The battle over the causes of cardiovascular disease heats up!

By George Henderson and Grant Schofield

In today’s Guardian, there’s a report on the backlash against an editorial in the British Journal of Sports Medicine entitled “Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions”.[1]

The authors are cardiologists Aseem Malhotra and Pascal Meier, well known for their support of low carb interventions (Pascal Meier is also editor of BMJ Open Heart). And, coming as a surprise to us, Rita Redberg, a cardiologist who is better known as the editor of the high-impact American journal JAMA Internal Medicine (perhaps making this the first meta-editorial). We recently had a letter published in JAMA Int Med questioning the analysis in a Harvard epidemiology paper concerning dietary fats and mortality (Wang response), so maybe this shouldn’t have been a surprise if they’re open to readers questioning the established wisdom.

The editor of BMJ British Journal of Sports Medicine has supported low carb in the past, publishing papers by Tim Noakes and Aseem Malhotra; there’s a fine tradition of the “reforming journal” which is being revived around the dietary guidelines question today, with some journals (the BMJ itself also comes to mind) not being afraid to court controversy.

Malhotra

The gist of the article is in the graphic above and in this press release:

Journals from BMJ Press Release:

Embargoed 23.30 hours UK time Tuesday 25 April 2017

BRITISH JOURNAL OF SPORTS MEDICINE

Popular belief that saturated fats clog up arteries “plain wrong” say experts

Best form of prevention and treatment are ‘real’ food and a brisk 22 minute daily walk

The widely held belief among doctors and the public that saturated fats clog up the arteries, and so cause coronary heart disease, is just “plain wrong,” contend experts in an editorial published online in the British Journal of Sports Medicine.

It’s time to shift the focus away from lowering blood fats and cutting out dietary saturated fat, to instead emphasising the importance of eating “real food,” taking a brisk daily walk, and minimising stress to stave off heart disease, they insist.

Coronary artery heart disease is a chronic inflammatory condition which responds to a Mediterranean style diet rich in the anti-inflammatory compounds found in nuts, extra virgin olive oil, vegetables and oily fish, they emphasise.

In support of their argument Cardiologists Dr Aseem Malhotra, of Lister Hospital, Stevenage, Professor Rita Redberg of UCSF School of Medicine, San Francisco (editor of JAMA Internal medicine) and Pascal Meier of University Hospital Geneva and University College London (editor of BMJ Open Heart) cite evidence reviews showing no association between consumption of saturated fat and heightened risk of cardiovascular disease, diabetes, and death.

And the limitations of the current ‘plumbing theory’ are writ large in a series of clinical trials showing that inserting a stent (stainless steel mesh) to widen narrowed arteries fails to reduce the risk of heart attack or death, they say.

“Decades of emphasis on the primacy of lowering plasma cholesterol, as if this was an end in itself and driving a market of ‘proven to lower cholesterol’ and ‘low fat’ foods and medications, has been misguided,” they contend.

Selective reporting of the data may account for these misconceptions, they suggest.

A high total cholesterol to high density lipoprotein (HDL) ratio is the best predictor of cardiovascular disease risk, rather than low density lipoprotein (LDL). And this ratio can be rapidly reduced with dietary changes such as replacing refined carbohydrates with healthy high fat foods (such as nuts and olive oil), they say.

A key aspect of coronary heart disease prevention is exercise, and a little goes a long way, they say. Just 30 minutes of moderate activity a day three or more times a week works wonders for reducing biological risk factors for sedentary adults, they point out.

And the impact of chronic stress should not be overlooked because it puts the body’s inflammatory response on permanent high alert, they say.

All in all, a healthy diet, regular exercise, and stress reduction will not only boost quality of life but will curb the risk of death from cardiovascular disease and all causes, they insist.

“It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat,” they write.

“Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 minutes a day and eating real food.”

But, they point out: “There is no business model or market to help spread this simple yet powerful intervention.”

The push-back in the Guardian made use of the Hooper at al 2015 meta-analysis of diet-heart RCTs:[2]

Dr Amitava Banrejee, a senior clinical lecturer in clinical data science and honorary consultant cardiologist at UCL, said: “Unfortunately the authors have reported evidence simplistically and selectively. They failed to cite a rigorous Cochrane systematic review which concluded that cutting down dietary saturated fat was associated with a 17% reduction in cardiovascular events, including CHD, on the basis of 15 randomised trials.”

