But not, perhaps for exactly the same reason as Margaret Thatcher. My problem is when an abstract concept becomes a real thing which is a form of ‘magical thinking.’

For example, on the left we have those who believe in ‘society’ and ‘the NHS’. On the right we have those who believe in ‘the Market.’ As in, the market won’t like this, or the market won’t like that. When the EU tries to bail out Greece, we are told that the Markets will stop this from happening. This idea, I believe, derives mainly from Adam Smith’s ‘The invisible hand of the market.’

I say. ‘Can you please introduce me to the ‘the Market’. Could I have a word with the market to understand what it thinks?’ Oops, silly me. There is no ‘market’. There are just individual bankers and financial workers and economists. These, in turn, are just individual men and women, with a high percentage of psychopaths sprinkled in.

You see, Market does not exist, it purely an abstract concept. Yet we talk about it as if it were almost a person, an entity with powers beyond mere mortal man. God like, in fact. The ‘invisible and all-powerful hand.’ Kind of like the vision of Emmet in the Lego Movie when he saw ‘The hand’.

When Nigel Lawson called the NHS the nearest thing the English have to a religion, he was right. In that many people have also raised ‘the NHS’ to a status of an entity. A super-corporeal being, infused with special powers and goodness beyond our understanding. An ‘invisible’ hand that works in mysterious ways to improve the health of the nation.

However, until we can stop thinking of the NHS as some sort of deity, and start thinking about the most equitable way to fund and provide healthcare in a rational way, all discussions about healthcare will become bogged down in cant and emotion. People will continue to wave banners about emblazoned with ‘Save the NHS.’ Politicians will gaze at television cameras with that special, coached, excruciating limpid expression on their face talking about how much they care about ‘the NHS.’ Bleurrgghh!

Guys, there is no such thing as ‘the NHS.’ There are paramedics and porters and lab technicians and nurses and managers and doctors and some buildings and equipment. What is the best way to use these resources to provide the biggest bang for your bucks? End of.

Sorry, I shall start slagging off statins again next week.

Are some diets ‘mass murder’

Yes, hallelujah, the headline on a paper in the BMJ by Richard Smith, the previous editor of the journal. He has finally, if belatedly, come to realise that the dietary advice that has dominated western medicine for the last fifty years, or so, is complete nonsense.

This damascene conversion is mainly due to the fact that he read Nina Teicholz’s book ‘The Big Fat Surprise.’ As he states:

‘…the forensic demolition of the hypothesis that saturated fat is the cause of cardiovascular disease is impressive. Indeed, the book is deeply disturbing in showing how overenthusiastic scientists, massive conflicts of interest, and politically driven policy makers can make deeply damaging mistakes. Over 40 years I’ve come to recognise which I might have known from the beginning – that science is a human activity with the error, self-deception, grandiosity, bias, self-interest, cruelty, fraud, and theft that is inherent in all human activities (together with some saintliness), but this book shook me.’

The amazing thing, to me, is not the Richard Smith has finally realised the diet-heart hypothesis is a complete crock. The amazing thing is that it still holds sway, despite the fact that it was never based on anything other than the propaganda of a power-mad egotist (Ancel Keys). Any evidence that saturated fat, or any other fat consumption, causes heart disease has always been weak at best, more usually non-existent, or just flatly contradictory.

Many years ago Dr George Mann (who was running the Framingham Study at the time) stated that:

‘The diet-heart idea – the notion that saturated fats and cholesterol cause heart disease – is the greatest scientific deception of our times…The public is being deceived by the greatest health scam of the century,’

And what effect did this comment have? Well, none. In 2008 the Food and Agricultural Organisation concluded the “there is no probable or convincing evidence” that a high level of fat in the diet causes heart disease. A 2012 Cochrane review found no benefit from total fat reduction and no effect on cardiovascular or total mortality. ”More recently we have the Women’s Health Initiative, which enrolled fifty thousand women in the randomised trials of the low fat diet and cost £460m. To quote Richard Smith again:

‘The women were followed for 10 years, and those in the low fat arm successfully reduced their total fat consumption from 37% to 29.5% of energy intake and their saturated fat from 12.4% to 9.5%. But there was no reduction in heart disease or stroke, and nor did the women lose more weight than the controls.’

A 23% cut in saturated fat intake, and no impact on anything. What effect has this had? Well, none. Evidence has never had the slightest effect on this hypothesis. As of today, you can still order posters and other information from the British Hear Foundation which announce, in bold, ‘I cut the Saturated Fat.’ The blurb underneath states1:

‘Find out how to reduce the amount of saturated fat you eat using our A2-sized wallchart. It includes information on the different types of fat in food and advice on the healthiest options to choose both when cooking and eating out.’

