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## Eighteen Months of Low Carb

Dietitian’s organisations frequently criticise low carbohydrate diets for not being proven safe in the long term. Poorly controlled diabetes (where blood glucose is higher than for people without diabetes) on the other hand, has been proven extremely unsafe in the medium to long-term.  For people with diabetes, a restricted-carbohydrate diet is almost certain to lower blood glucose and remove or eliminate medications. This one ‘radical’ diet change can hardly fail to alleviate most of the ill effects of diabetes, medicinal side effects and both of their risks. Clearly, the ‘unknown risk’ of the low carbohydrate diet in the long term can be weighed against the near certain risks of diabetes. Otherwise, blindness, amputation, cardiovascular disease, dialysis from kidney failure and a shortened lifespan will nearly always be the end result.

I have now passed eighteen months on a low carbohydrate diet. That means I have exceeded the 74 weeks of the ‘best’ vegan diet study by Barnard. I thought it was time to wrap up the comparison and reflect on my health progress to see where my health journey could now go. That is the focus of this post.

## HbA1c Chart

Let’s get straight into that with an update to my HbA1c chart.

At the end of August, I was a little disappointed. The downward trend ceased and my result was actually 0.1% higher than in May. This was mitigated by the fact that the result is only accurate to one decimal place anyway and the later result in December came in again at 5.6%. All these results are still in the non-diabetic range. I still take 500mg of metformin as this remains beneficial to further recovery despite having non-diabetic blood glucose. That can be compared with 2000mg of metformin, Januvia and Diamicron before low carb.

Unlike the conventional and vegan diets in the trial, my blood glucose has stabilised and not led to an increasing HbA1c after three to six months that sustains and increases medications. Compared to HbA1c population statistics, it is about four standard deviations lower than the vegan diet and that is maintained on a minimum amount of metformin- unlike the more heavily medicated study participants.

Finally, my ending HbA1C is about ten standard deviations less than the vegan study statistics. Statistically, it is practically impossible for any of the 49 vegan (or 50 conventional diabetes diet) participants to have achieved a similar result.

## Long-Term HbA1c & Glucose Control

In the context of my long-term results, the last eighteen months of a low carbohydrate diet since month 31 on this chart, have been an unqualified success. I have had non-diabetic blood glucose for fifteen months, and even non-pre-diabetic blood glucose for at least 6 months.

It is important to realise that HbA1c is really only an average. Large fluctuations up and down can still give a good average but have the considerable risk of complications due to glycaemic variability. My blood glucose measurements have a standard deviation of an excellent 0.8 mmol/l and the tight glucose control that a low carbohydrate diet gives can be seen below. I have a normal non-diabetic HbA1c with low glycaemic variability. My blood glucose measurements were 98% within target showing tightly controlled blood glucose. Such is the efficacy of carbohydrate restriction for diabetes.

You can also see the effect of one inadvertent meal which included carbohydrates at my daughter’s graduation function. Refined carbohydrates are insidiously a part of our food supply and no one is perfect!

## My Overall Health

Unfortunately, with very high blood glucose, I had just about every bad effect from diabetes that researchers have shown. So how is my health after eighteen months on a ‘fad’ diet of unprocessed foods low in refined carbohydrates and no ‘healthy’ whole grains?

But not everything is the same. I do have one negative. I am more prone to constipation which I almost never suffered from before. This is almost always a problem if I do not hydrate properly. Looking at the list above, I sure can live with that!

It is undeniable that my health is vastly improved. My doctor is extremely pleased, I am extremely pleased and my family is extremely pleased.

## Social Effects & Adherence

Quite bizarrely, the Dietitian’s Association of Australia cited (without evidence) that the low carb diet should not be used for diabetes because the health of other family members could be impacted. Would they make that comment for a coeliac? Nonetheless, I can report that when we have meals, the family generally eats the potatoes or carbohydrates and I have a different vegetable. If only I could get my children to avoid processed foods, skip the fries and stop asking for sugary drinks completely like I do! It seems that is even beyond my powers as a role model. However, because of my eating requirements and awareness, we have less refined carbohydrates and processed foods and my children have reduced their sugar intake. Maybe they meant that they didn’t want anyone’s health to improve?

When I go out to eat, I rarely have a problem finding something. If there are carbohydrates, I usually can get another vegetable substituted.

This is otherwise an unremarkable non-issue.

## Measuring My Metabolism

In late September, I had my metabolism measured by Metabolic Health Solutions (MHS). In full disclosure, this was done for me at no cost. I had not understood before how metabolism, weight loss and diabetes tied together. Now I think I do!

My testing showed that my Resting Metabolic Rate (RMR) was 2145 kcal which is towards the top end for my age and body. That is good. It explains that I have the metabolism to potentially lose weight without vigorous exercise. My efficiency (FEO2) was 17.3% confirming that I am no athlete as it would be optimal if less than 15!

Very surprisingly, the test showed that my fuel mix was 24.7% from fat and 75.3% from carbohydrate. This surprised me as I thought that, being on a low carb diet, I would automatically be a good fat burner!  Ideally, this should be almost opposite with 80% fat burning and 20% carb burning.

It seems my metabolism is more than happy burning carbohydrates from protein.  It does explain why I generally have had trouble losing weight and still have trouble. Clearly, if one is a good fat burner and does not eat a lot of fat then one will burn body fat. Being a carb burner fully explains why, when I went on a slightly higher fat moderate protein diet, I stalled. Even though it was low carb, my body was still getting most of its energy by making glucose from protein.

Solutions for me include some longer fasts, a more ketogenic diet to encourage fat metabolism, and exercise.

Since that testing (and to be transparent as my blog is non-commercial) I have begun working with MHS because I am impressed with how this information can inform your weight loss and metabolic health strategy. The world has a lot of metabolically sick people.

## Where to From Here?

It is still my aim to achieve an HbA1c of 5.1% or below. As I indicated in my last post, control theory would indicate that I am unlikely to achieve that on the current trajectory. The steady progression downwards has arrested and I am about one standard deviation from the target. I do want to lose further (fat) weight. I must change my approach or it seems I will always be above the setpoint or take a very long time to reach it. My sleep patterns are pretty good and my diet is working well. I am still doing only a little exercise. Here are some options.

## A Ketogenic Diet

Presently my diet has quite a bit of protein in it. This does not raise my blood glucose as carbohydrates do but it keeps me out of ketosis a lot of the time. By operating more deeply in ketosis, my blood glucose would fall markedly more and I would likely achieve my 5.1% HbA1c. That means a higher fat diet. If I limit my protein I will also have reduced capacity to burn carbs (presuming I can spare muscle) and this may help me become a better fat burner.

I enjoy the higher protein low carbohydrate diet. I do not see a ketogenic diet as a long-term option for me since it more difficult to get sufficient nutrient density on a high-fat diet- but this might be something I do for a while if it helps me to become a better fat burner.

## Some Longer Fasting

Most days I fast 16:8 by skipping breakfast. By extending this I can cause my metabolism to use my own body fat since while fasting it will not have carbohydrates, fat or protein from diet and should prefer to use my own body fat. As a 75% glucose burner, I need to be careful that my body does not decide to obtain glucose by catabolising muscle until I can change that.

## High-Intensity Exercise

I do not exercise much and have exercised little over the 18 months. Among other things, I wanted to see how far I could go with diet and did not want to confound diet and exercise. By building more muscle and doing high-intensity exercise I should be able to deplete my glycogen more easily and frequently, leading to a reduction in average blood glucose, as well as increasing my insulin sensitivity. High-intensity exercise will also be helpful, combined with fasting or a keto diet to reduce muscle loss, and help me to become a better fat burner.

To be honest, I have never been a marathon runner and likely never will be, so part of my challenge is to find the exercise that I will enjoy.

## Metabolic Health

Having some real numbers from metabolic health testing has allowed me to focus on what I can do to improve my metabolic health. I am now more motivated to exercise and then be re-tested to see how I have improved.

## A Note for Vegans

Sorry, but in my case, it was no contest. A vegan diet can (without question) improve your health if you are obese and have diabetes mainly by its calorie restriction, but Barnard’s study compared with my journey shows that it is neither as sustainable nor as optimal for me as carbohydrate restriction when compared against the study people. I went the distance of 78 weeks versus the study’s 74 weeks and it is “Game Over”.

## Final Word to Dietetic Associations

Shouldn’t I be dead by now from the ‘fad’ diet?  In fact, if I had listened to you I might have been well on my way to dialysis or amputation. I think you need to get over your prejudice against low carbohydrate and higher fat diets. After all, despite some health-washing to make the much-lauded Mediterranean Diet appear as a low-fat diet- it is actually also a high-fat diet.

It is without question for me or my doctor that a low carbohydrate approach has led me to vastly improved health and a reversal of diabetes. If you have any real semblance of taking an evidence-based approach, that should also be obvious to you. You say that your members deliver services that are not ‘one size fits all’ but in practice if you have dietary guidelines uniformly applied to everyone (sick and healthy) it really is lip service!

More importantly, when you get medically and metabolically tested, it is well apparent that your dietary, exercise and eating must be individualised to optimise your metabolic health and that it is likely to change over time. It is reprehensible that dietitians are not systematically identifying the people for whom a low carbohydrate diet is beneficial and helping them with an individualised journey.

It is a shame that you (dietetic associations) keep your members in the Dark Ages of dietetic practice. I suggest that if you don’t change then consumers should figure it out for themselves and vote with their feet.

Oh, that’s right. We are!

🙂

## What is a Superfood?

Nutrient density is defined as the nutrients divided by the calories in a food. The higher the number, the closer a food would be to being a superfood. I saw a table of these in this article which sets out reasons to become vegetarian. The table shows that raw leafy green vegetables are probably superfoods:

I don’t disagree that kale and spinach are high in nutrients for their calories, but something was missing from this table. It was a class of food that I believed was very nutrient dense. Within that class there was one particular food that I thought would meet the definition of a ‘superfood’- but it was missing. Why was it missing? That question started a journey that I hope you will find as interesting as I do.

## Superfoods (Eye Roll)

Like me, you probably roll your eyes at the ‘superfood’ term. Cynicism aside, it is a common term for foods regarded more highly than others for their nutrition. After a bit of media research, I found that none of these internet articles, which were the top hits in google for ‘superfood’ mentioned the missing food. I found that extraordinary when gram for gram it:

• Has about three times the iron of red meat
• Has about three times the protein and iron of black beans
• Twice the vitamin A of carrots with far more bioavailability
• Kills quinoa & whole grains for B vitamins, some of which are associated with a lower risk of cancer
• Is a significant source of phosphorus, potassium, copper, selenium, and zinc
• Has so much more….

What is this missing ‘superfood’ and why is it not listed with others? Well, the answer lies in the definition. You see if it is not considered very beneficial for health and well-being by ‘experts’, then it is not a superfood.

## The Ignored Superfood?

So while some dietitians and nutritionists wax lyrical about goji & acai berries, kale, blueberries, quinoa, broccoli, salmon and (of course) whole grains, this ‘superfood’ it seems, is not regarded as healthy. They tell you to eat ‘this and that’ in endless articles to spruik their dietetic prowess. They, and a chorus of others on the Internet, give you scientific reasons to eat less or more of all sorts of things. We are told about: fibre, low-fat dairy, high-fat dairy, eat eggs, don’t eat eggs, eat fish but don’t eat animal meat, free-range, grass-fed, non-GMO, stress-free, wild, Patagonian, rare, exotic, antioxidant, phyto-, anti-aging ingredients, but hardly anyone seems to pay any attention to this ‘superfood’.

Right about now you probably think I am trying to get you to eat more of this food. Maybe I have a supplement to sell you? That is NOT what this post is about. I care what I eat because I have had success using diet to reverse my diabetes. While I have incorporated this ‘superfood’ more into my diet, you can eat whatever you want. Do this for whatever reason of belief or science- but please don’t get those reasons mixed up!

## The Superfood not a Superfood

The superfood ‘in waiting’ is liver. Chris Kresser and Chris Masterjohn, have called liver a ‘superfood’. They and Zoë Harcombe make a good case for its nutritional qualities; but irrespective of their reputations, it does not make it much more a superfood. You see the term superfood is a social term deemed by consensus of more than a few people. The really interesting question, and subject of this post, is why there is little fanfare from other nutrition experts to give it superfood status.

But for that recognition, liver should be the king of superfoods.  Unless you are very young, your mother or grandmother would have told you how healthy liver is. Hunter-gatherer cultures used to eat it first after killing an animal. Carnivores are said to also eat it first when they kill their prey. It was the original super food so why are so many nutritionists and dietitians reticent to confer superfood status today? Why were organ meats and liver omitted from the nutritional density table in the vegetarian article? Why are they routinely omitted from other lists of ‘superfoods’?

## Do Superfoods need to Taste Bad?

Liver is not a superfood just because many find it unappetizing although some may joke that tasting bad is almost a necessity for superfood status. Just look at kale or broccoli! Liver can be eaten as liverwurst or paté and disguised and included in ground meat dishes. Chicken livers are even a traditional ingredient in Bolognese. I am sure these tips could be told to us by dietitians to encourage the consumption of a superfood. Its common practice in newspaper pieces from health experts for other superfoods.