This is nonsense.

1) The Hooper 2015 Cochrane meta-analysis gave no information on reducing saturated fat, because the only reduction in events was seen in some studies where saturated fat was replaced with polyunsaturated fat, not with carbohydrate. Based on population epidemiology, it’s likely that replacing carbohydrate with PUFA – and keeping SFA the same – would have had as much or a greater effect, except that this was never tested in these RCTs.

2) There were no reductions in heart attacks, strokes, cardiovascular deaths, or all-cause mortality from saturated fat replacement in Hooper 2015. The only reductions were in “unblinded” event outcomes, where the LDL level is one of the diagnostic criteria.

3) Hooper 2015 included many studies in which SFA was reduced by replacing processed food (pizzas, pies, desserts) with wholefoods (nuts, whole grains, fish, fruit). This improvement in food quality should have produced some benefit independent of fats. Ramsden et al isolated those studies where PUFA cooking fats and spreads replaced more saturated cooking fats and spreads, and there was no benefit overall, with some harm from high omega-6 interventions and a suggestion of benefit from omega-3 ones.[3] In fact, the Hooper et al studies that improved food quality should have produced better results than they did, and it is possible that the focus on saturated fat reduction and on keeping total fat low hampered them.

4) Statistical modelling in Hooper et al 2015 used the random effects model, which may have exaggerated the results of the smaller, more favourable trials; had an alternative model, inverse heterogeneity analysis, been used there would have probably been no significant associations at all. Watch this space as we (led by epidemiologist Dr Simon Thornley) prepare to publish an academic paper on exactly this, with a full reanalysis of this Hooper Cochrane review using this new more modern method for the meta-analysis.

Quite a few people cited in the Guardian did support Malhotra et al.

Gaynor Bussell, a dietitian and member of the British Dietetic Association, also offered the authors qualified support. “Many of us now feel that a predominantly Med-style diet can be healthy with slightly more fats and fewer carbs, provided the fats are ‘good’ – such as in olive oil, nuts or avocados,” she said.

However, saturated fats should comprise no more than 11% of anyone’s food intake, she said – far less than the 41% fat level backed by the co-authors.

While carbohydrates should still be part of every meal, people should routinely consume high fibre or wholegrain versions, Bussell said.

Well, this is nonsense. You could easily have a 41% fat diet that was 11% saturated fat if you used some olive oil. Fancy a dietitian and member of the British Dietetic Association making that mistake. But why should saturated fats comprise no more than 11% of anyone’s food (energy) intake? What is the evidence for this cut-off? It is 14% in Scandinavia, 10% in New Zealand – irrespective of the total fat intake which it’s part of, which is surely relevant; did every country pull their figure out of a hat?
And why should carbohydrates, that is, sweet and starchy foods, be part of every meal?
We think it’s probably beneficial to be in at least mild ketosis, and have low insulin levels, for at least part of the day. Otherwise you’re always in the fed state, always packing away energy as cholesterol and fat, instead of using it up. And surely that’s where the fat that can build up in your arteries comes from – whatever puts it there, whether it’s carried there by oxidised LDL particles or by magic pixies, it’s available to go there because it wasn’t used to fuel you, which is why CHD risk due to atherosclerosis is associated with overweight and obesity and offset by exercise.

There’s one criticism that’s probably justified;

Christine Williams, professor of human nutrition at Reading University, said the cardiologists’ dietary advice was impractical, especially for poorer people. “The nature of their public health advice appears to be one of ‘let them eat nuts and olive oil’ with no consideration of how this might be successfully achieved in the UK general population and in people of different ages, socioeconomic backgrounds or dietary preferences,” she said.

Doctors’ visits and PCSK9 inhibitors aren’t cheap either. There is a need to scale healthy low-carb advice for poorer populations. Fats like olive oil are cheap per calorie compared to most healthy foods, but dearer than other oils, so would some canola oil be okay? As far as anyone knows, peanuts and sesame and sunflower seeds are as good as the more expensive nuts. High-fat yoghurts and milk are the same price as the reduced fat versions; this is one way to save money. Whole grains are much more expensive than flour and sugar, but that won’t stop the experts recommending them.