So, saturated fat still demonised. And the BHF are still saying that:

‘At the crux of this debate is the role of saturated fat in our diet. Diets that are high in saturated fat have been shown to increase cholesterol. A high cholesterol level is linked to an increased risk of cardiovascular disease, so that’s why current recommendations emphasise the importance of reducing the saturated fat in our diets2.’

I suppose one could laugh at all this. Because, the BHF also states (in the same article) the following

‘Last week saturated fat came back to the top of the news agenda because research we’d helped to fund suggested there isn’t enough evidence to support current guidelines on which types of fat to eat. While the latest study didn’t show saturated fat is associated with cardiovascular disease, it also didn’t show that eating more of it is better for your heart health2.’

In short, the British Heart Foundation states that they funded a study which shows there is no evidence that saturated fat is bad for the heart. However, they also state that diets high in saturated fat have been shown to increase cholesterol and a high cholesterol level is linked to an increased risk of cardiovascular disease.

Be careful guys. If saturated fat does raise cholesterol, yet a high saturated fat diet does not cause heart disease then. Logically, you are stating that cholesterol does not cause heart disease/cardiovascular disease. In fact, this is exactly what they are stating. There is no escape from logic my friends.

This is just one example of the knots that people tie themselves into when they try to defend the indefensible. Luckily, for them, no-one seems able to draw the obvious conclusion from their incomprensible gibberish. Either the diet/heart (saturated fat) hypothesis is wrong, or the cholesterol hypothesis is wrong, or both. [The correct answer is, or course, both].

Of all the stupid scientific hypotheses of the twentieth century the idea that fat/saturated fat causes heart disease – or any other disease – is by all possible measures the most stupid. It is the most stupid because it has driven dietary advice to eat more and more carbohydrates a.k.a ‘sugars.’ Anyone who understood anything about human biochemistry and physiology could tell you what this would do

1: Cause millions upon millions of people to get fatter and fatter

2: Cause millions upon millions of people to become diabetic

3: Cause millions upon millions of diabetics to completely lose control of their sugar and fat metabolism, get even fatter and die prematurely

All of these things have happened, exactly as could have been predicted. Yet, our esteemed experts still propagate the dangerous myth that saturated fat is bad for us and we should stuff ourselves with carbohydrates instead.

Yes, some diets are ‘mass murder’. To quote Richard Smith for the last time:

‘Jean Mayer, one of the “greats” of nutritional science, said in 1965, in the colourful language that has characterised arguments over diet, that prescribing a diet restricted in carbohydrates to the public was “the equivalent of mass murder.” Having ploughed my way through five books on diet and some of the key studies to write this article, I’m left with the impression that the same accusation of “mass murder” could be directed at many players in the great diet game. In short, bold policies have been based on fragile science, and the long term results may be terrible.’

Richard, there is no may about it. The long term results have been terrible. So, to those ‘experts’ who continue to propagate the idea that saturated fat causes cardiovascular disease. Merry Xmas – you dangerous idiots. As it is the festive season, I shall refrain from calling them mass murderers.

1: https://www.bhf.org.uk/publications/healthy-eating/cut-the-saturated-fat

2: https://www.bhf.org.uk/news-from-the-bhf/news-archive/2014/march/saturated-fats-explained

Salt is good for you

One of the most pervasive and stupid things that we are currently told to do is to reduce salt intake. This advice has never been based on controlled clinical studies, ever. Yet, as with the cholesterol myth, the dogma that we should all reduce salt intake has become impervious to facts. I find that the ‘salt hypothesis’ is rather like a monster from a 1950s B movie. Every time you attack it with evidence it simply shrugs it off and grows even stronger.

Very recently, a study was done in Australia looking at salt intake. Actually it looked at sodium intake, not salt intake. I find this interesting, as no-one that I know eats sodium. In fact, it would be interesting to see someone try. To quote from Wikipedia

‘Sodium is generally less reactive than potassium and more reactive than lithium. Like all the alkali metals, it reacts exothermically with water, to the point that sufficiently large pieces melt to a sphere and may explode; this reaction produces caustic sodium hydroxide and flammable hydrogen gas.’

Consuming two grams sodium would likely cause you to explode, splattering sodium hydroxide over the walls. Along with various organs and other body parts.