## High Cholesterol?

Little has been written about liver’s fall from grace but like eggs, it is high in cholesterol. It may be inferred from the fate of eggs that it fell out of favour due to cholesterol being a nutrient of concern. Unlike eggs, it has not received redemption. It seems it has no friends to make its case. Why is that?

## Toxins?

It could perhaps be said that there is a fear that liver may concentrate toxins like heavy metals. Indeed now banned arsenic compounds have been used in factory chicken farming and accumulate in chicken livers. That really is a food safety issue. If liver is not safe to sell then warn the public and don’t allow it to be sold or change farming practices. We did not stop eating spinach when there were e-Coli deaths or stop eating berries when there were cases of cholera from frozen berries. If that is the reason then it is inconsistent.

Dietitians seem more likely to warn you not to eat liver than extol its virtues. Liver is so high in bioavailable vitamin A that in the UK, pregnant women are told to avoid it by dietitians because of the risk of birth defects. Rather, they should also take iron, folate (and now B6) supplements to prevent birth defects when all are in high amounts in liver! So effective is the message that pregnancy forums are full of mums-to-be frantically worried about an accidental meal of liver as though it will kill their unborn child!  It is more likely that your mother or grandmother was told to eat it when she was pregnant with you or one of your parents, and that she did so. I suppose it is lucky you are here!

## Superfoods are Mostly Plant-Based

Looking at the prominent superfood lists that I quoted, there are few animal-based superfoods and even fewer that are meat. Most of the lists of superfoods are exclusively or near exclusively plant-based. Since livers’ fall from grace as a cholesterol filled organ meat, meat (in general but not liver specifically) has been associated with cancer in a number of studies. Liver has about a quarter of its fat as saturated fat, but is not in itself a very high-fat food so fat is not a sound reason to avoid liver given its other nutritional virtues. Why else could it be neglected?

Some may say this is a conspiracy theory however in the field of anthropology and the social sciences, unlike the say the science of physics, what humans believe provides a prima facie case for associated outcomes.

## Vegetarian Agenda?

Is liver being unfairly denied superfood status because of a belief-based vegetarian zeitgeist? One that started with the introduction of dietary guidelines and has progressed through to today?

Here is what seems readily apparent:

1. On the basis of nutritional elements including proteins, vitamins and minerals, liver is clearly a superfood and one which outperforms others.
2. Liver was likely to have been your grandmother’s and/or mother’s superfood. It was probably your paleo ancestor’s go to food- if available.
3. It rarely (if at all) appears in lists of superfoods. Those lists are dominated by plant-based foods.
4. It is high in cholesterol but this is no longer a nutrient of concern. It is not particularly high in either fat or saturated fat.
5. I could not find any studies even associating the eating of farm animal liver to cancer or adverse health. (If you know of any, then please add to the article comments.)
6. Liver may not taste great to everyone, but this is not a reason to deny it superfood status.
7. Unlike eggs, liver has never recovered from the concern over dietary cholesterol. It seems it has had few friends to redeem its name.
8. Liver may be, without good evidence, tarred by associational studies of other meat products.
9. There is no nutritional benchmark for a superfood. It is a status conferred by social consensus.
10. Liver does not have that consensus and is mostly ignored as a superfood by the nutritional and dietetic professions.

## Liver: A Fistful of Supplements

What good reason is there for liver not to be a superfood when a serving clearly replaces a fistful of supplements? Why are offalorgan meats and liver as a food absent from our food guidelines altogether? Maybe liver is omitted from our guidelines for the same reason it is omitted from a table in an article convincing you to be vegetarian?

A vegetarian (plant-based) zeitgeist certainly explains it. We have guidelines and dietetics that includes the views that:

## An Inconvenient Truth

I made a bet on my health-based on guidelines that appear to be written with a vegetarian agenda and lost. Call me biased, but my hypothesis is simple.

True nutritional science would not have a plant-based bias. Liver is not a superfood because that is an inconvenient truth.

We can’t trust in the nutritional establishment to answer this charge. I am throwing this open to the ‘court of public opinion’.

What do you think?

## Engineering Nutrition?

With the failure of forty years of dietary guidelines to arrest or improve the incidence of diabetes and obesity, new thinking and approaches are needed. Applying an engineering mindset to nutrition has attracted attention as some of the new thinking has emerged using root cause analysis and other engineering tools. This has resulted in new insights for the medical and nutrition communities.

This is not really new, I pay homage to doctors like Dr Bernstein who trained as an engineer first, then as a trained doctor realised how controlling diabetes was like an engineering control problem.

Recently, however, as a recovering type 2 diabetic, I plotted my HbA1c against the results of a long-term vegan ‘cure’ for diabetes study to see how it compared. I was astounded by the superior result and tweeted that it was a fifteen sigma improvement. While not really correct, it got me thinking of my recovery in terms of engineering control theory and quality management.

Putting aside whether a cure is possible (for type 2 diabetes) and considering treatment, what if we view diabetes as an engineering control problem and applied control charting to understand the quality of different management options? Note that while I have type 2 diabetes, the glycaemic control problem is common to type 1 and so much of this analysis also is relevant to them too.

## Broken Control System

You might wonder, what will happen if you don’t eat any carbohydrate? Fortunately, probably as a result of adaptation, the body is fine as it can make what you need from other sources. This happens mostly in your liver. It is called gluconeogenesis or GNG for short.

Essentially with diabetes, the control system that reduces blood glucose (BG) is broken. The homeostasis (self-regulation) of your BG is ineffective because your body’s response to insulin (which lowers BG) is diminished (called insulin resistance) and/ or your ability to produce insulin in response to carbs is insufficient to lower BG quickly enough. For type one diabetes, insulin production is at or near zero.

Consequently, glucose that your body gets from carbs (or makes in the liver through GNG) will raise your BG and it will only fall slowly because your body is unable to produce or respond to insulin properly.  So BG is easily raised but slowly and poorly lowered.

## Conventional Diabetes Management

Let’s leave the medical theories about why the system is broken alone for the moment and assume we have to do the best with what we have got.

Conventional diabetes management seeks to lower your BG towards normal but not so that it drops too low. This is done by exercise (to consume glucose), diet and medications that replace insulin, reduce glucose production or eliminate glucose from the body.

In conventional diabetes management, juggling these factors on a daily basis is hard and is the focus for someone with diabetes. Every three months you go to see your doctor to see how you are doing overall and to see if your medication should be adjusted.

Unfortunately, it is hard to achieve and maintain this great juggling job. It is hard to replace a well working system in the body once broken. The typical person with diabetes has BG that, on average, is too high. It may also drop too low with too much medication leading to coma or death. High BG is associated with all of the ill effects that people with diabetes suffer including blindness, kidney disease and amputation. For most, eventually, doctor’s visits mean an inevitable adjustment upwards in medication and higher BG. High BG results in deterioration for a person with diabetes over time, more medication, more complications. Diabetes is therefore regarded as a chronic disease with an inevitable worsening progression.

With that prognosis, it makes little sense discussing getting back to normal BG. It makes little sense to see this as a control process that can be brought under near normal control.

THAT IS (FORTUNATELY) COMPLETELY WRONG!

## HbA1c Measurement

I mentioned a three monthly visit to your doctor. Your BG changes throughout the day. In order to assess your overall BG control, a test measuring ‘haemoglobin A1c’ (HbA1c or just A1c for short) measures how ‘sticky and sugary’ (glycated) your blood is. As blood cells turn over every three months, A1c gives you about a three month average of your BG control.

I mentioned that if your systems were working properly, your BG would average about 5.6 mmol/L (or 100mg/dL). It turns out that this corresponds to an A1c of 5.1% (or 33 mmol/mol). This is an average for the healthy population or ‘population mean’. Statistically, the standard deviation from the mean is about 0.5% and it is deemed that you have prediabetes if you exceed the mean by one standard deviation or >5.6%. Similarly above about two standard deviations (>6.1%) you are diagnosed as having diabetes. The higher above one standard deviation you go, the worse becomes the health risks of diabetes.

## Control Charts

Control charts are a tool used in engineering and management science to help us understand what is happening with a process. Essentially a control chart gives you a measure of how close a controlled system is performing to expected behaviour (the mean or average target for a parameter) when considering its deviation from the desired behaviour. Control charts give you a measure as to the quality of the outcome of a process and should help decide what you may need to do to bring a process back into control.

You can read about using control charts here.

If the aim is for a person with diabetes to approach the health of a ‘normal’ person, then we must restore the control as near as possible to the BG of a healthy person. A control chart type of methodology is used in some glucose monitoring programs to measure the quality of control of daily BG.

So when looking for long term control/ improvement, why not plot the mean of HbA1c and its standard deviations for healthy people? We can then use the control chart methodology as a yardstick to see how various treatments compare and to hopefully gain better BG control towards a cure.

## Diabetes Control Chart using HbA1c

I have reproduced the results of a study on diabetes as a control chart. That study looked at about 49 vegans and another 50 people on a conventional diabetes diet. You can read this study here.  I have added to that a plot of my history on a low carbohydrate diet. I have added in the bands of standard deviations (s, 2s, 3s, etc) in bands of colour from green to red.

1. Excellent control would see points close to 5.1% and ideally in the light green zone within one standard deviation (±s).
2. In control chart theory, any data point more than three standard deviations (±3s) is deemed ‘out of control’. Something is really wrong with the system and control process itself for this to occur.
3. Not one of the measurements is below the population mean of 5.1%

## Conventional Diabetes Diet

This diet was a low fat, calorie deficit diet designed for weight loss. This gave the worst outcome. At the end of the 74 week period, the average A1c results were nearly above where they started. No average A1c was better than 5s. By the end of the trial, only about half of the participants were adhering to the diet. This was despite cooking lessons, weekly meetings with a dietitian and other intensive assistance. This diet was high in carbs as they are 60-70% of total energy.

## Vegan Diet

The vegan diet lacked meat, eggs and dairy but was not calorie restricted. This gave a slightly better outcome. No average A1c reading was better than 4s. By the end of the trial, only 44% were still adherent and the outcome was beyond 5s. This was despite similar intensive assistance to that given on the conventional diet. Probably, as a result, some of the gains in A1c made earlier in the trial were lost and the vegans also deteriorated again. Had the trial and the upward A1c trend continued, it appears that the vegans might also have ended up worse than they started. This diet was very high in carbs being 75% of total energy.

## LCHF/Keto Diet

My diet lacked carbs. No sugar, rice, pasta, bread, sugary fruit and starchy vegetables. I also drank alcohol sparingly. Most people with diabetes are advised to eat between 200g and 300g of carbs per day spread out over the day. I aimed at first for less than 50g per day (<10% carbohydrate) and after about three months I was reliably lower than 25g (<5% carbohydrate) per day. This normally would be a ‘keto diet’ however it is hard for people with diabetes to stay in significant ketosis without extended fasting so I prefer to call it LCHF. I also did practise intermittent fasting simply because I was not as hungry as I was with a higher carbohydrate diet. Many people report this. Typically this involved not eating breakfast so that it was 16 hours after the previous night’s dinner before I ate the next meal.

There was no assistance from a dietitian or cooking lessons for me. I did read the free information on the dietdoctor.com website to get the bulk of my nutrition from real food sources (meat, eggs, fish, fruit, vegetables, nuts & dairy) that were low carb. Unlike the diets in the trial, adherence was easy for me, although I had to unlearn a lot of ‘advice’ that dietitians had previously told me on my way to developing diabetes. Unlike the study diets, I ceased three diabetes medications after three months but then began taking one-quarter of the dose of metformin again at that time.

I did no appreciable exercise like running, swimming, cycling but took an occasional walk. In the first six months I easily lost about 12KG of weight, moving from obese to overweight. My weight has been quite stable since then.

Unlike the other diets of the study and my previous diabetes history, all my readings (except baseline) were within 2s and went below s before the year on LCHF was finished. Clinically, below 2s is pre-diabetes and below s is non-diabetic so I have been very happy with that result. The downward trend was recently confirmed as still occurring with a recent estimate of A1c from my glucose meter readings.

## Engineering Analysis

Straight away we can say that the study diets are ‘out of control’. With no points less than 3s there is little prospect of either ‘process’ (diet) bringing control to equal the population mean. Further with all points 4s or higher, the mean (goal A1c of 5.1%) will never be reached. Quite simply, something is causing the A1c to be unacceptably high that the process being used cannot overcome. From an engineering standpoint, these are defective processes that cannot achieve the target. The trends were initially towards but end up moving away from the target long term. Management theory would tell you that the individual in the process (person with diabetes) will be powerless to achieve control. It is ridiculous to blame the person with diabetes for this result yet many of us blame ourselves. The theory says that to continue to expect reasonable control to the target wanted is foolish. You must use a different process or make some other significant change to the system.

That is not the case with the LCHF diet. All points are within 2s, some s, and we have a trend that may eventually result in the target being achieved although none of the measurements so far have been below the target.