Postscript

In case you think that “inflammation” in the BMJ Sports Medicine editorial was too briefly described or explained, here’s a superb review of the “alternative hypothesis” of heart disease from 2011, which deserves to be more widely read.
Kuipers et al

References

[1] Malhotra A, Redberg RF, Meier P. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. 

[2] Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD011737. DOI: 10.1002/14651858.CD011737.

[3] Ramsden CE , Zamora D , Majchrzak-Hong S , et al . Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota coronary experiment (1968-73). BMJ 2016;353:i1246. doi:10.1136/bmj.i1246

The fat emperor again

Ivor Cummings latest talk is worth a watch. He basically does my entire third year “Lifestyle Disease” class in a single lecture. So you can save taking that and just watch this.

I don’t buy the whole “you have to be an engineer to have a problem solving brain” line Ivor.  I’ve heard enough of that from my Dad over the years, who is also an engineer.  True though, they are both good problem solvers.

http://www.thefatemperor.com/blog/2017/4/3/fat-emperor-at-weston-price-limerick-a-root-cause-talk-cholesterol-diabetes

Audio: Low Carb Healthy Fat for sports performance. World triathlon age champion Bevan McKinnon

I’ve witten a lot about fuelling for training and racing for sport performance, especially endurance, and most especially Ironman triathlon.  That’s what inspired What the Fat? Sport Performance, and several blogs about this guy: Bevan McKinnon and his sucess in using low carb healthy fat.

He’s now the current Ironman 70.3 and Ironman Hawaii World champion. That follows from his record time for an age grouper at Ironman NZ, Match 2016, and an group win in the ITU long course world champs in 2015.

Here’s the audio of my interview with Bevan following all this success and just exploring the in’s and out’s of nutrition in training and racing at the highest level.

 

Its a good listen with lots of gems from a very experienced athlete ad coach. Total time 34 minutes.

Australia’s response to the diabetes epidemic – shooting the messenger.

175107-940df042-9f9c-11e3-9b56-731fc0e47d8f

On the Sunday current affairs program in New Zealand there was a report on the diabetes epidemic in South Auckland. This is our largest (and growing) health problem, and two of the players in this tragedy had messages that stood out. An elderly woman, overweight and now condemned to thrice-weekly dialysis, told us “I didn’t do anything wrong”.

How right she was. The Ministry of Health website still offers this “healthy eating” advice – “Fill up on breads, cereals, pasta and rice.”

Junk epidemiology and junk food

The epidemiologists from Harvard recently grabbed headlines with claims that polyunsaturated fats are the healthiest fats, that chicken is one of the healthiest animal proteins, and that plant proteins are healthier than animal proteins. In South Auckland, a staple food is Kentucky Fried Chicken. Chicken is a meat naturally high in polyunsaturated fat, KFC is fried in “healthy” polyunsaturated vegetable oils, and therefore a good source of these, and it even comes with a bean salad – plant protein. This junk food meal, eaten wherever diabetes is rampant (the franchise only came to New Zealand in the 1970’s), actually ticks most of the boxes thrown up by junk epidemiology.

With this sort of dangerous misinformation on official government websites and in the media, how can anyone know what is “right” or “wrong” when it comes to their risk of type 2 diabetes?

The look of success?

One chap in the Sunday program, Kim, had it figured out. He’d reversed his diabetes by, firstly, losing weight rapidly on a low calorie diet (like the Newcastle diet, but with real food instead of Optifast), by exercising regularly, and by eating a diet described as “lots of vegetables” – we saw a delicious looking stir-fry – “no bread, potatoes, rice, pasta” – he didn’t even need to mention sugar.

Incidentally, what is a “fast-acting” carbohydrate? Previously, it was assumed that fast-acting carbohydrates were sugars or juices. It is now known that this is not true, and if there were a fast-acting carbohydrate, it would probably be a starch. “Fast-acting carbohydrate” is a term we need to eliminate from our diabetes vocabulary. – Marion J. Franz, MS, RD, LD, CDE

“So what’s left?” asked the interviewer. “Eggs, meat?” “You’d be surprised how much there is left that’s good to eat!”

