Dr Jay Wortman – Friday Feb 20, 2015
The Low-Carb, High-Fat Diet for Obesity, Metabolic Syndrome and Type 2 Diabetes
Canada has a healthcare system that doesn’t care about nutrition and a food system that doesn’t care about health.
Research shows that everything we ever thought about nutrition is wrong.
Major food corporations produce foods that comprise three ingredients –refined grain, sugar and toxic seed oils – that are driving the epidemics the world is experiencing.
I’m going to talk about my personal journey into the traditional diets of indigenous people. I have become fond of traditional food gathering.
I grew up in the far north of Canada, where the sun doesn’t shine in winter, and shines all day in summer. I lived in the First Community in Western Canada that supported the fur trade. I remember a trapper pulling out a piece of smoked dried moose meat that kept me busy chewing nit for an hour. I remember how good it tasted.
Traditional diets have changed, and with it people’s health. Both my grandparents developed type 2 diabetes. They had nine children. All developed diabetes or heart disease or both. Both my parents were Type 2 diabetics; mother had breast cancer as well.
I was not spared the predisposition that indigenous populations have for type 2 diabetes.
I remember the day I found out I had type 2 diabetes. I was fatigued, gain weight, urinating more frequently, my vision was blurry. I thought these were natural effects of ageing, but realised I had a family history and genetic predisposition. Although I should have seen it coming, I got a profound shock. As a doctor, you know too much. I have a young child, and realised that my life expectancy could be much shorter.
I knew nothing about nutrition. I surreptitiously stopped eating carbs, and tried to hide it from my wife, so as not to worry her. When she noticed I had stopped eating carbs, she said: “You’re on the Atkins Diet, dummy.”
My recover was miraculous.
I started researching traditional diets. I discovered:
- Coast Salish – they ate oolichan grease, from a small fish, staple highly valued food used as a condiment and medicinal; it accounts for more than 25% of calories in the diet of current users.
- Northern First National – bear moose fat
- Inuit whale fat
- Plains First Nations – pemmican
- Innu – caribou fat
- Australian aborigine – emu fat
These people ate no carbs traditionally. Their diets have changed, and they now eat processed foods. Their diets have shifted from low-carb high fat and moderate protein to majority of high-carbs and the worst possible kind of diet. It isn’t any wonder that they started leading epidemics on diabetes, obesity and metabolic syndrome in a very short period.
We designed a study, trying to do something different, because clearly what they were doing wasn’t working. We put them on a low-carb, ketogenic diet.
I began to realize that there was a continuum of health problems linked together:
- Overweight and obesity
- Metabolic syndrome
- type 2 diabetes
- CVD and stroke
We make artificial boundaries, but underpinning them all is insulin resistance. It’s not my original idea. A report in the Journal of Internal Medicine in 2000, said “The Metabolic Syndrome is synonymous to an iceberg with glucose intolerance above the surface but a group of other key cardiovascular disease risk factors lurking below”.
These are: insulin resistance, hyperinsulinaemia, central obesity, dyslipdaemia, hypertension. I would add a bigger part of the iceberg is obesity.
The conditions associated with Metabolic Syndrome and Type 2 diabetes:
- Oxidative stress
- Polycystic Ovary Syndrome
- Sleep Apnea
Gerald Reaven showed in 1997 that the basic defect in Syndrome X is resistance to insulin-mediated glucose disposal. If dietary carbohydrate is increased in an iso-caloric diet, additional insulin must be secreted to maintain glucose homeostasis. The orthodox approach is the shotgun of medication, the polypill:
- Blood sugar control: sulfonylureas, meglitinides, biguanides, TZDs, alpha-glucosidase inhibitors, SGLT2, DPP-4 inhibitors, insulin.
- Blood pressure control: ACE inhibitors, diruetics, beta-blockers, vasodilators, calcium channel blockers.
- Cholesterol control: statins, niacin, bile-acid resins, fibric acid derivatives, cholesterol absorption inhibitors.
- Coagulation control: aspirin
- Inflammation control: (statins)
- Weight control: SNRI, pancreatic lipase inhibitors, appetite suppressants.
Polypharmacy and money are involved in managing these problems.