## Engineering Solution

If I were presented this as a control system problem I would immediately conclude that there was an unaddressed control offset, especially in the study diets. The engineering solution would be to apply ‘Integral Control‘ to attack that offset so that the control range is eventually brought closer to the target. This means relatively slowly increasing or reducing the level of the controlling factor until control can be achieved.

Further, both diets represent a perturbation in the system that slowly corrects back to its original level. Like throwing a stone in a pond. The ripples eventually subside and things head back to what they were- in this case, a level that is too high.

We know that carbs, be they from the liver (GNG) or diet, raise BG and A1c in people with diabetes who do not have enough (or do not respond properly to) insulin. The amount of carbohydrate is the controlling parameter for BG and A1c. It is straightforward that a solution is to reduce carbs permanently- but by how much? For me, the LCHF result shows that even if we drop dietary intake to a minimum, the target would still not be reached quickly due to their production by the liver (from GNG).

So a very apt control analogy is a sink with a small inflow of water from the bottom (GNG), a drain draining away by a controllable flow (insulin action and exercise), and a tap with the ability to put in a variable inflow which by eating carbs could be continuous if spread into small meals, large and rapid if a lot of carbs (say sugar) is consumed or minimised if restricted.

Now if we want to keep the sink at a certain level (say half way) we can exercise to drop BG and eat fewer carbs to lower the level. If we leave the tap running at a rate that exceeds the draining rate or suddenly empty a large bucket of water into it, the sink fills and we will now be permanently above the level we want. This is what we see with conventional and vegan diabetes management in the study. In this situation, it is common sense to turn off the tap- carbohydrate restriction. 200 to 300g of carbohydrates per day is the problem in this control system.

## Exercise Helps but Diet Rules

Exercise is a help but consider that the average person must run about 7 km to ‘burn the carbs off’ from a 500ml serve of coca cola. Even if you do run the 7km, in the time between drinking the drink and completing your run, those carbs are giving you high unhealthy BG. Better just not to eat or drink the carbs in the first place. You cannot outrun a bad diet.

All of the diets have too many carbs for the available and effective insulin to bring down BG to normal metabolic levels and that explains why the target was never reached by any of them.

## Reaching the Target

Unlike the study diet, we should expect the LCHF diet might reach the target in the next nine months or so if the present trend continues.  The simplest course of action for the LCHF diet would be to keep going and see if the system settles to the desired target. If it does not or if a quicker result is wanted, other interventions could be tried to reduce carbohydrate including longer fasting, increasing exercise, upping metformin dosage or looking for another metabolic option. So now, as a vegan doctor (Dr Joel Kahn) commented to me upon looking at my results on Twitter, maybe slow and steady wins the race? That might well be the first of his advice I have ever taken.

## Am I a Special Case?

At this point, you may be wondering if carbohydrate restriction might help your diabetes or am I a one off? Let us explore that. My results prior to carbohydrate restriction were consistent with the conventional diet people from the study. The best HbA1c I saw was 7.3% and as you can see below, carbohydrate restriction was the difference beginning around month 31.

The value of a case study is that it shows what CAN happen. There are no guarantees, but given similar circumstances to me, yes this can happen for you. Many other people report that it happens for them. In fact, we would expect it to happen from the biochemistry and control theory I have explained. This is even though everyone with diabetes is a little different. It means your mileage may vary.

Biochem is complex. Perhaps the major appeal of LCHF to an engineering mind is that, based upon engineering theory, it makes perfect sense. Dietitians are constrained by a myriad of epidemiological studies which show increased risk of this or that from doing that or the other thing. If you accept that A1c is a measurable proxy for the underlying health issues of diabetes, clarity to focus on the job of controlling A1c occurs and carbohydrate restriction is obvious. Once that is done, focussing on optimising diet within that constraint is the task. This fits nicely with the theory of constraints as a way to tackle complex systems.

## LCHF, Vegan or Conventional Diets?

The vegan diet did perform better than the conventional diet in the study but both were a control chart fail. It is however theoretically possible that one of the 49 vegans achieved similar results to me. My result towards the end shows that my A1c was about fifteen standard deviations below the vegan mean. In other words if we assume a normal distribution and there were 100,000,000,000,000,000,000,000,000,000,000,000,000,000 vegans in the study, we could expect about one to have results as good as mine. Unfortunately, there were only 49 vegans in this study. This is a time when an n=1 (me) is statistically significant.

To be clear I am not saying that a vegan diet could not achieve the same result, but it would have to be low in carbohydrate and total energy so a vegan (or any) starvation or fasting diet would probably also work.

If common sense, the engineering theory, my simple Biochem explanation or my results do not explain why a carbohydrate restricted approach is best then read this paper. An excellent (and more complicated) comparison between the Keto (LCHF) and vegan approaches to managing diabetes is available from Marty Kendall’s website. You will also find a lot of other excellent information on nutrition there should you be concerned that restricting carbs may put you at risk of nutritional deficiency.

The Vegan propaganda machine is fond of saying that restricting carbs (the keto diet) masks the problem by addressing the symptoms whereas only the vegan diet ‘cures the disease’. Based upon the study we looked at, it appears to be an untrue claim. I don’t care whether you eat live chickens or just grass to avoid animal harm, the first thing that someone with diabetes should do is minimise their carbohydrate intake. If you must eat some, then not too many and make sure they are ‘complex’ and unrefined.

## Dietitian Says ‘No’

So what if you see a dietitian and they try and dissuade you from a carbohydrate restricted approach. They may have the following objections to which I give you some answers:

1. You need carbs and your diet will lack fibre and vital nutrients from foods you will exclude like whole grains.
Answer: Some fats and proteins are essential but carbs are not. Even if you could have zero carbs in your diet, your body makes them (via GNG). If fibre is of concern then eat more low carb vegetables. Vital nutrients? See Marty Kendall’s website. If a dietitian can’t give you a healthy carb restricted eating plan, time to walk!
2. It helps some people but people can’t stick to it in the long-term. We also don’t know how safe it is in the long term.
Answer: Well what if a person it can help is me? Shouldn’t I try it? Looking at the conventional and vegan diets in the study, adherence was also less than 50%. Adherence is a matter for any way of eating and it is up to you. You don’t have to be a statistic. Finally, what does the long-term look like if your A1c stays at ~6, 7 or 8% and above? The risks of a high A1c are very well known. If LCHF is a devil, it is the devil you want to know.
3. Keto? Low Carb? Control charts? [Insert other doubt raised here]? Do they have any evidence of success from a study in a peer reviewed journal? My clients have excellent success on [insert a diet/ program here] instead.
Answer:  Please give me evidence of a study showing [insert their diet/ program] can achieve an A1c approaching 5.1%. Please give me evidence of the success rate of your clients achieving a sub 5.6% A1c.
4. On LCHF/ keto you are limited. Studies show that eating [insert food of concern] or not eating [insert dietitian ‘superfood’] will make you die sooner.
Answer: Have you ever seen someone on dialysis or with a diabetic foot? It is your job to give me a diet for normal blood glucose, then we can optimise it for other concerns. Do your friggin’ job and shelve your dogma.

The system is failing all of us. More of us are getting obese and diabetic following the standard way of doing things. I developed diabetes on a near exemplary low-fat diet. I can only encourage you to be a robust health consumer. You should not assume that in the face of the diabetes epidemic that has grown under national eating guidelines and dietetic advice, that the experts have it right. Diabetes takes no prisoners and you shouldn’t compromise your outcome just to be nice to a health professional.

## Time for Dr Google?

Dietitian’s organisations lampoon ‘Dr Google’ just like clothing retailers said people would never buy clothing online. Honestly though, if you are seeing a dietitian who is not on board with carb restriction for diabetes, you are wasting your precious time and health.

If you can’t get proper help from a local professional then there are sites like dietdoctor.com, forums like the ketogenic forums and facebook groups like type 2 diabetes straight talk or type one grit. If you are in the US, Virta’s service could be a good choice. Any of these would be preferable to a low carb inexperienced dietitian!

If you DIY then be conscious that some medications that you may be on (notably sulphonylureas and insulin) can be very dangerous to take if you suddenly reduce your dietary carbohydrate. If trying this, you should consult your doctor to clear or adjust your medications appropriately.

## Hypocrisy of the Church

Religions are often accused of being hypocritical. When you set a high moral standard, you often end up with egg on your face when you do not live up to it. Whether it is paedophilia and the Catholic Church or Buddhists releasing birds as a good deed, we can prosecute, punish, amend behaviour and seek forgiveness.

But what of those who act hypocritically to begin an inquisition as did Bloody Mary?

In the context of dietitians, what if they claim to be an evidence-based organisation and then proceed to ignore scientific evidence? What if they apply their scientific knowledge inconsistently? Should there be a ‘Special Place in Hell’ for them?

## Veganism

While vegetarianism has been around for a long time, its more extreme sibling, veganism, traces its named history to 1944.

Veganism has its proponents and critics. The PCRM, related to the animal rights organisation PETA, has championed the research and arguments for the healthiness of the vegan lifestyle.

Let me state that I have no problem if you choose to follow a diet for any reason. That includes fasting if that is the informed effect that you wish to achieve. I have nothing against vegans personally, although I do not agree with them if they use ‘dodgy’ scientific reasoning to make claims that the vegan diet is superior for health.

One voice against veganism is Lierre Keith (a former vegan) who has written a book criticising veganism. Dr Zoe Harcombe has summarised that book well in her blog post if you wish to understand the case against veganism. You can read the book if you want the detailed case.

To be balanced here is a pro-vegan book and a link to a pro-vegan site.

While there is an abundance of some nutrients on a vegan diet, we learn from the pro-vegan site:

Vegans are vulnerable to deficiencies in vitamins B12 and D, omega-3 fatty acids, and calcium. …  Vegans need to supplement B12 because there is no reliable source in their diet.

So it is no secret and even the pro-vegans will tell you that a vegan diet has dietary risks and you must plan that diet well and need supplements to be healthy.

## Veganism & Dietetics

We also learn from this website that a vegan diet is supported by Canadian Dietitians and Australian Dietitians among others. In fact, there is wide support for the vegan diet across dietetic organisations internationally. British Dietitians even have an alliance with the Vegan Society and an MOU.

South African dietitians (ADSA) don’t seem to have public statements about their policy on veganism however they endorse vegan nutritional science by promoting veganism and a number of their registered dietitians support plant-based diets and practice vegan dietetics. Like Canadian, British and Australian dietetics organisations, South African dietitians also belong to the International Confederation of Dietetic Organisations. The next ICDA Congress will be in Cape Town in 2020.

It should not be surprising that internationally all dietitians sing from the same hymnbook. Vegans would make very good clients for dietitians given that a vegan diet needs to be well planned and supplemented to be healthy.

## LCHF & Dietetics

Unlike veganism, which has the full support of dietitian’s organisations, a low carbohydrate (Banting or LCHF) diet is labelled by them as a diet that is dangerous. I won’t repeat the volumes that have been written about the dietetic organisations’ fear and loathing of low carb. Here is just one example from the Dietitian’s Association of Australia.

What is the reason for this? Low carbohydrate diets involve avoiding starchy, sugary and vegetable oil-based processed foods from the food industry that are a regarded by many as a modern scourge to health. LCHF eaters are more likely to be shopping at the farmers’ market, cooking food from scratch, and avoiding ‘soda pop’ and boxed cereals. The case has been made that commercial interests (such as sponsorships by the food industry of dietetic associations) are behind their non-acceptance of low carb diets.

## Double Standards?

Vegan diets strictly omit all animal-derived products notably meat, eggs, fish and all dairy. LCHF diets limit or avoid sugary fruits, starchy vegetables and grains but include low carb fruits & vegetables, dairy, meat, eggs, and fish. The picture below gives you an idea of just a few of the many foods that are typically included in a low carb diet.

If there were any valid concern over the healthiness of LCHF diets then surely such a diet could be well planned by a dietitian just as a vegan diet is? If the diet was perhaps deficient in a vitamin surely it could be supplemented as vitamin B12 must mandatorily be on a vegan diet? Are dietitians competent with the vegan diet and clueless to deal with other diets that do not include certain foods? It seems unlikely. Instead, it smells like hypocrisy and I was not the first to notice this.

## Complaint Against Prof. Tim Noakes

You may be aware that Claire Jusling Strydom, the former ADSA president, lodged a complaint with the Health Professions Council of South Africa (HPCSA) against Prof. Tim Noakes, a distinguished South African scientist and medical doctor. This was because of this tweet that he made three years ago suggesting that babies can be weaned onto LCHF foods. The tweet was in response to a question by a lady who was asking on twitter about the best foods given that she was breastfeeding and some elements of her food might come through her breast milk. The lady in question was not his patient. The resulting inquiry has been described as the nutrition trial of the century. If you wish you can read more of the details here.

The complaint was prompted by a tweet from Professor Tim Noakes offering low carbohydrate and high fat complementary feeding advice to a mother. This advice is considered unconventional advice that is not evidence-based nor in line with the current paediatric food-based dietary guidelines for South Africa or any international paediatric dietary guidelines.