Now, the direct end result of type 2 diabetes is a series of complications which include cardiovascular disease, retinopathy, neuropathy, kidney disease and gangrene (caused when vascular damage cuts of blood supply to the extremities, usually the feet, compounded by neuropathy preventing pain warning of injury, and infections fed by high sugar levels and suppressed immune function). Gangrene often requires the amputation of the affected parts, and the surgeon who has to perform this procedure is an orthopedic surgeon.

The case of Dr Gary Fettke

Gary Fettle is a friend of mine. He’s also an orthopedic surgeon in Tasmania, Australia who performs dozens of these operations on patients with type 2 diabetes every year. “I used to do one amputation every 6 to 12 months and now I’m doing one a week”. Seeing, as anyone can who has eyes in their head, the link between diet and diabetic blood sugars and the risk of complications (hardly controversial), he had dared to make a study of nutrition and diabetes literature – something which, as a highly trained medical professional, he was well able to do – and advise his patients, and the public, about how to eat to beat, and avoid type 2 diabetes and/or its complications.

Now Dr Fettke has been banned from giving any diet advice, to patients or in any media, until further notice.

Why? What he is advising is plainly good sense as well as evidence-based. It’s the same message Kim gave on the Sunday program, except that Dr Gary Fettke is a highly trained medical professional with hundreds of hours of clinical experience.

Here’s a great response to the silencing of Dr Fettke, written by Tyler Cartwright for the Ketogains website, that puts the case better than we can.

Meanwhile the Australian authorities continue to allow Associate Prof Sof Andrikopoulos to give diet advice, despite his telling the Australian public to eat sugar with burgers – based on his experience with mice. (I guess that also makes the soft drinks at KFC part of the healthy menu now).

Gary’s not the first and won’t be the last

In 2005 the Swedish dietetics authorities tried to silence Dr Annika Dahlqvist. Their heavy-handed actions led to a court case in 2008 which Dr Dahlqvist won, publicising the benefits of LCHF all over Sweden, and as a result  a significant proportion of the Swedish population soon knew about the diet, and butter sales went up – leading to much hand-wringing around the world among people committed to outdated bad advice, but no adverse effects in the Swedish population – according to the Swedish government’s health data base, heart attacks are now at an all-time low.

20-85+ 39,418 38,846 37,150 34,780 34,140 32,814 32,149 29,823 28,783

Heart attacks in Sweden by year, 2006-2014.

 

 

In this recent Australian TV series, The Saving Australia Diet, Dr Fettke is seen advising the patient Tony on how to treat diabetes with the LCHF diet, with the help of chef Pete Evans. For no good reason that we can see, other than some virulent local strain of the Tall Poppy syndrome, the Australian establishment hates Pete Evans, and this has made some scientists who should know better indulge in bottom-of-the-barrel stunts like Ass Prof Sof Andrikopoulos’s “Paleo mouse” attacks on low carbohydrate diets. It is almost certainly his association with Pete Evans that has drawn the complaint that has led to Dr Fettke being silenced.

Of course, this kind of heavy-handed, bloody-minded action is only possible because Dr Fettke is a health professional, and therefore subject to the discipline of a regulatory body, even if it is being abused for unworthy personal ends and is clearly not in the public interest. Pete Evans, on the other hand, is a member of no such body, so he can’t be silenced, thank goodness.

This is why it’s important for everyone who speaks on nutrition to have a proper qualification – so they can be silenced when they embarrass the authorities, for example by being right about something the government and its appointed experts have been consistently wrong about. Especially in the middle of an epidemic, when damage control is the order of the day.

Well, here’s an idea – instead of “damage control” being about saving reputations, can’t we have damage control that will mean saving feet, eyes, and kidneys?

We don’t always say good things about Aussies (us New Zealanders, and vice versa), but they are our mates really and Gary Fettle is one of the good ones.  Shame on you Australia and the Australian Medical Authorities for allowing this to happen.

Intro to low carb and fasting seminar

MIL154729 HPC Facebook Post (1200 x 1200)We are doing a seminar Sept 8th, AUT Millennium Auckland

Presenters – me (Grant Schofield), dietician Dr Caryn Zinn, and Jimmy Moore all the way form the USA talking about his experiences with fasting.

