Hi everyone. Welcome to the first of my monthly blogs. In these blogs I want to give you lots of background information as well as giving you my thoughts on the the latest research, media posts, newspaper articles etc
What have I been doing?
2018 has been a busy one for me, finishing A Fat Lot of Good, speaking at a number of international conferences and working on the SugarByHalf campaign.
My first conference was the Wales Exercise Medicine Symposium in Cardiff in late January. London cardiologist Aseem Malhotra and I gave the Keynote addresses to an enthusiastic audience. My topic was Why we are getting fatter and sicker - and what you can do about it. It was also a chance to catch up with Zoe Harcombe author of The Obesity Epidemic and we had a great dinned cooked by her husband Andy at their beautiful cottage in a village in the Welsh countryside. After the symposium I spent afew days in London speaking on nutrition matters to the sport and exercise medicine doctors in London and also at Arsenal Football Club. Got to see some Premier League games as well.
Went straight from the UK to the Australasian College of Sports and Exercise Physicians conference on the Gold Coast. I was one of the Founding Executive members of the College and has two terms as President back in its formative years. It was great to catch up with old friends and wonderful to see the College thriving. My talk there was entitled What the sports physician needs to know about nutrition. It went down well.
The next international gig was the Low Carb Breckenridge conference on the beautiful ski resort of Breckenridge, Colorado at the end of February. I have skied all my life so I couldn’t resist the urge to go over a few days early and have a couple of days skiing with my son Joe and his girlfriend Caroline who came over from Los Angeles where they both work as scriptwriters. The conference was brilliant with an amazing array of outstanding speakers, mainly American, including Nina Teicholz, Ivor Cummins, Dave Feldman, Andrew Mente, Steve Phinney, Robb Wolf, Andrea Eenfeldt, Georgia Ede, Ben Bickman, Jake Kushner, Eric Kossof, Sarah Hallberg, Eric Westman, Dave Diamond, Mike Eades and lots of others. I felt very privileged to be part of it. My topic was Fats or Carbs? What is the best fuel for high performance? I was also part of a panel (see below).The conference is run every year by Jeff Gerber (Denver’s Diet Doctor) and our very own Rod Tayler of Low Carb Down Under. The talks will soon be available online and I will let you know where in a future blog.
After a couple of weeks back in Melbourne for, among other things, my daughter Julia’s wedding- a great day - I was back on the road with a quick dash across the Tasman wearing my sports medicine hat to speak at the International Shock Wave Therapy conference in Auckland. I did get the chance to catch up with some of the Auckland low carb group (below) – Grant Schofield, Catherine Crofts, George Henderson and the wonderful Libby from DitchtheCarbs. Grant has a new book out which I will review next month and I will also do a feature soon on Libby’s website.
Back to Melbourne for ten days including the first in a series of talks I will be giving to general practitioners who are part of the Primary Health Care group. These have been organised by their Head Dietitian Nicole Moore, and both Rod Tayler and I will be crisscrossing the country over the next few months introducing GPs to the concept of healthy eating.
After that it was back to the US as an invited speaker at the AMSSM (American Medical Society for Sports Medicine) meeting in Orlando, Florida. The topic of my keynote was Fats or Carbs – what is the best fuel for performance. This conference is the main US one for primary care sports medicine docs and was attended by over 2000 doctors. My talk created quite a stir and I suspect many of the audience have gone home with the aim of improving their diet. I have to admit somewhere like the Disney resort is not the easiest place in the world to eat properly but we managed OK. It is pretty scary to see what the crowds of people at Disney World were eating. It is no wonder the US has such a high rate of obesity.
A FAT LOT OF GOOD
Well the day has finally arrived – Monday April 30 the official publication date of A Fat Lot of Good – and I missed it!! I was on a flight back from the U.S. and I spent publication day in the air. It was pretty exciting when I landed to walk past the airport bookshop and see a copy of the book prominently displayed.
On Saturday I spoke at the Low Carb Down Under conference in Sydney. A packed house of 250 listened to a great array of speakers including our hosts Doron Sher and Paul Mason as well as Gary Fettke, Maryanne Demasi, Rod Tayler, Vanessa Muratore, Jessica Turton, Taryn Polovin and Lindsay Woods.