In summary, during and after an inquiry lasting three years:

1. The ADSA usurped responsibility for the complaint from its former president.
2. Well before a ‘verdict’ had been reached, the HPCSA falsely pronounced Prof. Noakes ‘guilty’ in a press release.
3. An investigative journalist has written that the food industry may be behind this trial.
4. Prof Noakes was actually found ‘not guilty’ on all ten points.
5. During the trial, he presented the evidence-base for an LCHF diet and why it is healthy. You can review that substantial evidence-base conveniently divided into 80 short videos of testimony on youtube.
6. The HPCSA has now appealed the decision of its own tribunal and this debacle is set to continue.

## Common Sense Check

As a quick check, look at the picture above showing a small subset of foods that would commonly be understood to be LCHF by the public. It was taken from one of the prime consumer websites for LCHF (dietdoctor.com). Do those foods look unhealthy for a young infant as they transition to solid food? A quick common sense test tells you something more than the salmon in the picture is fishy with this whole affair.

Let us have a closer look at the critical part of SA’s paediatric guidelines for a child after six months of age as they begin complementary feeding and start the move to more solid foods:

PAHO and WHO provide the following guidelines with regard to complementary foods that can provide adequate nutrients to meet the growing breastfed child’s nutritional needs: • Provide a variety of foods to ensure that nutrient needs are met. • Meat, poultry, fish and eggs should be eaten daily, or as often as possible. At this age, vegetarian diets cannot meet nutrient needs, unless nutrient supplements or fortified products are used. • Vitamin A-rich vegetables and fruit should be eaten daily. • Provide diets with an adequate fat content. • Use fortified complementary foods or vitaminmineral supplements for the infant, as needed.

Again, look at just the small subset of LCHF foods in the picture.  Do you see a major problem? To me, this looks compliant with the guidelines yet the ADSA was not satisfied. Note the text in green above. You may well ask that if a vegetarian diet is explicitly called unsuitable, then what of its more extreme sibling the vegan diet?

## SA Dietitians and Vegan Diets for Infants

Well, you may be surprised to learn that registered South African dietitians do not seem to have a problem with the vegan diet for infants.

In an article in defence of a vegan diet for infants (in response to concerns over the death of an Italian child fed vegan food) South African registered dietitian Jessica Kotlowitz was quoted as saying:

So if any of the people quoted in this article really want to make a difference and prevent childhood deaths from malnutrition, they will promote the adoption of vegan and vegetarian diets.

I am not a dietitian but sorry Jessica, that is not consistent with SA’s paediatric guidelines for complementary feeding. Please see the text in green.

In an article posted on the ADSA’s own website, SA registered dietitian Cheryl Meyer says:

Contrary to common belief, a properly planned vegan diet is proven to be healthy and nutritionally adequate for people of all ages.

Cheryl, that advice (at 131 characters) is equal to a tweet. You didn’t mention breastfeeding as long as possible which ADSA criticised Prof. Noakes about after the trial but you had room in the article to do so. The essential need to supplement B12 is not mentioned at all in the entire article! Again, I am not a dietitian but I am sorry Cheryl, but that is also not consistent with SA’s paediatric guidelines for complementary feeding. Read the text in green above. Especially, not mentioning the need for B12 supplementation at any age is a dangerous omission for the public who read your article.

## What Should Vegan Babies Eat?

So what should vegan babies be weaned onto? Well the SA dietitians don’t say but their US cousins give us the following advice:

Wean vegan infants with soy milk fortified with calcium and vitamins B12 and D. Milk alternatives, such as soy, rice, almond, hemp, etc., are not recommended during the first year of life as a primary drink because it is low in both protein and energy.

Wow! Do dietitians really think that is a healthy option? They also do not mention how the baby will get critical omega 3 fatty acids commonly supplemented to kids in fish oil. It certainly flies in the face of South Africa’s paediatric dietary guidelines.

When parents get this wrong the results are horrific. Aside from the Italian case mentioned above, there was this more recent case in Belgium. Here is yet another warning.  More here and this paper gives a case study of what happens when a vegan breastfeeding mother does not supplement adequately.  Where was that advice from the dietitians?

Unlike LCHF, a bad vegan diet is a proven risk to infant health, however, dietitian organisations tolerate that risk. It appears that the ADSA has not counselled, cautioned or complained about its dietitians to the HPCSA or had them retract their public statements nor has it issued a clear policy on vegan paediatric nutrition. At the same time, they have set off a nebulous complaints process over LCHF that has dragged on for three years against Prof. Tim Noakes and which now is going to appeal. How can this be reconciled?

## ADSA Noakes Aftermath

In their press release after the not-guilty verdict, the ADSA expanded the detail of their concern about Prof. Noakes’ tweet. Among their criticism was that Prof. Noakes did not emphasise that breastfeeding be continued. This was not emphasised by either Jessica or Cheryl either and they had much more space to use than the 2 spare characters that Prof. Noakes had in his tweet. That press release also makes much of the uncertainty caused by twitter but the vegan advice given by its own dietitian’s remains unaddressed and it is in more conventional media than twitter.

The ADSA further expanded their concern (post-verdict) with the following text:

When foods rich in carbohydrates such as whole grains and legumes are avoided and other carbohydrate food sources such as dairy, fruits and vegetables are restricted, thediet can become deficient in certain essential nutrients, such as vitamin C, B1, B3, B6, folate, magnesium and fibre. Because infants and young children are considered a vulnerable group, the potential for nutrient deficiencies is a serious concern. Deficiencies can compromise growth, and cognitive and physical development.

It is a bit late to expand to this after the trial. If you didn’t say that in the trial and it is a material criticism then why expand now? If it was said and considered during the case then its sour grapes after a verdict where it must have been considered.  Let us see how their text looks if properly worded for concerns over a vegan diet for infants:

When foods rich in protein such as meat, fish, eggs, and dairy are restricted, the diet can become deficient in energy and certain essential nutrients, such as vitamin B12, D, Omega-3 fatty acids and calcium. Because infants and young children are considered a vulnerable group, the potential for nutrient deficiencies is a serious concern. Deficiencies have caused death and can compromise growth, and cognitive and physical development.

I think you can see that a vegan diet presents at least an equal risk, and more likely a greater risk than an LCHF diet for infants.

This hypocrisy has its parallel with (Bloody) Mary Tudor who issued a proclamation that she would not compel her subjects to follow Catholicism and then proceeded to put the senior clergy on trial.

## Effective Leadership or Piousness?

The press release by the ADSA following the verdict can be described as extraordinary for both its lack of leadership following the events that they themselves created and the lack of any concrete response to a three-year nutrition inquiry.

The ADSA would do well to learn about the failure of Mary Tudor’s ‘inquisition’ to bring back the Catholic faith to England. Unlike the successful Spanish Inquisitions, the failure of Mary’s effort is attributed to the inability to conduct trials in secret. The truth came out to the public. Of course, Dr Gary Fettke has suffered the fate of a successful secret LCHF trial in Australia allegedly vexatiously instigated by its dietitians.

Suffering from failure due to the effects of the truth, Mary Tudor, had a propaganda letter published entitled “A Godly Treatise concerning the Masse, for the Instruction of the simple and Unlearned People” and this press release is reminiscent both of its necessity and tone.

ADSA president Maryke Gallagher stated:

We have no personal gripe with Professor Noakes. Our concern has always been about the health of babies.

If ADSA’s concern was about the health of babies, then why have you not acted against your vegan dietitians who have committed dietetic indiscretions that at least equal Tim Noakes’?  It certainly makes this appear to be a lie and the complaint an inquisition. I note that the public already has the ADSA pegged as liars from the press release.

## Hypocrisy and Denial?

With apparent hypocrisy over the acceptance of veganism as safe for infants and denial to confront the science of LCHF, why should we not see the ADSA as a religion with anointed clergy? A anti-scientific religion running an inquisition that didn’t burn Prof. Noakes at the stake the first time.

Maryke, Queen of Dietitians, concludes with:

South Africans have also been confused by the ebb and flow of this divisive nutrition debate and the inconsistent nutritional advice provided over many years. That is unfortunate. I’m pleased this is over and we can now focus on other urgent nutrition challenges we have in South Africa.

What could be more important than addressing South Africa’s diabesity crisis with a weight normalising dietary change? One that your actions forced a scientist and doctor to provide testimony about to show as healthy?

An evidence and science based organisation cannot just ignore 80 videos of Prof. Tim Noakes’ scientific evidence.  Prof. Noakes is the real A1 rated scientist here and at least that was begrudgingly acknowledged.

This seems the kind of arrogance that we would expect from a monarch having failed in an inquisition.  “There is nothing to see here, move along and keep faith in the anointed.” In the meantime, the inquisitors continue to try and burn the heretic with an appeal that could have stopped by admitting it was a scientific mistake.

No Maryke, Queen of Dietitians, this is not over and the ADSA cannot continue like nothing happened. The ADSA is not blameless- dietitians are the instigators of this inquisition. It seems despite publicly brushing your hands, the HPCSA is determined to keep your complaint going and that was within your power to remedy.

## A Special Place in Hell

I asked the question at the beginning if there was a special place in hell for hypocritical science-based organisations that ignore scientific evidence. If there isn’t then there should be.

As a health consumer, I ask you to consider carefully whether your health is worth risking with anti-science anti-evidence organisations. Choose your dietetic advice and dietitian wisely and that applies even if you are vegan and in any jurisdction in the world.

Consumer imposed hell by voting with your feet is the best message you can send and if you cannot find a dietitian, there is plenty of more scientific advice on the Internet.  Errr yes, the horror of truth from ‘Dr Google’ is something that the Spaniards unfortunately never had.

What happened to Mary Tudor? Well, every school girl and boy knows that history did not treat her kindly and despite her many machinations, the truth won and England chose the Anglican way.

## My Daughter’s Angst

I want to tell you a true story about my diabetes and it is also about lions and sheep.

Recently I rolled my ankle while exercising and as a result, I had a sore foot. I was hobbling around at home and my daughter noticed.  She didn’t say anything but a few days later my wife relayed a conversation that she had with another mother from my daughter’s school about my diabetes. That mother was a nurse.

You see my daughter had been picked up from school by the nurse with her daughter. During the car ride, my daughter had said that I had diabetes. My daughter was really worried that my foot was going to be amputated because that is what happens to people with diabetes. The mother, very concerned, proceeded to tell my wife about possible treatments for diabetic feet.

## What Would you Say About Diabetes Complications?

Do you have diabetes? What would you say to your daughter or loved one? I’ll tell you what I told her. I hope it is useful for you if you are in a similar situation.

“Firstly,”, as I explained to my daughter. “you need to be aware that retinopathy is diabetic blindness, neuropathy is diabetic nerve disease (a precursor to diabetic amputation) and nephropathy is diabetic kidney disease that usually leads to dialysis.”

“Now a measure of your diabetes severity is called HbA1c or A1c for short. Your A1c is a measure of the sugar in your blood cells. This is useful because your blood cells are renewed every three months so you kind of get an average of the sugar level in your blood over that time.”

## A Dirty Little Secret

“Below 5.8% you are normal, and above that, you have pre-diabetes until 6.5% when you have full diabetes.  Diabetes organisations tell us to aim for an A1c of between 6.5% to 7.0% but darling there is a dirty little secret there. You see eating carbohydrates (as they recommend) it is hard to get that low. If fact many people do not get below 7.0%!”

“Sweetie, have a look at this graph that maps those complications against HbA1c in people with diabetes.”

“You can see that someone with an A1c of 7.0% has almost double the risk of all those complications as someone at 6.0%. Someone wth an A1c of 9.0% has about five times the risk of going blind!”

## My Diabetes Results

“But you said that most people struggle to hit 7.0% where they double their risk” she said: “Daddy, what is your A1c?”

I showed her my test results. “Well, when I was taking 3 different diabetes medications my A1c was 9.0%, but when I restricted carbohydrates (LCHF diet), my A1c dropped to 6.0% while taking no medications.  That took three months. Now my A1c is 5.8% and my risk is essentially the same as someone without diabetes.”

The nice ending to this story is that now my daughter’s mind is at ease AND she thinks her daddy is a ‘lion’ for beating diabetes complications.

But I am not an animal superhero. This kind of result has been repeated by many people.  It is a result based on science and results like mine must, therefore, be repeated by others.

So if you have had this awkward conversation with your son, your daughter, your wife, husband, lover or another dear relative or friend, consider backing up your assurances that you will be all right by taking control of your health. Restrict your dietary carbohydrates.

Maybe you have denial and uncontrolled diabetes and haven’t told anyone close to you. If you have not had this conversation, then still take control of your diabetes and nix your chances of complications so you can have a positive experience like I did. Better than having instead to try and explain your complications to close ones in the hospital.

## Be a Lion, not a Sheep

Dietetic and diabetes associations do not want you to know this information. They have tried to silence the people that are telling you and expect you to use their services like helpless sheep. Thank God they cannot stop me telling my daughter the truth nor telling you this true story.