It’s definitely an intro night, so well suited to those just getitng into or supporting others getting into this lifestyle

Limited space – book online here

  • Date: Thursday 8th September
  • Location: AUT Millennium, The Finish Line,
  • 17 Antares Place,Mairangi Bay, Auckland
  • Time: 6.30pm –8.30 pm
  • Tickets: $25, limited to the first 150 people
  • Buy your tickets online at shop.autmillennium.org.nz
  • Sorry no door sales

PDF flyer here MIL154729 HPC Flyer 8.9.16 2

 

 

Our research published in the Lancet!

 

20130710Wellingtonareapic.jpg
Beautiful Wellington – the most active of the 14 cities worldwide

The Lancet: People who live in activity-friendly neighbourhoods take up to 90mins more exercise per week (link to the full paper)

We’ve been collecting data in my research team for almost 20 years now on how active people are, how that affects their health, and what helps them get more active. The direction we’ve taken over the last 5-10 years has been environmental. We reckon how you set a city out has a big effect on activity levels.

But, it’s hard to do randomised controlled trials at this level (changing whole cities). So we have worked in the space of large cross-sectional studies. Not ideal given the need to show causality in science. It’s hard to measure things like activty too.

Prof Jum Sallis who lead the overall international study (I was PI for New Zealand) says it well

” most studies have been conducted in single countries, mainly in North America, Europe, and Australasia. We were concerned that each country has a limited range of environments, which may lead to underestimating the role of built environments in physical activity. It is unclear whether findings from one country can be applied to other countries, because every study used different methods. The International Physical Activity and Environment Network (IPEN) Adult Study was designed as a more definitive study of the importance of the design of cities for physical activity and health internationally…..

The relation of city design to physical activity was much stronger in this international study than in prior studies conducted in single countries. The findings were similar across countries. Thus, it appears that designing to cities to be “activity-friendly” is a globally-applicable solution to the pandemics of inactivity and non-communicable diseases such as heart disease, stroke, diabetes, and some cancers.”

So, the best-designed neighbourhood can confer up to 90 mins extra activity a week (even taking into account self-selection issues (read the paper). We measured this with motion sensors over 7 days.

As well, New Zeland had the most active city (Wellington), which may primarily be due to the natural design constraints around this beautiful city which create density and other useful features.

Thanks! This work has taken a long time with a massive team in New Zealand – Dr Melody Oliver, Assoc Prof Erica Hinckson, Dr Hannah Badland, Julia McPhee and our whole Human Potential Centre team for years including our students undergrad and masters/doctoral thesis students, Prof Karen Witten and her team at Massey University, and Prof Robin Kearns from the University of Auckland. As well, there are collaborators worldwide in this IPEN and IPEN youth projects.

Here’s the research brief from our IPEN network (the collaboration). 

  • Here’s the full story (below) from the Lancet and here’s the full article online

lancet-lancet-1.jpg

Screen Shot 2016-04-01 at 3.19.56 PM.png

Living in an activity-friendly neighbourhood could mean people take up to 90 minutes more exercise per week, according to a study published in The Lancet today. With physical inactivity responsible for over 5 million deaths per year, the authors say that creating healthier cities is an important part of the public health response to the global disease burden of physical inactivity.

The study included 6822 adults aged 18-66 from 14 cities in 10 countries from the International Physical activity and Environment Network (IPEN) [1]. The cities or regions included were Ghent (Belgium), Curitiba (Brazil), Bogota (Colombia), Olomouc (Czech Republic), Aarhus (Denmark), Hong Kong (China), Cuernavaca (Mexico), North Shore, Waitakere, Wellington and Christchurch (New Zealand), Stoke-on-Trent (UK), Seattle and Baltimore (USA).

The research team mapped out the neighbourhood features from the areas around the participants’ homes, such as residential density, number of street intersections, public transport stops, number of parks, mixed land use, and nearest public transport points. Physical activity was measured by using accelerometers worn around participants’ waists for a minimum of four days, recording movement every minute.

On average, participants across all 14 cities did 37 minutes per day moderate to vigorous physical activity – equivalent to brisk walking or more. Baltimore had the lowest average rate of activity (29.2 min per day) and Wellington had the highest (50.1 min per day).