Always love catching up wth Gary and Maryanne, two courageous outspoken advocates of healthy eating.
Managed to sell out all copies of A Fat Lot of Good at the conference!
I have a few talks in Melbourne before heading to the UK for the Public Health Collaboration conference in London on May 19&20. I am giving the Opening Address at the conference and other speakers include Aseem Malhotra, Zoe Harcombe, David Unwin and Tim Noakes.
What is SugarByHalf up to?
Things are always busy at SugarByHalf. Our wonderful Campaign Manager Tania Sincock has been in Sydney at an Action on Obesity meeting and is developing good relations with the other bodies interested in this area. We are developing a national campaign which we are hoping to roll out later this year – all we need is more funding!!
PERSON OF THE MONTH: NINA TEICHOLZ
Nina Teicholz is a New York-based journalist who grew up in California and subsequently attended Stanford, Yale and Oxford Universities. She became interested in dietary fats while writing a series of food articles for Gourmet and started to research the topic. Her years of research culminated in the publication of her classic book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet (see below) in 2014.
Since then Nina’s passion has been to update the U.S Dietary Guidelines and she has been supported in this work by the Laura and John Arnold Foundation.
She published a controversial article in the British Medical Journal in 2015. Read here
The article challenged many of the accepted beliefs in nutrition and was widely criticized. Despite pressure from a number of lobby groups associated with the food industry, the BMJ refused to retract the article.
Nina is currently leading a group called the Nutrition Coalition to tackle the U.S. Guidelines.
Nina is one of the most impressive people I have met and we were delighted to host her visit to Australia last year for one of Rod Tayler’s Low Carb Down Under conferences
BOOK OF THE MONTH: THE BIG FAT SURPRISE
Nina’s 2014 book, The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, traces the history of US diet guidelines; in the book she investigates the science behind the guidelines and the influence of industry lobbying on them, and also questioned their emphasis on avoiding saturated fat. Nina advises readers to "eat butter; drink milk whole, and feed it to the whole family. Stock up on creamy cheeses, offal, and sausage, and yes, bacon".
The book made The New York Times Best Seller list that year, and was named one of the Top 10 Non-Fiction Books of 2014 by The Wall Street Journal and one of the year's best science books by The Economist.
I reckon this is the best book I have ever read and I would encourage any health professional, or indeed anyone interested in nutrition, to read it. It is a fascinating tale of politics and health. I carry some copies around with me and if any health professional shows any interest in this area, I give them a copy of the book. I don’t ask for payment but instead I ask them when they have finished reading it to pass it on to another health professional. I defy anyone to read that book and not be blown away by the story. It will change your life for ever.
On my list of Top Ten books found elsewhere on this site, A Big Fat Surprise in Number 1.
WEBSITE OF THE MONTH: WWW.DIETDOCTOR.COM
This is the number one low carb website in the world. It was started by Dr Andreas Eenfeldt, a very tall, charming, ever-smiling Swedish doctor who gave up his medical practice in 2015 to devote himself to the website. It started off in Swedish in 2007 and has become the biggest health blog in Sweden and soon after he launched an English version (2011) which has become huge (250,000 visits per day)
Andreas now has 17 co-workers and there is a vast amount of material on the site with new videos, podcasts, interviews and articles being posted daily. The site is completely free from ads, product sales or industry sponsorship and instead fully funded by the people, via over 40,000 optional members. I strongly recommend subscribing.
Whether you are just starting out on your low carb journey, or you are already firmly committed but want more information, and even if you just want to explore these new concepts, then this is the website for you. On my list of Top Ten websites found elsewhere on this site, DietDoctor in Number 1.
PODCAST OF THE MONTH: NINA ON JOE ROGAN
Joe Rogan is a well known stand up comedian with a number of hour long TV comedy specials under his belt, On top of that he is a former Tae Kwon Do champion and expert commentator on UFC fight cards. He has a very popular long form podcast and he had an excellent chat with Nina Teicholz a few months ago.
FOOD OF THE MONTH: BREAD
This is part of what I say in the book about bread ….
I don’t know how many people, when I tell them I’ve given up eating bread along with other carbs, have said, ‘I could give up everything else, but not bread.’ Bread has long been known as the ‘staff of life’, and the Bible says, ‘Give us this day our daily bread.’ So why are we saying now that bread may be not so healthy for us?