Consider that:

1. The Association of Dietitians from South Africa (ADSA) complained against Prof. Tim Noakes and continue to ignore the evidence that he presented in pursuing his comprehensive acquittal. It showed that the LCHF diet was beneficial to health.
2. Dietitians complained against Orthopaedic Surgeon Dr Gary Fettke to silence him against giving this advice to patients. How despicable to ask him to keep quiet when he can prevent amputation by diet.
3. The Dietitians Association of Australia (DAA) deregistered dietitian Jennifer Elliott after another dietitian complained a patient was confused by her low carb advice and they reinforced their advice that results in higher risk of diabetic complications.
4. The DAA complained against Carynn Zinn, another low carb dietitian in New Zealand where they had no authority nor any reasonable business to do so.

## Why is this being Suppressed?

Low carb is actually quite simple and its safe.  On one level its just “give me a plate of healthy meat and vegetables for dinner (and hold the potatoes)” but the organisations act like you will eat rat poison.

I do not believe in conspiracy theories- but business is business. Businesses love sheep that just keep paying money for their products. As they are profitable, they have money for marketing to keep everyone buying. Marketing can pay for favourable research studies and it can sponsor dietitian’s conferences. It is worth spending marketing money to keep revenue streams going and growing. That is completely normal.

LCHF means you eat a lot less processed food (like breakfast cereals) from the food industries that sponsors dietetic associations. It appears dietetics associations are happy to ignore science and promote bad and unscientific advice from their members because it keeps you going back with a chronic condition or when their advice fails and you regain weight or worsen.

Consider too that the amount of diabetes medicine you need is almost proportional to the carbohydrates you eat.  I ate next to no carbohydrates and went to no medications. You will need less medication if you restrict your carbs- naturally if you do plan to reduce medications then talk to your doctor first.  Any reduction benefits your health and wallet but is not good for pharmaceutical companies.

Be a lion, not a sheep, and if you are still not sure I leave you with part of the testimony by Tim Noakes that these organisations do not want you to see. If this does not convince you there are 80 more short videos that the dietitians pretend to ignore that you can watch.

Whether you have type one diabetes and follow Dr Bernstein’s low carb diet or type two diabetes, if you do take this journey I know you will almost certainly have similar results. Do tell me and pay it forward by telling others, but do me a favour and don’t tell my daughter.

You see it’s nice for a daddy to be a lion to his little girl for more than just one day.

## Low Carb Yoghurt: Tips & Tricks

For a change of pace after a lot of heavy posts,  I thought I would share some money saving tips about yoghurt- inspired by Joseph Finau who is helping people do low carb on a budget.

Some people don’t eat dairy at all on a low carb diet, and many following a paleo lifestyle also do not regard it as paleo. Coconut yoghurt may be an option, but that is a different beast to the milk based yoghurts that I will discuss and it often has gelatine or other thickeners. Unlike dairy milk, coconut milk is also already low carb and sugar is sometimes added to ferment it.

This post is about getting the sugar (lactose) and cost out of dairy yoghurt. Some people are lactose intolerant but can tolerate yoghurt which has reduced lactose. Many others have a high regard for fermented foods like yoghurt in their diet. Yoghurt (and especially Greek yoghurt) can be very expensive. If you do eat dairy, but are put off by its carbs or price, then this post is for you.

Many commercial yoghurts are high in added sugar and carbs. They may have additives like gelatine or other thickeners. Most of all they are expensive. A one-kilo tub of premium yoghurt can cost $7 to$8. Making your own can make it more carb friendly, even lower in lactose and a lot cheaper.  Would you believe $1 a litre or maybe less? It is pretty easy once you get the hang of it. We never buy made yoghurt, and you will probably not do that either once you learn some tricks. So how do we do it? ## Do You Need Yoghurt Maker? You can make yoghurt in a warm place in a bowl, but a yoghurt maker takes the guesswork out of it. A 1-litre electric yoghurt maker can be picked up on eBay for around$12. I recommend getting a bigger one (1.5 to 2 litre in capacity) if possible.

If you don’t use a yoghurt maker, then an insulating the container like a wide mouthed vacuum flask or wrapping the bowl in a tea towel might be useful. Having somewhere warm to keep it while it ferments (like a warmed oven) is useful. Using a light bulb for heating (as it a chicken incubator) may also be an option. Whatever you do, it is important to keep it below 45C or 113F or the culture may be killed.  If the temperature is lower than 40C or 103F then it may take much longer to ferment.

You need milk and some starter, and that is all.  You can use some store bought yoghurt (if it has live cultures) as a starter or you can purchase the culture from a cheese supply store some of these stores sell online and ship the live culture in a cool pack. Here is a google search that you can add your country’s name onto to find a possible online source.  Although more expensive (about $13), once you are a committed yoghurt maker I recommend purchasing the starter because: • It gives consistent results. Most cultures are a mix of two or more bacteria. Re-using yoghurt batch after batch may deteriorate the ratio. • It is small and stores in the freezer • Commercial strains may be chosen for sweetness. You want a high acid/ low lactose variety • I only use a tiny amount (about 1/8 teaspoon) • You can search for a more acid tolerant starter culture which should give you lower carbs. • My last small jar of culture went for more about eight years of yoghurt making! So divide the cost by 300 to 400! Which starter? There is some technical info here. You can always email the vendor and ask for their most acid tolerant starter or ask for one leaving the lowest lactose. ## Instructions 1. Heat the milk until it is nearly boiling. 2. While hot, pour into the container you will make the yoghurt. 3. Allow it to cool to be lukewarm. Use about 1/8 a teaspoon of yoghurt culture or a tablespoon of yoghurt from a commercial yoghurt. If the milk is too hot (>45C / 113F), you will kill the culture and the milk will not ferment. 4. Allow the milk to ferment for 12 hours (or longer) in a warm place (40 to 45C/ 103 to 113F ). That is what your yoghurt maker does. 5. If there is a clear liquid on top, don’t worry, that is normal. It is whey. 6. For Greek yoghurt, allow it to strain through a sieve until it is the right consistency. 7. Store in a container in the fridge adding in low carb sweetener when you use it. ## Making Lower Carb Yoghurt As the lactose is fermented by the bacteria in the culture, it is converted to lactic acid which makes it sour. Commercial yoghurts may shorten the fermentation time to save money or to make a sweeter product. Only 20 to 25% of the sugars are converted. Once they are chilled, further fermentation is very slow. By making your own and fermenting it for longer, you can make sure it is much a lower carb yoghurt. It is suggested to ferment it until the whey (clear liquid) separates which can be as long as 20 hours. The fermentation slows as the acidity rises stopping at about 4 to 5 grams of carbs. This is where a high acid culture can help to reduce carbs further. Now you have basic yoghurt. If you paid$1 a litre for your milk, you now have a litre of low carb yoghurt for $1. The next trick to go even lower carb is straining. ## Straining Greek yoghurt is yoghurt with some of the whey strained out usually for about 4 to 8 hours. Labneh is a yoghurt cheese that has substantially all of the whey removed, often using a weight or pressure. It may have salt, sweetener or herbs and spices added. By straining yoghurt for longer (1 to 2 days), you get labneh. You can buy a commercial greek yoghurt strainer, but a colander with filter paper or muslin cloth over a bowl or the sink does an excellent job. If you use a bowl, you can use the whey in other cooking. It is possible to just use a very fine sieve (metal or plastic) if you very carefully spoon the set yoghurt into it using a large spoon and taking care not to disturb the ‘curd’. I prefer this as I don’t like buying filter paper to throw away or washing muslin cloth. If your yoghurt runs through your sieve then your sieve is too big, you didn’t ladle it carefully, or it wasn’t fermented for long enough. ## Advantages and Disadvantages of Straining The benefits of straining are: • You lose more of the lactose and other sugars that were not digested by the bacteria as they are soluble and in the whey, so it becomes lower carb even still. • You lose the whey which is a protein that some people with diabetes regard as being insulinogenic (stimulates insulin to rise). • The yoghurt becomes thicker naturally without adding anything, and this makes it more versatile for use as a dip or cream cheese. • The acids are also soluble and disappear with the whey so the yoghurt can be less tart. The disadvantages of straining are: • You lose about a third of the volume of the yoghurt (hence why I recommend a large yoghurt maker). • The lower acid may mean it will keep for less time. On the shorter shelf life, it usually isn’t a problem as you are making it at home you don’t need to factor in time for it to sit in the supermarket waiting to be purchased. Salt is often added to labneh, and this probably extends its shelf life a little. You and your family may find it so yummy that it may also be irrelevant. ## What is the Carb Count? Here are a few commercial yoghurt carb facts. Standard unsweetened commercial yoghurt may have 8g of carbs however this can halve to about 4g when more fully fermented which is where commercial greek yoghurts and labneh also sit. You should do even better than that. I expect that my home-made Greek yoghurt and labneh approaches 2g. This article has a good overview. ## Squeezing Out the Cents Having squeezed out the carbs, let’s squeeze out the cents. I often make yoghurt with the milk that the supermarket is selling cheap because it is close to the ‘use by’ date. It is fine for that because you pasteurise it and the yoghurt bacteria do an excellent job of acidifying and creating other antibacterial agents that stop other mould and fungi anyway. Making yoghurt is a biological ‘reboot’. If you don’t want to invest approximately$40 capital in your yoghurt factory, by now you can see that you could get your yoghurt factory to pay for itself.  Make your first few batches without a yoghurt maker and using some leftover yoghurt.  Make it with reduced price milk from the supermarket to save even more. By putting your savings into a piggy bank, a few batches of that pays for your yoghurt maker.  The next few batches pay for some starter which you can even share with a friend if you wish to get going sooner.

After that, you are miles ahead.  It isn’t difficult or time-consuming to make, but you do need to plan ahead.  I often make it overnight, and it is nice to think of billions of bacteria working for you for free while you sleep. It is kind of therapeutic like counting sheep.

## Time to Rethink Yoghurt?

If you are like me, you may have dropped yoghurt when you stopped eating horse food (aka cereal). It could be a chance to rethink this naturally fermented food. Make your own to keep it low carb and real. As for uses, there are plenty of yoghurt recipes that you might have been avoiding due to the carbs. How about for dressings, sauces or as a (frozen) dessert? How about a refreshing lassi made with your own low carb yoghurt- great on a hot day. It sure beats coca cola or franken-soft drinks full of chemicals.

## Australia’s Indigenous Health Woes

The official statistics I have quoted on indigenous health related to diabesity are appalling.  Anecdotally too, there are horrific case examples.

We looked at the nonsensical state of innovation in diabetes and diet. In a situation analogous to the slowness to accept the cure for scurvy, we have seen forces that appear to be holding back effective dietary solutions for indigenous health. Those solutions, based on a traditional diet, were demonstrated back in the 1980s.

The situation looks bleak, but the low-carbohydrate movement has always focussed on grassroots solutions. That is a good strategy. You see the stakeholders who have the most to gain are people whose health is improved. The problem with low carb is that almost everyone else has something to lose. That is particularly the case for the food and pharmaceutical industries who benefit from the status quo. If you are in government and reading this, I have a message. It is incredibly short-sighted not to openly understand whether there are the disempowered stakeholders you should put first. This is an ancient problem for bureaucracy. You need to be counter-intuitive and anthropological. But we are getting deep.  The efficient management of innovation by the government is a topic for another post.

## Be Like Daphnis

The good news is that change is happening at the grassroots. I came across this Internet meme about Daphnis.  It is one of the smaller moons of Saturn and the small ripples it makes in the rings of its much larger neighbour, and it seems appropriate to represent the change we can individually make. I think it is also very apt for this post.

We examined the success of Joy Aghogho in Nigeria. Dr Jay Wortman has done fantastic work with the First Nations peoples of Canada (see his comment in a previous post). Island nations like Vanuatu are going back to traditional foods although one wonders if they have the science completely right.

## Joseph Finau: A Kiwi Tongan

I want to focus on the efforts of one individual in New Zealand who is making a difference. Joseph Finau commented on one of my posts, and I think it is worth considering his recent journey.

Joseph is a single dad from Auckland, New Zealand who has a remarkable story of battling diabesity and weathering personal tragedy.  Losing 100KG (220 lb) is something entirely amazing but moving beyond that I want to celebrate his success in innovating within his community.

According to the 2013  NZ census, about 60,000 people of Tongan descent live in New Zealand.  Most live in the North Island in and around Auckland. Like many Pacific peoples, and in common with the Aboriginal and Torres Strait Islanders, Tongans have suffered from diabesity in the transition from a hunter-gatherer diet and lifestyle to a Western diet and lifestyle. For their diet, diabesity is commonly blamed on the eating of turkey tails, lamb flaps and corned beef.  Joseph has a different point of view- one born from the perspective of his success.

I believe that going back to the way our ancestors ate is the only way to cure ourselves from this western disease (Diabetes). for the last 3 years I’ve been eating Island foods mixed in with Western foods. example: Taro leaves & coconut cream & corned beef. Tongans loves corned beef but told it’s no good. the thing is? CORNBEEF has NO CARBOHYDRATES or SUGAR which means it’s low carb.

Joseph has adapted the Western foods Tongan’s love with some traditional food (less the starchy staples) to make Tongan and Pacific island dishes the low-carb way. That is also what the Nigerians have done and it is also what Western low-carbers have done. Corned beef cooked with cabbage in coconut cream and raw fish (AKA ceviche or kokoda) are but two dishes. Joseph has addressed one of the complaints, that low carb is too expensive, by also thinking about the economics for large families who need to be fed on a budget.