The four neighbourhood features which were most strongly associated with increased physical activity were high residential density, number of intersections, number of public transport stops, and number of parks within walking distance. The researchers controlled for factors including age, sex, education, marital and employment status and whether neighbourhoods were classed as high or low income. The activity-friendly characteristics applied across cities, suggesting they are important design principles that can be applied internationally.

The difference in physical activity between participants living in the most and least activity-friendly neighbourhoods ranged from 68-89 minutes per week, representing 45-59% of the recommended 150 minutes per week.

Professor James Sallis, lead author of the study from the University of California, San Diego (US), explains: “Neighbourhoods with high residential density tend to have connected streets, shops and services meaning people will be more likely to walk to their local shops. Interestingly, distance to nearest transport stop was not associated with higher levels of physical activity, whereas the number of nearby transport stops was. This might mean that with more options, people are more likely to walk further to get to a transport stop that best meets their needs. The number of local parks was also important since parks not only provide places for sport, but also a pleasant environment to walk in.” [2]

“Despite its humid subtropical climate that usually makes people less physically active, Hong Kong showed above-average levels of physical activity, similar to those observed in New Zealand,” says Professor Ester Cerin, co-author from the University of Hong Kong “Hong Kong has very high residential density and good transport access. This combination means that people are more likely to walk to local services, or to catch a metro, bus or boat on a daily basis. When done regularly, this kind of incidental physical activity accumulates and is an important contribution to overall levels of physical activity.” [2]

Professor Sallis adds: “Physical inactivity has been linked to diabetes, heart disease, and some cancers. Creating healthier cities could have an important impact on improving levels of physical activity. As part of their response to rising levels of non-communicable diseases, public health agencies should work with the urban planning, transport, and parks and recreation sectors towards making cities more activity-friendly than they are today.” [2]

Writing in a linked Comment, Dr Shifalika Goenka, Public Health Foundation of India, Delhi, India, estimates that the “total health gained by changing to optimal activity friendly environments will be close to 2 million fewer deaths and around 3% fewer non-communicable diseases.” Dr Goenka says that while the article presents clear evidence for the role of the urban built environment in enhancing physical activity levels of entire populations, she notes that “Other vital attributes of the built environment that support physical activity and are taken for granted in all the countries of Sallis and colleagues’ study, might not be noted in many other developing countries and need urgent attention—safety, pedestrian priority, availability of adequately wide, useable, unencroached pedestrian pathways, convenience and safety in cycling, and adequate capacity in public transport.”

She concludes: “We need interventions to counter the rapidly growly inactivity that urbanisation leads to, by providing environments that change the way we live our daily lives. It is high time that built environments provide the quadruple boost towards health, environment, equity (or public good), and habitat.”

Link to the full paper

Screen Shot 2016-04-02 at 11.48.02 AM.png
Front page on the LAncet no less

Thanks to

  • Funding for coordination of the IPEN adult study, including the present analysis, was provided by the National Cancer Institute of the US National Institutes of Health (CA127296) with studies in each country funded by different sources.
  • For the New Zealand arm of this study we thank the Health Research Council of New Zealand for their support fo this project (Grant Schofied Lead investigator).
  • [1] IPEN http://www.ipenproject.org/

MOre cveragein NZ media

Screen Shot 2016-04-02 at 11.49.42 AM.png

 

 

Very low-carbohydrate diets in the management of diabetes revisited

Screen Shot 2016-04-01 at 1.15.06 PM.pngJust out –  our latest paper in the New Zealand Medical Journal – a review and viewpoint on low carb for diabetes.

We’re just continuing to make the point that low carb eating is a very sensible way to go for people with diabetes. The outcomes are better. Here’s the abstract.