Bread is made from a combination of flour, yeast, and sometimes sugar and salt. The flour usually comes from wheat, although other forms of flour exist – such as spelt (an older form of wheat), rye and barley. The problem is that bread is just not good for you. Dr William Davis, a cardiologist and the author of Wheat Belly, calls wheat ‘the perfect chronic poison’. Or as Michael Pollan says in his book Food Rules, ‘The whiter the bread, the sooner you’re dead.’
There are two ways in which bread negatively affects our health. The first is that bread (and wheat and flour) is full of carbs and has a very high glycemic index, which means that eating bread causes a rapid spike in glucose and insulin levels.
The second problem revolves around the hundreds of different proteins contained in wheat. The best known of these is gluten, which has glue-like properties (hence the name glu-ten) that are responsible for dough’s stickiness.
A significant proportion of the population appears to be sensitive to gluten. Ingesting gluten gives them a range of symptoms including abdominal pain, bloating, discomfort and diarrhoea. Gluten and other wheat proteins may increase intestinal permeability resulting in an autoimmune response to substances not usually present in the gut wall and bloodstream.
The author of Grain Brain, American doctor David Perlmutter, suggests that the proteins in wheat have an adverse effect on brain function, which may be related to the gut–brain connection. In his experience, removing gluten from the diet results in an improvement in symptoms.
Gluten is only one of many proteins contained in wheat and it is likely that many people are sensitive to various different proteins. By avoiding bread and other products derived from wheat products, many have experienced improvements in health.
If you’re insulin sensitive and can tolerate bread, sourdough bread may have some health advantages over conventional bread. Sourdough is an old form of bread leavening that relies on a mix of wild yeast and lactic acid bacteria, rather than added baker’s yeast. Its lower gluten and phytate levels due to the fermentation process make it more nutritious and easier to digest. Sourdough bread also seems less likely to spike your blood sugar levels. Wholegrain sourdough is preferable.
Wraps aren’t so great. Even though the fillings are often healthy, the wraps themselves are no different in their content from regular white bread.
But we’ve been eating bread forever …..
If the human race has been eating bread for centuries without any ill effect, why are we having problems now? According to William Davis, wheat today is completely different from the wheat that was eaten years ago. We used to consume ancient varieties of wheat such as emmer, einkorn and kamut, but most of the wheat eaten today is high-yield dwarf wheat developed by cross-breeding and genetic manipulation in the 20th century.
Dwarf wheat has shorter stems and a much greater yield, which makes the grain it produces cheaper than the older varieties and more economically viable. Wheat is also processed differently now. Since the late 19th century, milling techniques have made it possible to produce large quantities of refined wheat flour cheaply. In white flour, the nutritious components of the grain (the bran and germ) have been removed from the endosperm, where most of the starchy carbs are contained. This makes it much less nutrient dense and means it spikes blood sugar very quickly.
And we used to prepare our grains differently. They were soaked, sprouted and fermented, and bread was baked using slow-rise yeast. Sprouting and fermenting grains increases the quantity of the amino acid lysine, reduces anti-nutrients (such as phytate acid and lectins), disables enzyme inhibitors and makes the nutrients more accessible. Commercial bread is made with bleached flour and baked with quick-rise yeast. The grains certainly aren’t soaked, sprouted or fermented.
As a result, Davis says, modern wheat is less nutritious than old wheat. The amount of minerals such as zinc, copper, iron and magnesium has decreased by a quarter. It also contains more gluten. Some studies show, for example, that people with coeliac disease can eat older wheat varieties without a reaction.4 Relative to older wheat varieties, modern wheat has been said to have adverse effects on cholesterol, blood mineral content and inflammatory markers, potentially contributing to disease.
All of this probably explains the widespread lack of tolerance to modern wheat. It takes generations for the human body to adapt to these sorts of changes.
Do we need to eat grains at all?
While there is no doubt that whole grains are better for us than refined grains, the question is do we need grains at all. The Dietary Guidelines have grains and cereals on the bottom rung of the Food Pyramid and want us to eat lots of them.
We certainly don’t need to eat grains as there are no nutrients that cannot be supplies by other foods. However whole grains certainly have some benefits particularly as a source of fibre.