Prevention methods have involved telling people to eat less and exercise more. But research shows that fat in the diet is not the primary cause of weight gain and associated problems.
Even huge Women’s Health Institute cohort study could not show benefit from reduced total fat and increased intake of veg, fruits and grains. Clearly it is not saturated fat that is driving insulin resistance and diabetes.
I have also realised that it was hormonal problem causing extremes, but a little more complicated than just insulin.
Sugar is toxic out of the normal range in the blood. The body goes to extraordinary lengths to keep it in normal range. When you take in a huge amount, say from a banana, with waffle and syrup, the body suffers a metabolic emergency, trying to dispose of the toxic stuff.
Insulin is secreted in large quantities. It pushes fat out of the way, and pushes glucose to the front of the queue to be burned.
The body is not burning glucose because it likes glucose as a fuel. It is burning glucose because it is toxic. Insulin takes excess glucose in the blood and turns it into fat.
Another hormone involved is leptin, the messenger from fat tissue to your brain that tells you can stop eating. In people who are IR, the leptin signal does not get to the brain. Insulin acts as a leptin antagonist.
All animals react the same way, when they don’t get a leptin signal – they are starving and seek food. The same thing happens with humans. It’s a primitive survival signal.
Our prescription is to tell people to get their sorry butt off the sofa and go jogging and stay away from the fridge. Some people can overpower primitive survival signals telling them to do the exact opposite, but most fail.
The medical paradigm has been the energy imbalance theory:
Increased calories + decreased activity make you fat.
The WHO has said: “the fundamental cause of obesity and overweight is an energy imbalance between calories we consumed on one hand and calories expended on the other hand.”
The UK Medical Research Council has said: “Although the rise in obesity cannot be attributed to any single factor, it is the simple imbalance between energy in (through the food choices we make) and energy out (mainly through physical activity) which is the cause.”
But it is not about calories. It’s about which food you eat.
In my paradigm, the target for intervention is not calories, it’s carbs.
Scientists have tried to tease out the variables to show how low-carb diets wok to achieve weight loss. It hasn’t been easy. They have invented other names for diets, such as the Lo-BAG diet, and got funding.
There is research to showing:
- that no association between national percentage of energy from fat and median body mass index in (European) men … fat intake varied from 25 – 47% of energy
- in 65 counties in China, no correlation … dietary fat from 8 – 25%
- fat consumption within the range of 18 – 40% of energy appears to have little if any effect on body fatness.
- clear inverse relationship was observed in women
- diets high in fat are not the primary cause of the high prevalence of excess body fat in our society, nor are reductions in dietary fat a solution.
Studies that properly administer a carbohydrate-restricted diet demonstrate:
- significant weight loss
- correction of insulin and leptin resistance
- normalization of blood sugar
- normalization of blood pressure
- normalization of cholesterol
- reduction in inflammation
One of our studies looked at a 48 year old First Nations man
with type 2 diabetes. He had
- hypertension, dyslipidemia
- history of stroke
- on insulin for 17 years
- Humulin N 25u, R 3-5u qid
- Ramipril 10 mg
- fasting glucose 9 – 10 mmol
- weight 291lbs (135 kg)
- begins carbohydrate restriction
Within two weeks he had a weight loss of 17 lbs (8 kg) , normal blood glucose and was able to discontinue insulin. By 18 weeks he had a weight loss of 46 lbs (21 kg), and all his markers were normal: glucose, BP cholesterol and he was off all medication.
The interventions are simple. We advise patients to find the balance that our ancestors ate and:
- Avoid foods that promote caries or gingivitis,
- Don’t eat fermentable carbs – sticky/sugary foods, dried fruits, refined grains, crackers, potato chips that are bad for teeth,
- Eat less carb more natural fats, cholerol and protein,
In answer to the question of whether the brain needs carbs: Just ask any eskimo. The brain functions well on ketones from carnivours
Ketogenic diets are not for everyone, but are helpful for someone like me who struggles with blood sugar, and is helpful for:
It is clear that our belief that a low-fat diet is healthy is based on terrible research. We began telling people that fat was the primary cause of heart disease, and a food can’t make you fat if it doesn’t have fat in it. That just led us to eat more carbohydrate foods, and sugar. That’s the driver.
We need to go back to the balanced diet of our ancestors.