Full text here

ABSTRACT 

Humans can derive energy from carbohydrate, fat, or protein. The metabolism of carbohydrate requires by far the highest secretion of insulin. The central pathology of diabetes is the inability to maintain euglycaemia because of a deficiency in either the action or secretion of insulin. That is, because of either insulin resistance often accompanied by hyperinsulinaemia, or insulin deficiency caused by pancreatic beta cell failure. In individuals dependent on insulin and other hypoglycaemic medication, the difficulty of matching higher intakes of carbohydrates with the higher doses of medication required to maintain euglycaemia increases the risk of adverse events, including potentially fatal hypoglycaemic episodes. Thus, mechanistically it has always made sense to restrict carbohydrate (defined as sugar and starch, but not soluble and insoluble fibre) in the diets of people with diabetes. Randomised clinical trials have confirmed that this action based on first principles is effective. The continued recommendation of higher-carbohydrate, fat-restricted diets has been criticised by some scientists, practitioners and patients. Such protocols when compared with very low-carbohydrate diets provide inferior glycaemic control, and their introduction and subsequent increase in carbohydrate allowances has never been based on strong evidence. The trend towards higher-carbohydrate diets for people with diabetes may have played a part in the modern characterisation of type 2 diabetes as a chronic condition with a progressive requirement for multiple medications. Here we will introduce some of the evidence for very low-carbohydrate diets in diabetes management and discuss some of the common objections to their use.

Henderson-1998-NZMJ-1432-FINAL

Sports nutrition session Wednesday March 16th

Reminder – myself, Dr Caryn Zinn and Olympian Tim Gudsell talking abbot teenage athletes and their parents.  This is shaping up as  great event. Don’t miss out.

Date: Wednesday 16th March
Time: 7.00pm – 8.45pm
Location: Rosmini College Auditorium, Takapuna, Auckland
Tickets: $10 buy online at shop.autmillennium.org.nz

Book now

THE SCHOOL WILL ALSO YAKE CASH EFTPOS ON THE NIGHT

Proceeds go to Rosmini College 1st XI Hockey

Ful flyer here: profileOverlapDiagram270715

Peak performance nutrition evening for teenage athletes and parents – March 16

cropped-food-copy-2.jpg

Peak performance nutrition is a seminar for teenage athletes and their parents. We will look at the science, the practice and the reality of trying to be awesome. We’ll cover how to eat enough, how to stay lean, how to have enough energy to be the best you can be, and how to get your parents to help you get there. This will be fun, but really informative.

Catch the best in their field Professor Grant Scho eld, Dr Caryn Zinn, and two time Olympian Tim Gudsell.

We’ll focus on all sports from high insanity team sports to endurance..

Date: Wednesday 16th March
Time: 7.00pm – 8.45pm
Location: Rosmini College Auditorium, Takapuna, Auckland
Tickets: $10 buy online at shop.autmillennium.org.nz

Book now limited space

Proceeds go to Rosmini College 1st XI Hockey

Ful flyer here: profileOverlapDiagram270715

Sam the fat burner

Ca9HLvlUYAA60Oc.jpg-large.jpeg
Sam Wallace before (November 2015 and after (Feb 2016) his low carb healthy fat change
Ca-8gvyVIAEn-5r.jpg
Sam does the weather and then talks fat burning after his VO2 and metabolic flexibility testing at our AUT Millennium Human Potential Clinic

Last Friday Sam Wallace, Television NZ’s roving weather man visited our lab to do his weather cross.

We tested Sam lat least year and advised him on some serious dietary changes – cut out the carbs and eat more fat.  Train your body to become a fat burning machine. Or in science speak – “stress your brain and body with low carbs and learn to supply energy from ketones.  Get yourself metabolically flexible.

We felt he would have a better energy supply (he was bonking 90 mins into his rides), he would feel better (maintaining his high energy over the day with super early starts for breakfast TV was an issue), and he would lose some unwanted extra body fat (it pays to be lean for cycling long distances, and you look better – see above – he does look better!).

Well, here are the results.

  1. 4.5 kg weight loss
  2. Feeling full of energy, and any anxiety around harder TV segments disappeared
  3. Improvement in VO2 max of nearly 20% from 40 to 48.5 mlO2/kg/min. OK he actually trained more so that’s only partially diet related. He did around 1600 km cycling  over three months which isn’t loads but still adds up.
  4. His maximum power improved from 300 Watts to 370 Watts on the VO2 ramp test (again training helps).
  5. Sam went from being a carb burner to a fat burner. At 100 Watts and 140 HR in the first test he was burning exclusively carbs and no fat. In the second test he was burning exclusively fat right up until he hit around 220 W and then was able to maintain a 50/50 fat/carb burning mix until just under 300 Watts.