While many people tolerate grains well, there is a significant proportion of the population who are better off without grains altogether. Especially if you have some gastrointestinal (GI) symptoms such as bloating, or if you have been diagnosed with GI disorders such as IBS (irritable bowel syndrome) or GERD (gastro-esophageal reflux disease) then you should consider at least a trial of grain-free low carb eating. I have had numerous patients who stopped eating grains especially all wheat-containing foods for another reason (e.g. weight loss), whose GI symptoms disappeared once they ceased the grains.
Flour is the basis of so many modern foods, it’s hard to avoid it completely, but flour alternatives, such as almond flour and coconut flour are good for cooking, and aren’t associated with the same health issues as wheat flour.
There are plenty of low-carb breads available that are made from flour alternatives such as almond and coconut meal. Be wary of commercial gluten-free breads, as they often contain other high-GI starches.
The simplest gluten-free bread recipes contain almond flour, eggs and baking powder, although most are very dense. Adding the egg yolks and whites separately, then folding in the whites after beating, can help overcome that problem. If you want to bake your own low-carb bread, there are lots of recipes on the internet. One of my favorites is from the great website Ditch the Carbs
Libby’s 3 Seed Bread recipe
- 35 g chia seeds
- 75 g sunflower seeds
- 75 g pumpkin seeds
- 25 g coconut flour
- 75 g psyllium husks
- 1 tsp baking powder
- 1/4 tsp salt optional
- 50 g butter melted
- 2 eggs
- 250 ml water warm
Place all the dry ingredients in a large mixing bowl and stir.
Add the melted butter and eggs. Stir until almost mixed.
Add the warm water and stir until all the ingredients are full incorporated.
Place in a loaf tin and bake at 180C/350F for 35-45 minutes. Ensure it is golden on the outside and cooked in the centre. Cooking times may vary with each oven.
Here is a selection of recipes for other low carb breads
Diet Doctor: Best breads https://www.dietdoctor.com/low-carb/keto/recipes/bread
Ditch the Carbs Best 20 breads https://www.ditchthecarbs.com/best-low-carb-breads-on-the-internet/
MEDIA ARTICLES OF THE MONTH: THE AGE
My favorite article for the month was from Peter Martin the Economics editor of The Age/ looking at the effect of the UK sugar tax even before it came into law. Maybe we should try the same here!! READ HERE
MEDICAL JOURNAL ARTICLES OF THE MONTH: PURE STUDY
For this blog’s medical journal articles I want to go back to a series of articles published last year on the PURE study. The PURE study is arguably the most important nutrition research study ever done. PURE stands for Prospective Urban Rural Epidemiology and in these papers the researchers investigated the effect of dietary nutrients from over 120,000 participants from 18 countries in North America, South America, Europe, Africa, and Asia. In the two papers I am going to briefly describe here, they looked at the effect of dietary nutrients on:
1. blood lipids and blood pressure
2. cardiovascular disease and mortality
The first study investigated the effect of dietary nutrients on blood lipids and
blood pressure, two of the most important risk factors for cardiovascular disease. They also aimed to examine the association of isocaloric replacement of saturated fatty acid with other nutrients on these cardiovascular disease risk markers, and to assess whether the changes in risk markers with changes in total fat and saturated fatty acid vary significantly by level of intake. They also compared whether the associations observed between saturated fatty acid and carbohydrate intake and cardiovascular disease could be explained by their associations with specific lipid markers.
Their findings suggest that reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might be beneficial for some risk markers (LDL cholesterol and blood pressure), but might worsen others (HDL cholesterol and triglycerides).
They concluded that the current recommendation to reduce total fat and saturated fatty acids, which leads to a de facto increase in carbohydrate intake, is not supported by our data. SEE HERE
In the second PURE study published in The Lancet the investigators found that fats, including saturated fatty acids, are not harmful and diets high in carbohydrate have adverse effects on total mortality. They did not observe any detrimental effect of higher fat intake on cardiovascular events.
They concluded that their data across 18 countries adds to the large and growing body of evidence that increased fats are not associated with higher cardiovascular disease or mortality. I
The implications of all the available evidence were that removing current restrictions on fat intake but limiting carbohydrate intake (when high) might improve health. Dietary guidelines might need to be reconsidered in light of consistent findings from the present study, especially in countries outside of Europe and North America. SEE HERE