## Is Low Carb Too Expensive?

The economics of low carb are an interesting topic perhaps for a future post. Let us just say here that the current criticism that low carb is expensive has some validity.  It is also true that economies of scale have not yet kicked into the food supply. For sure there will be winners and losers.  We only need to look at what has happened to the cost of solar power as economies of scale kicked in. A technology that was always a great idea but was uneconomic is now economic.

However, for the moment Joseph does have solutions that work for him and his community on a budget. As he shows, it doesn’t have to be about grass fed steak, tinned corned beef (which Tongans already eat) is fine.

## LOW CARBZ 4 STARTERS & BIG FAMILIES. (Food is medicine)

Joseph has a Facebook group to reach out to people in his community and around the world.  He runs cooking workshops, and his group has a procession of recipes from the one thousand or so members.

Now one thousand members may be small compared to the 340,000 now in the Ketogenic Lifestyle (Nigerian) group, but with 190,000,000 Nigerians and only 170,000 Tongans and Kiwi Tongans, it is actually quite significant.

## What are the lessons for Australia?

Many people have long regarded Tongan diabesity as an intractable problem. Joseph is proving them wrong.

It seems that low-carb can be adapted to almost any cuisine and budget. By analysis of the Nyungar diet and by looking at the work of Prof. O’Dea and (most importantly) consulting with the communities, we should be able to adapt Western food to be closer to the macronutrients that Aboriginal and Torres Strait Islanders became metabolically used to for 30,000 to 50,000 years. It should be possible to make it affordable, available, and it should be more culturally appropriate than the food choices available today.

I am not saying it would be easy. I hesitate to suggest solutions for a people who have had plenty of ‘advice’ from my kind in the past. Social issues are always complex. Any solution must come from their grassroots. We need some champions like Joseph to lead the way to say eating needs to be different. Staple ‘modern’ bush tucker needs to be redefined and delineated from a preference for McDonalds or KFC. Awareness needs to be built about traditional diet and the reasons that fats and sugars are sought after, but need not be consumed in excess. That needs to be internalised. If it is hard for urban dwellers to avoid fast food, then the other side of the coin is poor access to healthy food in remote communities.

In the end, it will be a personal choice. However, if people and communities don’t have knowledge of this option, how can they choose a traditionally oriented diet for optimum health?

‘Blind Freddy’ can see that the existing approach is not working.  It doesn’t work for the indigenous people of the world, and it isn’t working for us. We need different thinking.

## Is a ‘Sugar Tax’ a Solution?

A sugar tax might provide revenue for some change while food supply economics normalise. If we are to have a sugar tax, why not apply it to tax the majority of unhealthy eating Australians to subsidise the food supply of those who may struggle to afford healthy food because of their socioeconomic or geographic disadvantage? Focus the funds on innovation to change ingrained food habits. This would be likely to normalise when the economics of the food supply and demand and supply settle down anyway.

No-one is arguing any more against sugar being unhealthy (apart from the food lobby). Before taxing other ‘unhealthy’ foods, the science needs to be settled.

It is in the nature of researchers to always call for more research funding. Frankly, when you see misguided research that appears to be being undertaken into diabesity, there are much better uses for the money. I am neither anti-research nor anti-academic, but funding should be judicious and focussed on settling the science for starters.

## What are the lessons for NZ?

My Anzac cousins, you chose not to federate with us, and I get that. The last thing you need is some Aussie blogger telling you what to do!  Joseph is doing fine, and you have other fantastic people in the low-carb community, but I have to question:

Why on Earth do your bureaucrats and food policy people follow Australia when we think that our dietary guidelines and institutions are dumb and broken?

It perhaps says a lot about the power of trans-Tasman economics over trans-Tasman rivalry, and there is probably a PhD thesis somewhere in that.

I think it is time to assert some of that famous independent Kiwi thinking. Otherwise, pretty soon the change will be over in Australia, and we will claim that Prof. Grant (Schofield) was really an Aussie researcher- just like Split Enz was an Aussie rock band.

## Keep Going Joseph

My message to Joseph is simple. You may not have 340,000 group members on facebook but you are like Daphnis, and you are making waves at the grass-roots and leading by example.

You are not half the man you used to be, but twice the man most of us will ever be.

“Kai mate”, my Kiwi Tongan friend, and may that eating be low carb for a long and healthy life.

## A Paleo Solution?

In our last post, we saw that Paleo dietary solutions were researched and shown useful for diabetes in Aboriginals in the 1980s. Diabetes and other chronic disease were obviously caused by a western diet and lifestyle, and yet the recommendation to Aboriginal and Torres Strait Islanders was to eat the very same Western diet that was making those chronic diseases prevalent in Western people like me.

Here are the healthy eating charts for Aboriginal and Torres Strait Islanders and the one for all Australians.

Prof. O’Dea’s work showed some forty years ago that we are metabolically different yet these nutrition charts treat us as metabolically equivalent. Prof. O’Dea also revealed that the traditional diet reversed chronic diseases for the First Australians however but for token changes, neither chart reflects a traditional diet. A traditional diet would be around two-thirds meat with few carbohydrates and seasonal fats. It would not have taken too much effort to look at the macro-nutrients of the Nyungar diet or Prof O’Dea’s data and devise a better-suited eating chart. Instead, I am sorry to say; this is like someone drew in a token lizard and kangaroo and substituted and moved some other pictures around. The emergency of diabetes and chronic disease among Aboriginal and Torres Strait Islanders deserves better than this. In fact, as Prof. O’Dea alluded to, we all might be better eating from the same chart reflecting an Australian ‘Paleo’ diet.

## A Deeper Mess

When we examine what people diagnosed with diabetes should eat, the recommendation is that they still eat the same as in these charts. All Australians with diabetes should ask themselves something at this point.

If we have used those dietary guidelines as a nation and we have ended up getting fatter and sicker, why will continuing with that advice solve the situation?

The question is profound, but the answer is obvious. Of course, it won’t. Like this country’s obesity and diabetes statistics, your personal statistics will continue to get worse trying to follow that advice. Australia is chronically sick as a nation trying to eat that way, and you are also chronically sick trying to eat that way. Aboriginal and Torres Strait Islanders are even more unwell, and they point the way for all of us.

I must emphasize the word “trying”. You see some people try to explain away the problem by saying that people do not follow the guidelines. They imply that their technical perfection is the only effort needed as if their job was done. Population health demands actual outcomes not theoretically perfect guidelines that people cannot or will not follow.

## Where is Innovation?

What has held Prof. O’Dea’s revelations of forty years from a possible practical application? It would be scandalous if this was deliberate as it really would by tantamount to a systematised dietary genocide of the First Australians. We can probably rule that conspiracy theory out though as it is killing us all. How could we arrive at this point where we are all getting sicker trying to follow this advice? This is not a problem of nutrition, and it is not an issue of the science. It is a problem of innovation.

We have already seen in past posts that dietetic organisations like the DAA appear preoccupied with things other than our health (including whole-grain breakfast cereals) and what seems to be dietary dogma. This contributes to the innovation problem.

What about the diabetes research community? While the problems are systemic, innovation can sometimes be held back by an individual at the top who holds views of the status quo. Usually, it is that the existing paradigm and way of thinking is a source of their power. Sometimes there are other reasons. It is instructive to look at the views of those who rule the roost on diabetes advice.

## The Australian Diabetes Society

Prof. Sofianos Andrikopoulos is arguably the foremost Australian diabetes researcher being the current CEO and past president of the Australian Diabetes Society (ADS). The  ADS vision is: “To be the leading society for research, medical practice and education in diabetes”. They work with Diabetes Australia and the Australian Diabetes Educators Association (among others) who are on the front line to deliver diabetes management in practice. The ADS lists ‘innovation’ as a value.

## Organisational Innovation

It takes a certain mindset for organisations and individuals to embrace innovation. In my analysis of companies, the innovative ones have CEO’s that can think differently and embrace with an open mind and build that capability in their organisation. Those organisations have the capability to think of the things that delight the ‘end user’ including things that even the end user never even thought of.  They also have the understanding to look for user trends. Users often ‘hack’ a product to make it work better. When they see that ‘hack’ they pick up on that and research it thoroughly to find out why their product or service is being hacked for insight. They don’t discount anecdote or exclaim “N=1!” because that is frequently how invention starts.

Innovation is often mistaken for invention. These are different words with different meanings. Invention is discovery, while the act of innovation is the process of introducing something new. One need not invent to innovate and ego, expertise and the need to be seen as infallible are often the enemies of innovation.

## Innovating to Solve Scurvy

I am reminded of the health innovation to use citrus in the British Navy to cure scurvy. There is ample literature on this subject and I don’t propose to redo that work. Here is one reasonable account. My summary:

1. In the 1700s, the British Navy was facing a battle with a chronic disease called scurvy. In some ‘battles’ it lost most sailors to scurvy than to the troublesome French with whom they were fighting. No matter what they seemed to try, the health of sailors degenerated until they died.
2. Scurvy is of course due to vitamin C deficiency but this was unknown at the time. Scurvy was seen as a complex problem that was multifactorial and even James Lind (who eventually solved it) “saw scurvy as having many causes, including poor hygiene and discipline“. Most believed that diet was a factor.
3. Lind undertook ‘medical trials’ to determine the root cause and pioneered the use of citrus juice to prevent scurvy as early as 1753, however authorities did not endorse it.
4. In the meantime, while citrus juice was still not official policy, “some naval surgeons, however, looked on it as a medicament that they might occasionally provide from their own purse“. No doubt their lack of scurvy was just an anecdote.
5. Historians attribute a big part of the delay to accept Lind’s work to the personal beliefs of the very eminent Sir John Pringle, who held a differing theory on the cure for scurvy.
6. It took Pringle’s retirement and death  (in 1782) and the appointment of Gilbert Blane as the commissioner of the Sick and Hurt Board, for this simple treatment protocol to be agreed by the Admiralty. That was not until 1795.

## The Analogy

What does this have to do with diet and diabetes?

1. We are facing an epic battle with diabetes as a chronic disease- just like scurvy.
2. Diabetes is seen to be a complex and multifactorial problem with diet being a major factor- just like scurvy.
3. O’Dea’s work in the 1980s showed that a Paleo diet, high protein but lower in carbohydrate and fat was a solution for the most sensitive people to this problem (Australian Aboriginals)- just like Lind.
4. Many of us who have effectively cured our diabetes with that kind of diet are like those lemon juice drinking ship’s surgeons. Some of us are indeed doctors.
5. So what are the ‘beliefs’ of Prof. Andrikopoulos about the paleo (low carbohydrate) diets and are they holding up acceptance? We can point to two major pieces of work.

## The Paleo Mouse Study

In early 2016, Prof. Andrikopoulos published a study of the effect of a paleo diet on mice. His own university wrote a summary of it here. A perusal of his publications shows an extensive list of endocrine-related papers but, unless I am mistaken, no more mainstream diet and nutrition studies until this one.

This study really hit the headlines and caused a media frenzy. I lost count of the news and blog articles that it caused and I spied articles in China, India, Canada and the United Kingdom.

I am not going to analyse this paper in any detail however, many others have found issues with it.

Primarily those issues are:

1. Mice are not representative of people for dietary research (although they may make good models for endocrine research).
2. There are plenty of RCTs in humans that show the opposite effect to this study.
3. This was not a human Paleo diet anyway. Neither by type of food nor by macro composition.
4. It was not the ancestral (Paleo) diet for a mouse so no wonder it caused health issues.

## Mouse Study Fallout

Many critics in the paleo and low-carb high fat (LCHF) community were annoyed by what they saw as a biased attempt to discredit their way of eating and some disparagingly tagged the professor with the nickname “Dr Mouse”.

It certainly left other academics scratching their heads. Prof. Aaron Blaisdell wrote:

Why would the lead author, a scientist of reputable standing in the Australian academe, have been so misled?

Cambridge scholar, Nathan Cofnas, wrote back to the journal the paper was published in to say (among other things):

Mice in the experimental condition were fed something loosely based on a version of the human Paleo diet, which for mice is not Paleo.

An academic peer from New Zealand, Prof. Grant Schofield, seemed annoyed when he wrote:

We think that the way Prof Andrikopoulos presented his results in the media was disgraceful. He can’t be unaware of the human research into LCHF for diabetes and the problems with mouse models. He could easily learn, if he wanted to, about relevant research into the Paleo diet too. Absolutely none of this research supports the claims that he’s making on the basis of his 9 mice.

His claims, despite being based on minimal evidence having very limited relevance. seem designed to disrupt the efforts of those of his colleagues who are using LCHF diets to benefit people suffering from obesity or diabetes.

He and three peers G Henderson, C Crofts, and S Thornley also wrote in their letter to the Journal of Nutrition and Diabetes:

The unfounded conclusions of Lamont et al., and the widespread publicity given to their criticisms of LCHF diets, amount to ‘an unjustifiable interference with a method that is working well’.