In other words….Sam became metabolically flexible. He trained his body, through diet and some exercise, to use more stored body fat as fuel and reply less on carbs. This means he creates less inflammation and reactive oxygen species when he exercises – meaning he spares his immune resources and recovers faster, feeling better. It means he spares precious muscle and liver glycogen (sugar) and can access his fat stores – this means he’ll burn fat and lose fat, as well as not run out of glycogen while cycling (he is more or less bonk proof). And last, because he burns exclusively fat when he is resting and walking around he won’t fall off the glucose cliff every few hours and be driven to find high carb food.

He’ll have sustained energy and be able to stay lean!

Good stuff Sam.

I’ve included a short excerpt from our latest book –  What the Fat? Sport performance below about the whole concept of metabolic flexibility if you are interested.

Metabolic flexibility – The ONE big idea to understand

Metabolic flexibility really is the holy grail of nutrition for sports performance. Understand this and you will give yourself a powerful new weapon in your competitive toolbox. After all, knowledge is power! You will see how it’s actually done in the chapters that follow, but in the meantime, it’s important to know the science. We know science can be heavy going for the non-science-wired mind, but we really want you to understand the fundamentals, so we’ll guide you through it slowly and keep the really technical stuff for the ‘Extras for experts’ section at the end of each chapter.

Humans are designed to be metabolically flexible. That is to say, if you want to get the best out of your brain and body then you should be able to rely on fuel from both carbohydrates and fat as and when you need them. Someone who is metabolically flexible can use fat as the primary (and almost exclusive) fuel when they are resting, sleeping and moving around at a fairly slow pace. As they start to move around at a quicker pace – like fast running – they will be able to take advantage of extra fuel supplied by carbohydrate, and when they are going nearly flat out they will rely almost exclusively on carbs for fuel.

We measure metabolic flexibility in our lab using online gas analysis. We measure proportions of inhaled and exhaled oxygen and carbon dioxide to understand just how much fat and how much carbohydrate someone is using from rest to flat out exercise. What you want to see is represented in Figure 1.1; that is, this athlete mostly uses fat for fuel at low running speeds and mostly carbs at faster speeds. This athlete is a male triathlete who has been eating Low-Carb, Healthy-fat for over two years. He is highly metabolically flexible.

 

MF1

Figure 1.1: Calories per hour derived from carbs (red) and fat (yellow) [vertical axis] for a metabolic efficiency test; treadmill-running speed (min/km) [horizontal axis] using respiratory exchange. The athlete is a 39-year-old male elite triathlete who has been LCHF for at least two years.

Other athletes we test aren’t as good at using fat as this athlete. Here’s another test where the athlete is metabolically inefficient (Figure 1.2). This woman is a pretty good age-group triathlete, but she is really not able to access her body fat stores as a fuel source at any exercise intensity.

MF2

Figure 1.2: A metabolically inflexible athlete. This is a high-carb eating, high-level age-group female triathlete.

These two athletes are chalk and cheese. One can easily access his body fat stores as primary fuel at low exercise intensity. He can provide energy from fat right up to very high exercise intensity. He is a fat-burning machine who can access the tens of thousands of calories of fat he has stored around his body. He can maintain a healthy lean body weight easily and doesn’t have to eat sugar and carbs every time he goes training.

The other has to rely on the very limited carbohydrate (around 2000–2500 kcal) she has stored in her muscles and liver. She has to eat extra sugar every time she trains and fuel up again afterwards. She’s tired and has trouble getting her weight down to race.

Being a fat burner has obvious advantages in some sports, like endurance where having enough fuel to make the distance is an issue. Endurance includes long distance running, triathlons, cycling and anything else where you are training, racing or competing for a few hours or more. The fat burner has access to a big fuel tank (fat) and can spare the small tank that provides extra power when you need it (carbs). You can go faster for longer.

But it doesn’t stop there. The fat burner has the potential for significant health and performance advantages in any sport where weight, cognitive performance, fuel, and high training and competition loads are a factor. This includes weight class sports, all day sports like sailing, and team sports.

What the Fat? Sport Performance.  Leaner, fitter, faster on low carb healthy fat