So why do people talk about sodium consumption? I have never really worked this one out. But it does make things rather confusing. The latest guidelines suggest we should consume less than 2300mg of sodium a day, even as low as 1500mg. Go on, try it. Any idea how much salt (NaCl) that would be? Any idea how much salt you consume every day? No, thought not.

Yes, we have been given guidelines that are totally meaningless, and impossible to follow. In fact 2300mg of sodium is roughly 6000mg of salt (NaCl). So why are we not advise to eat six grams of salt a day? I have no idea. Perhaps someone can tell me. What is this sodium nonsense? [Not that anyone has any idea what six grams of salt even looks like poured out of a salt shaker – I know, I have tried this several times.]

Of course, when I started looking into this area, I went at it sideways. If we eat salt we are eating both sodium, and chloride. You cannot have one without the other. So I became interested in the chloride issue, not the sodium. We are always warned about sodium, but no-one ever mentions chloride levels. Is there any evidence that high chloride consumption is bad for us?

This is an area mostly defined by silence, and zero research. But I have found a few papers looking at chloride levels in the blood and, guess what? They have all found that a low chloride level is associated with a higher mortality. Here is one such, entitled ‘Serum chloride is an independent predictor of mortality in hypertensive patients.’

‘Low, not high Serum Chloride- (<100 mEq/L), is associated with greater mortality risk independent of obvious confounders. Further studies are needed to elucidate the relation between Cl- and risk.’  (view here)

There you go. Having a low chloride level makes it more likely you will die early. Yet, having a high level of sodium consumption makes is supposed to kill you? And you cannot eat sodium without eating chloride at the same time. Go figure. You mean you can’t?

Anyway, to return to the, not yet published Australian study, here is what they found.

‘In a multivariate-adjusted model, those who consumed less than 3000 mg of sodium per day had a 25% increased risk of all-cause mortality and cardiovascular events compared with those who consumed between 4000 mg and 5990 mg/day (reference group).’ [1]

The guidelines tell us to eat less than 2300mg of salt. At this level, if we use the Australian data, overall mortality will be increased by 25%. Excellent advice then. And this is not just one contradictory study. Several other trials have clearly demonstrated that reducing salt intake significantly increases mortality in high risk patients. Particularly those with heart failure, where it would be expected that salt reduction would have the greatest benefit. Yet the trials showed the exact opposite.

As explained in the Journal Stroke. The section I have quoted below is taken from a reply to an article entitled “Reducing Sodium Intake to Prevent Stroke: Time for Action, Not Hesitation” In this article Appel, the author, argues strongly that we must, absolutely must, reduce sodium intake. In reply, three cardiologists make the following points:

‘In regards to patient-oriented outcomes, Appel dismisses randomized trials in patients with heart failure as irrelevant because of the unconventional treatment approach of the investigators. Yet these trials—showing increases in hospitalizations and mortality with low-sodium intake versus normal-sodium intake—tested identical diets in intervention and comparison arms with the only difference being the level of ingested sodium (making these trials more relevant than DASH-Sodium and other trials Appel cites). Also, Appel fails to cite 3 relevant heart failure trials, all consistently show harm with reduced sodium intake.’ [2]

In short, Appel, along with most ‘experts’ in this area had dismissed evidence he did not like.

The simple fact is this. If you strip out all the data on salt consumption there is considerably more, and considerably more powerful data, suggesting a strong link between low salt consumption and increased mortality than the other way around.

In reality, you can eat just about as much salt as you can stand – without harm. (Unless you have damaged kidneys and/or very high blood pressure)

How can I possibly state this? Well, a very wise Swedish professor pointed something out to me a few years ago. If a patient is very ill in hospital and cannot eat, or drink, they will have a drip put up to replace fluids. This very often contains 0.9% NaCl. Or nine grams of salt per litre. Quite often the patient will have two litres of this replacement fluid a day – which is (as you may have figured) 18 grams of salt.

So, we quite happy to give critically ill patients 18 grams of salt per day to help them get better – which has no discernable effect on their blood pressure, or anything else. Yet we tell people that they cannot eat more than six grams a day. Ho, ho. You earthlings are so funny.

References (may require site registration or membership to access)
[1] http://www.medscape.com/viewarticle/824749?src=emailthis
[2] http://webappmk.doctors.org.uk/Session/1405533-8qblkO84E9hsUXe6OUa4-aoqmidt/MIME/INBOX/125637-02-B/Stroke-2014-DiNicolantonio-STROKEAHA.114.005067.pdf to be published soon