It is unclear how this research fits into a systematic endocrinal research program as may be seen in Prof. Andrikopoluos’ other work. Instead, this sudden foray into dietetic research appears to support assertions of interference and a disruptive agenda. I note that at the time that this research was being contemplated and undertaken, Chef Pete Evans and the Paleo diet was very topical. It is possible that Pete Evan’s popular message had somehow upset the Prof. Andrikopoulos and motivated this study to be undertaken. While I applaud academics who involve themselves in topics of controversy (we need more of it), I question the use of these research resources when diabetes is in crisis if that was the motivation. That is, unless the NHMRC is counting media articles instead of citations these days as a KPI.

## The MJA Paleo Article

Prof. Andrikopoulos doubled down with a second foray into nutrition when he wrote a journal article for the Medical Journal of Australia that was also not supportive of Paleo diets (low carb) for diabetes in August 2016.

It was also reported widely in the medical media and it was also criticised again– although not as resoundingly as the mouse study. I think it should have been due more criticism.

## In the Shadow of CSIRO

It is surprising to realise that when the journal article was written, the CSIRO had already done considerable work on its low carb diet with 93 participants for 24 weeks for diabetes and published in mid-2014 yet that is mentioned nowhere. With his profile in the ADS, that work must have been known to him. About six months after that ‘warning’ that went to doctors through the journal, the CSIRO has published a popular book on the subject on sale to the public. Imagine when patients begin talking about the CSIRO diet and their doctors lack information.

It is all the more surprising when you realise that the mouse study itself was undertaken in the shadow of the CSIRO work. While the diet composition was different (58% vs 80% fat for example) they are similar enough to question why the mouse trial was done at all.

## Diabetes Research Leadership?

Prof. Andrikopoulos concluded in his mouse study:

The potential effect of popular weight loss diets needs to be carefully considered with the help of sound evidence before they are recommended for type 2 diabetes.

… and his journal letter:

…. clearly more randomised controlled studies with more patients and for a longer period of time are required to determine whether it has any beneficial effect over other dietary advice.

Prof. Andrikopoulos, as a diabetes research leader through the ADS should be and should have been the driving force to solve these questions. Leadership is not owned, it is given. Unless he has been very busy in the last months solving these important questions of potential dietary diabetes therapies, his leadership position looks diminished.

If indeed, it is as it seems (that these research questions have already been answered) then it would instead appear that his beliefs have been killing the innovation efforts of others.

## Back to Our Historical Analogy

What I curiously discovered in writing this blog is that Prof. Andrikopoulos refers to one of Prof. O’Dea’s papers from the 1980s when writing his journal article. Was that reference by Prof. Andrikopoulos to Prof. O’Dea similar to how Pringle may have referred to Lind’s work?

History is indeed repeated by those who do not heed its lessons. If O’Dea is Lind, and Andrikopoulos is Pringle. One speculates who will be the Gilbert Blane who now shows the leadership to bring change and when?

Whether a low-carb paleo diet is 80% fat as in the mouse study or low-fat high protein as in O’Dea’s work, the ADS cannot ignore the low-carb issue any longer. People are getting sicker and dying waiting for innovation. Chronic disease in Aboriginal health is a national shame. It is time for change.

In my next post, I will examine how other indigenous people and groups are tackling their diabesity challenge at the grass roots.

## NOTICE

Aboriginal and Torres Strait Islanders to should use caution viewing this post, as it contains images of dead persons. Nothing in this post should be taken as criticising or diminishing the efforts of the Nyungar or Aboriginal and Torres Strait Islander communities in pursuing their health or be construed as criticism of them for an unfortunate situation.   The Nyungar have a deep and rich oral culture of which I am not a part. Therefore, I hope to be excused for any error due to the interpretation of things via the written words of mainly white historians. It is worth the risk to be wrong because this issue deserves highlighting and, as always, my comments are open to people to improve the information on this blog.

## Nigerian Musings

In my last post, I talked about the phenomenal success of the ketogenic diet in Nigeria where hundreds of thousands of Nigerians were using a Facebook group to solve their obesity, diabetes and PCOS health problems with a ketogenic diet. Then I saw an article on Siberian health problems from carbohydrate consumption and other lifestyle change in Russia. It got me to thinking, how are Aboriginal and Torres Strait Island Australians faring?

## A Diabetes Emergency in Aboriginal Australia

It is, unfortunately, no secret that diabetes is out of control for them and this crisis was seen as that many years ago. Even when compared to lower socio-economic Australians the statistics are horrifying. Whereas among other Australians, type 2 diabetes is virtually unknown in people under 25, the rate for Aboriginal Australians is 1.5% for people aged 15 to 24, and 0.5% for children aged 2 to 14! After that, the rates are about four to five times other Australians until age 55+ where 40% have diabetes.  In general, Australian Aborigines develop diabetes twenty years earlier than other Australians and are about twice more likely to be hospitalised.

## Why is it so bad?

Indigenous peoples in other places like the Arctic and the Pacific Islands experience similar problems with obesity and diabetes. This was blamed on ‘thrifty genetics’ that predisposes them to weight gain.

While the existence of a thrifty gene is now disputed, the common thread is that their hunter-gatherer lifestyle has changed to a Western diet. As concluded from this study, that change results in health problems linked to insulin resistance. The fat deposition is very noticeable in aboriginal people. They tend to put on weight around the middle yet can remain quite lean elsewhere, and this is backed up by the cited study.

There is a predominantly central pattern of fat deposition in both men and women, which is associated with greater insulin resistance and cardiovascular risk than is peripheral fat deposition.

## Past Research into Diet

Prof. Kerin O’Dea undertook pioneering work into traditional aboriginal diets, obesity, diabetes and heart disease. In her study from 1988, it was noted that even in underweight subjects still adhering to a more traditional way of life; there was higher fasting insulin and elevated triglycerides (signs of insulin resistance) even though their diet was low fat and comprised of lean meat.

In a book chapter from 1988 “The hunter-gatherer lifestyle of Australian Aborigines: implications for health.” Prof. O’Dea looked precisely at what we could learn from a ‘Paleo’ type diet of aborigines. In summary:

1. Aboriginals become obese and develop diabetes (along with high blood pressure and heart disease) when they stop eating traditional food.
2. Before European contact, they were lean and physically fit, and there was no evidence of chronic disease. They were ‘underweight’ with low BMI (13.4 to 19.8 kg/m²) without having signs of malnutrition.
3. There was a lack of literature and nutritional data on an entirely traditional diet, and so she studied people living mostly traditionally.
4. One group she studied had “a traditionally oriented diet” with a BMI of ~17kg/m² and exhibited low fasting glucose (3.8±0.4 mmol/L) but still showed other diagnostic signs of insulin resistance.
5. Referred to her previous seven-week study of a traditionally oriented diet (about 1200 calories). It had two-thirds of calories from meat, 13% from fat, 54% from protein and 33% from carbohydrates when the group were inland where tubers and honey were more plentiful. The carbohydrate quantity dropped to a level estimated at less than 5% when on the coast with protein at about 80% and fat at about 20%. The trial showed a normalisation or improvement of the metabolic factors associated with diabetes.
6. She concluded that a traditional aboriginal (Paleo) diet could reduce primary diabetes and cardiovascular risk factors in the general population but noted it was unlikely to be popular with nutritionists.

This type of diet is also unusually rich in animal protein and high in cholesterol- characteristics not generally favoured by nutritionists in making recommendations for better health.

## Other Research

Prof. O’Dea performed other ground-breaking research regarding diet, diabetes and Australian aboriginals.  These included:

• A 1980 three-month cross-over study that compared an aboriginal urban diet and traditionally oriented diet (50% protein, <20% carbohydrates, >30% fat) with a Caucasian control group that showed aboriginal people exhibit a stronger insulin response to glucose than Caucasians which was less pronounced after a traditional diet. This was likely to be a major factor in their predisposition to diabetes.
• A study in 1982 on the effect of a high protein, seafood based, very low carbohydrate ketogenic diet for two week period. This showed a significant but small improvement. Most other trials of ketogenic diets have proceeded for longer periods as two weeks is about the time required for initial ‘fat adaptation’. It can be wondered what might have been the result had this trial been longer.

## The Nyungar

My armchair research is not as ground-breaking, but I do want to add. I decided that I would like to focus this blog on one particular group.  The Nyungar (or Noongar) whose lands I dwell upon in South Western Australia. Why? The Nyungar were lean and healthy eating a traditional diet until relatively recently, and much of that diet is well recorded.

It is unknown exactly when the Nyungar came to these lands, but there is evidence dating to at least 30,000 years- or greater than 1,500 generations ago.  History records that Europeans did not first settle here until 1826. Along with European settlement came new foodstuffs, disease and farming practices previously unknown to the Nyungar. Flour became especially attractive to them as they had nothing as starchy in their traditional diet. Some of the trouble with settlers was for stealing flour however despite new found foods, the traditional way of eating is said to have existed until the 1960s. Allowing some leeway, it was only three to five generations ago that the Nyungar changed their diet.

Many things changed with the coming of settlers, but I will focus on their food. It is common sense to do so as obesity is roughly 80% metabolism and diet and only 20% exercise and other lifestyle factors. The Nyungar did not run marathons for fun. Like other hunter-gatherers, their activity was low level for long periods and aimed at surviving. If you doubt that common sense, remember that it takes a 6.8km run to burn off a serve of coca cola and takes little effort to drink a few serves.  I do not know why people confound themselves with other factors and think that we are obese because people just aren’t moving as they used to. It is a factor, but you cannot outrun a bad diet- contrary to the favoured myth of the fitness industry.

## Nyungar Diet Today

So what was their diet like then and what is it like now? Some of the information I am about to present comes from this paper from 2010.  It suggests that the current diet is high in fat, sugar, fast food and carbohydrates and that it is given to infants at an early age.

The majority of infants had received ‘fast foods’ by 12 months of age with 56.2% had been given coca cola, 68% lemonade and 78% fried chips.

Unsurprisingly, many are on the same poor Western diet that causes diabesity all around the world. The same one that results from giving advice to the populous to minimise salt, fat, sugar, avoid saturated fat and to eat 45 to 65% of dietary intake from carbs (Australian Dietary Guidelines) and the food industry adjusts its products to match. The diet exacerbated by the fast food industry with its fattening mix of carbohydrates and polyunsaturated seed oils.

What was their diet? Well, the account of foods is quite detailed in this paper too. It was a meat based diet rich in meat, offal, but low in green vegetables with some tubers with limited grains, fruit and sugars. The effect of that diet is apparent below.

Respectfully, I have not put any pictures here of today’s Aboriginals and Torres Strait Islanders following (as best as they can) the Australian Dietary Guidelines but you can do your own google search. You are likely to find that, along with all Australians, people are not as lean. It is important to remember however that research showed that even lean Aboriginal and Torres Strait Islanders were predisposed to diabetes.

I think it is important that a reader gets some context of the ‘bush tucker’ food available here- especially the carbohydrates. The exceptional skill that the Nyungar had to live on this land is hard to appreciate unless you have spent time here. We do not have natural forests of edible nut trees with an undergrowth of berries. There was no farming, and everything was taken in season leaving enough to replenish naturally. Surviving on meat and fish here is one thing, determining the edible plants among the majority that are toxic belongs to Nyungar knowledge won over millennia that is foreign to me. Let us look more closely at the carbohydrates in their diet. These were said to be from the zamia palm, seeds and nuts (primarily wattle seed), fruits, nectar, honey and tubers.

## Sugars: Nectar, Honey and Fruits

Nectar from plants like the Banksia was seasonal at the flowering time. The nectar would obviously form a seasonal treat or snack in their diet- much like when Europeans suck on a honeysuckle.

There was no organised cultivation or production of snack products. As you might imagine too, just like these available for all Australians at my local supermarket, such snack treats would not form the mainstay of their diet.

## Honey

Honey is a product of the concentration of nectar by bees. Unlike the European bees that arrived with settlers, most Southwest Australian bees are solitary and small.  You just don’t get the same prodigious quantities of honey from them. Australia’s honey producing stingless native ‘sugarbag’ bees are not native to South Western Australia.

## Fruit

The fruit the Nyungar ate is typified by the native peach or ‘Quandong’. It is the size of an oversized grape and has limited meat. In fact, the ones in this picture are quite luscious compared to ones I have found in the wild. The ones I have seen have very thin flesh and a large nut with an oily kernel eaten roasted. It is a bit like a macadamia with a root beer flavour.

The Quandong has a short season of about a month over Summer in each locale ripening progressively from North to South in range over four months. It is also a small parasitic tree depending on specific compatible host trees, so both the fruit and the tree are not plentiful. The quandong is high in vitamin C but not overly sweet. If you can gather a sufficient quantity (an undertaking of some effort) and then combine with sugar, it makes a pleasant jam. Eaten fresh, the Nyungar would have had a tart treat.

While sugars were undoubtedly sought after, you would defy credibility if you were to maintain that the traditional Nyungar diet had any substantial sugar. It is recorded that the Nyungar collected nectar mixed with water for a sweet drink and also fermented it into an alcoholic drink (called Gep). Without bees to do the work, you can be assured that even when such seasonal pursuits were possible, they were well below the WHO stretch target of 5% of calories from sugar. You can be fairly sure that due to local availability and seasonality, most days would have no sugar intake at all.

## Starches: Wattle, Tubers and Zamia

Wattle seed was probably the dominant seed that was eaten. In season it was ground and made into cakes cooked on an open fire and qualifies as the primary Nyungar grain. It would have been typical of the seeds that the Nyungar ate. Nutritionally, it was very high fibre (54%), and with a net carbohydrate content of 10.5%, 20% protein and about 6% fat, it is a very low carbohydrate grain compared to wheat (~70% carbohydrate).

Tubers were the last and probably most significant of the starches, and the Nyungar diet had a varied number. While I can find no nutritional analysis for these plants, it is important to remember that they were opportunistically collected, seasonal and never farmed or selected to improve the size and nutritional content. It is also a factor that tuberous plants tend to be found inland in the forests, and not on the coast.

## Zamia: Carbohydrates or Fat?

Unlike other groups in Australia, the zamia palm is said not to have been eaten by the Nyungar for its more starchy seed, but instead for the poisonous oily macrocarpa which was specially treated to make it safe to eat. Contrary to what may have been assumed, to the Nyungar this was valued as a fat and not a carbohydrate source- much like the oil palms of the tropics.

## Nyungars were not Vegans

The major part of the Nyungar diet, as written in many sources, was animals, eggs, birds, fish and grubs. As previously linked:

Traditional foods from this region varied but included emu, kangaroo, possum, goanna, fresh water crustaceans (maron and gilgies), bardi grubs from under the bark of eucalyptus trees or in the roots of mallee trees, wild duck, mallee hen eggs taken from the mound where multiple eggs were found and fish for people who lived on the coast permanently or in different seasons. Everything edible on an animal carcass was consumed, including organs such as the liver, kidney, brain and intestines.

It is evident through their preference for eating the oily zamia palm and other accounts of meat eating that they did seek fat although it was also not a high-fat diet. Fat would have been mostly from animal sources, and most wild sources from meat are not as high in fat as the domesticated ones that we now eat.

## A Paleo Diet?

Putting this diet into modern terms, it would be pretty close to what people call a ‘Paleo Diet’.  No dairy, but with eggs, meat and fish as available with limited vegetable content as could be foraged. Looking at the descriptions of Prof. O’Dea’s work and the descriptions above, most Nyungar would probably be on a high protein (say 40%) medium fat (say 40%) and low carbohydrate (say 20%) diet with inland Nyungar probably eating more tubers for some more carbohydrates than others.

The actual composition would be subject to the seasonal and local availability of the carbohydrate sources like tubers; it would have been at times, a ketogenic diet- particularly if the hunt and forage were insufficient.

With so few carbohydrate and fat rich foods, there is no doubt that the Nyungar would have prized fat and carbohydrate foods as high energy sources.  This is likely to be why they took the time and trouble to detoxify oily zamia palm fruits.

## The Cause is Apparent

We have looked at some of the past research and taken a look at the likely composition of the Nyungar diet. It should be fairly obvious why the Nyungar would suffer from insulin resistance, obesity and diabetes when fed a Western diet. Even if you disregard the similar opportunistic diet that they ate while migrating to Southwest Australia they have had more than 1,500 generations to adapt to the low carbohydrate, low-fat food in their country. We have given them three to five generations to adjust to a high carbohydrate, high-fat Western diet. The effect of our dietary advice has tripled obesity since the 1970s for all Australia. It even gives us the diabetes epidemic that Australia now faces. No wonder the Nyungar have been so severely affected by it.

I am of Northern European descent. My ancestors have had over one hundred generations to adapt to a higher carbohydrate diet made possible through agriculture, but even that is not long enough. No wonder I developed diabetes in my forties while some Nyungar get it in their twenties. Doesn’t that make perfect sense?

## The Australian Dietary Guidelines

Even if the diet that Australians ate was exactly to the Australian Dietary Guidelines (essentially low-fat with 45 to 65% of energy from carbohydrates with multiple meals spread throughout the day), it still is far from their traditional diet of one main meal, low in carbohydrates, after the hunting and foraging were completed.

Now we hit the great conceit. You see with all of our science and technology we have worked out that the ‘perfect’ diet for Australian humanity is expressed in the Australian Dietary Guidelines. The Nyungar and other groups should eat our perfect diet born of science because to do otherwise would be to deny them health. It would be discriminatory to have them follow a different diet.

If I were to espouse their original low-carb, low-fat, high protein diet, people would say: “Yes but in their primitive way of life they died young”. To that, I would say: “That is why we have modern medicine including antibiotics, sterile surgery, vaccinations, pre and ante-natal care, effective drug therapies and more”. Further, as obesity and diabetes were completely unheard of on their traditional diet, no-one would likely die of diabetic complications, suffer diabetic induced cardiovascular disease, diabetic blindness, kidney failure and amputation. Isn’t that what we are seeking to fix?

No one is suggesting that the Nyungar must go back exactly to their traditional diet and lifestyle. There is no reason though why healthy eating of similar composition to their traditional diet cannot be recommended.  It is not, though. In fact, the diet that I am on is denied as an option for the Nyungar by Diabetes Australia and Diabetes WA. My diabetes effective low carb healthy fat diet would be pretty close to their traditional diet. It is safe, maintainable and gives me normal blood glucose that means I will avoid diabetic complications.

Most importantly, it has reversed my diabetes.

## Calling it Out

No Facebook groups are helping the Nyungar, or other groups achieve low carb weight loss and curing their diabetes as the Nigerian ladies have achieved through self-organisation. Our First Australians are depending on not-for-profits who are failing them.

Advice from Diabetes Australia for Aboriginal and Torres Strait Islander’s with diabetes may include the call to eat more bush tucker, but it is otherwise much the same as for all Australians. In particular, it does not suggest limiting, total carbohydrate. The CSIRO has recently proven this to be effective, and actually, Prof. O’Dea’s studies also showed its efficacy some forty years ago. It seems unfortunate that it was not a favoured message of the nutritionists either now or then.

This issue has to be called out, and so I am doing so. To continue pushing the Australian Dietary Guidelines for people with diabetes, and in particular for the First Australians like the Nyungar, is tantamount to Australian Dietary Genocide. It is making us all, white fella and black fella, very very sick.

My next post will examine this issue further.

## Our Shame

In Australia, our fat-cat bureaucrats, egghead scientists, over-lobbied politicians, salivating not-for-profit CEOs, conflicted dietitians organisations, greedy pharmaceutical companies and over sweetened food industry CEOs are debating obesity strategy and sugar or health taxes. The government has already dispensed a National Diabetes Strategy that this motley crew put together that wouldn’t even make it onto the fiction best seller’s list, let alone solve the problem, as it fails to contemplate changing dietary recommendations as solutions. Taxing us to tackle obesity? Unfortunately, they take themselves too seriously.

As a health consumer, what do you think? Before you answer, I’ll tell you that you should simply not give a damn (or insert your favourite four letter word here). Sorry for the language but when you realise that other than your statistic, it is not about you. Not one of these is truly advocating for you with your chronic obesity or diabetes. It is all to do with their interests like funding for their members and organisations, research buckets of money or profits. They have forgotten you and the experts are dead. After all, if they actually fix your chronic diabetes or obesity, what would they do with themselves?

## Meanwhile, In Nigeria…

A quiet revolution is underway. Let us look at something that really should matter to you much more than the business plans and career advancement of all those types above.

Nigeria’s population is pushing 190 million. The traditional diet is quite high in carbohydrates with palm oil and other fats, and it used to be a sign of affluence to be chubby- but not anymore. It has upwards of five percent of those people with diabetes, many more pre-diabetic and far too many are obese. The obesity rate climbed eight times from 1.3% in 1974 to 10.3% in 2014.  Fertility is impacted by PCOS. Yessiree, Nigeria has an insulin resistance problem.

## Is Nigeria Lacking Dietetic Advice?

How can this be? Surely most people are not so affluent as to be obese? Nigerians probably have a good deal of plant-based diet as meat is more expensive. They have national dietary guidelines that are just as good as ours. Those guidelines recommend that Nigerians have a rich carbohydrate diet, limit fat and avoid saturated fat. Those guidelines say they should have lots of fruits and vegetables and not eat too much red meat. They have a dietitians association that gives them the same advice as everyone else in the world gets. Perhaps Nigerian Dietitians have the same problem as the DAA in that they have the same fantastic dietary guidelines, but no one follows them. Strangely this is an epic fail in every country, but we keep on doing the same thing and hearing the same excuses.

Perhaps it is all the new sedentary jobs in Nigeria that have caused these health problems? The Internet penetration is at about 52%- approximately 97 million people and about 16 million of those are on Facebook. Of course, to think of Nigeria as a poor, backwards country is not only insulting, it is untrue. There is one key technology statistic they lead in. I noticed that they even beat the United States.

If you search for the term ‘ketogenic’ on Google Trends, you see that Nigeria beats all other places in the world. “It must be some mistake,” you say? It is not. While our societies are nauseatingly debating sugar taxes, how to prevent obesity, coming up with ineffective national diabetes strategies and suppressing low carb for greed under a thin veneer of philanthropy, the ladies of Nigeria are transforming their health and the health of their country.

Now the low-carb deniers are probably going to suggest some tin-foil hat conspiracy. Maybe Prof. Tim Noakes has been commuting North every week spreading his vile message? No. It is a grassroots revolution.

In Nigeria, the low-carb diet is best known under the term ‘ketogenic’ diet, and so it has slipped under the radar compared to terms like Paleo, LCHF and Banting.

The Google trend search also shows that adoption has been extremely rapid. From a near standing start, it accelerated in about August of last year. It had the usual January bump that we see in diet trends. What is driving this? No surprises folks. It is because it works and the ladies know it.

## Ketogenic Lifestyle

One of the largest groups on Facebook is called “Ketogenic Lifestyle”.  It started posting its ketogenic information in August of last year when the surge happened. It has about 316,000 members and has grown very fast. What may surprise you is that this group caters to provide support for Nigerian low-carbers. Almost all of the members are Nigerian, and the majority are women. How the three admins manage a Facebook group with over 300,000 people is probably worthy of a separate post (and a gold medal)!

This group was started by Joy Aghogho whom some of the members refer to as “Aunty Joy”. Joy is exactly what they feel every time a sister, infertile in the past from PCOS, announces their pregnancy. The posts are a procession of advice and information and then beautiful ladies. Beautiful and large before, beautiful and healthier after keto. They know the keto diet is a therapeutic diet that can counter the health scourges of their country (diabesity) as well as PCOS and epilepsy. There is not a dietitian in sight. These are ketogenically educated ladies, and they seem to know it better than most Australian APDs!

## The Numbers

Let us just run some numbers for the bureaucrats and CEOs who may happen to come across this health consumer’s blog. 316,000 Nigerian Facebook users can actually be doubled when you consider that their partners are probably eating keto too. That is four percent of the Facebook user population. Given that societies like Nigeria have very dynamic and active personal networks radiating from each user, that figure may well be a good proxy for the penetration of the ketogenic diet into Nigeria itself. This figure is significant as the official rate of diabetes in Nigeria is 5%, and the ketogenic diet normalises and reverses type 2 diabetes and offers type 1s normal blood glucose. There is likely to be a great crossover between the obese and diabetic population (10.3% and 5%) and the ketogenic diet population.

## The Implications

So here are some questions and implications for various people from the ketogenic health explosion in Nigeria.

### For Government Health Ministers and Health Bureaucrats:

Will Nigeria beat diabesity before your country even considers the right move? It looks like you need to get away from the noisy lobbyists and interest groups and investigate what is happening for health in our own Facebook communities.

### For Pharma CEOs:

Nigeria is probably not even a blip on your sales figures, but you now have a duty to your shareholders to inform them of the risk from other country populations adopting low carb- particularly at the rate of growth seen in Nigeria.

### For Pharma Shareholders:

Along with the Credit Suisse report, time to reassess your long-term investment unless your CEO has communicated a clear strategy to manage dietary change to low carb.

### For Diabetes Not-for-profits:

Are you really committed to innovation to improve the lives of people with diabetes? If not then find another job.

### For Food and Drink Industry CEOs:

Time to stop resisting with marketing that will damage your future brand. Consider what your products will be in a low carb future and like pharma executives- consider your projections carefully.

### For Food and Drink Company Shareholders:

Along with the Credit Suisse report, time to reassess your long-term investment unless your CEO has communicated a clear strategy.

### For Dietitians and their Not-for-profits:

Even if you STILL think this is a diet fad, shame on you to force health consumers to fix themselves via Facebook. Ignoring this health revolution is making you irrelevant.

### For the higher carb chronic disease sufferer:

Time to try what these smart Nigerian ladies know.

### For the researcher:

Plenty of epidemiological data here about the mass-effect of ketogenic diets on weight loss, POCS, Diabetes and health. Time to pull out your head and head to Abuja or talk nicely to Joy.

### For the existing low-carber:

See what the low carb community can do.
Keep calm and keto on with our Nigerian sisters!