NZ’s health leaders respond to our research publicity: Saturated fat…its bad, low carb radical and unsafe

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It was no surprise to see this one coming.  A perfect storm for the old powers that be in New Zealand obesity research and practice. The BMJ paper on why we got the saturated fat thing wrong, the ABC Catalyst series, and me out and about in the media talking about low carb high fat. I just noticed another one the NZ Herald just now by a NZ dietitian.
Looks like I (and those associated with me, sorry everyone) are now officially on the outer after this press release today (see this Experts decry fat diet – press release from the University of Otago (Professor Jim Mann)). It’s undersigned by key members of virtually every health organisation in the country.
I guess they are thinking that this document will shut everyone up, calm the uneducated masses, and we can continue our solution to the world’s problem with chronic disease?  How’s that going by the way?
I know you’d like me and my team to go away, but it’s not happening. Sorry for the inconvenience. Oh, and because of the Internet and open access science, the public is now able to do its own research.  And guess what? It has decided that the evidence isn’t convincing either. The world has changed.
The science of nutrition and chronic disease, and the public health approaches to nutrition are not solved. Let’s just get that straight – we (my team) don’t have all the answers, and neither do you.  I’ve been wrong before and could be wrong again, the reverse also applies guys.  Things will change.  Change is happening now.  It will happen again in the future.
Jim, do you recall being the younger scientist taking on the older ones in the BMJ 1979 in “Fats and atheroma: A retrial?”  Back then you were arguing about the complexity of nutrition and the need to go beyond fat and think about refined and processed carbohydrates. Everyone here has more in common than not.
For the record, I did correspond with Jim Mann yesterday.  Here’s part of what I sent him.  I think it puts down a reasonable position.
Jim…….My take is that I haven’t particularly been walking around promoting saturated fat (although to be fair I haven’t been talking about reducing it).  I have been walking around talking about diets higher in fat and lower in refined and processed carbohydrates.  I think I have some sound scientific reasons for this.  I will continue the line of research for the foreseeable future. I haven’t done much on athletes as they said in the paper.  Most of the recent work is secondary analysis of a few very large datasets we have from the US in hyperinsulinaemia. Also some basic work in low carb high fat eating.  So don’t believe everything you read in the newspaper. We do have a reasonable line of research going across this topic.
 What, in my view, we (all) have in common:
  1. That whole plants and animals are likely to be good for you and your chronic disease risk
  2. That foods which reduce inflammation are good for reducing chronic disease
  3. That sugar and processed carbs are not good, especially if you are insulin resistant (most of the vulnerable populations)
  4. That hyperinsulinaemia and chronic inflammation (both highly inter-related and can cause one another) are a problem and part of the mechanism for developing CVD and other chronic diseases.
  5. The Standard American industrial food diet and lifestyle is toxic, and much of the research showing different ways of eating show benefits simply because this diet is so bad.
  6. Trans fats and high omega 6 seed oils are inflammatory
  7. The interplay between hormonal physiology, built environment, food, and physical activity is complex.  This influences catabolic and anabolic states and therefore human energy homeostasis.  We don’t know exactly how the system works.  We have made the mistake (using Einstein’s words “make it as simple as possible but no simpler”) to describe the calories in and calories out dogma which we need to move on from.
What we seem to disagree on is:
  1. That SFA from whole healthy animals has any proven negative effect on human health in the context of the above (whole food eating).
  2. Attributing changes in populations to specific nutrients in a complex multifactorial disease using epidemiology which measures eating is fraught and is giving answers the opposite to those observed in decent robust RCTs.
  3. That low carb high fats diets are safe, efficacious, and useful for the public.

My response to the technical points in the media release asking for evidence today

  1. The actual trials showing SFA reduction and health improvements are fraught because they are still mainly in the Standard American Diet (SAD) paradigm with small dietary modifications.  I agree that SFA intake in the context of the SAD might be problematic.  What I still have a problem with, in these trials, is that many (most) still use a control group eating the same old food.  Putting anyone on a diet different from the SAD will probably help.  Here’s the latest meta analysis.  In fact, the reality is that consuming SFA has positive effects on HDL cholesterol and reduces triglycerides.
  2. I’m not bothering with an in-depth rebuttal of the population studies.  There’s just too much (uncontrolled and unmeasured) going on there, with poor food measurement to say saturated fat causes anything.
  3. I particularly draw to your attention to the bit in the media release directed straight at me (just say my name guys I am comfortable with that). “However, the group suggests that those who advocate for radical new dietary approaches have a responsibility to provide convincing peer-reviewed evidence of long term benefit as well as absence of harm. Such evidence does not exist for diets high in saturated and total fat, and very low in carbohydrate”. I have tried to address these issues in depth below. But first, how a diet full of whole plants and animals, similar to what humans have eaten the whole time they have been on the planet (up until recently, when human life expectancy halved (agricultural revolution) and then got full of disability from chronic disease (last few decades)) is radical is beyond my reasoning.  Read the latest nutritional biochemistry and draw your own conclusions.
  4. Low carbohydrate diets being safe, efficacious and useful? RCT and mechanistic evidence shows that dietary saturated fat alone, in the context of a low carb diet doesn’t have the proposed cardio-metabolic risk effects of being harmful.  In fact, things all go the other way (improve) which is a very good sign.  I have put some references below, but also here’s a  recent meta analysis of the clinical trials of low carb high fat diets and their metabolic effects. People generally do better metabolically, adhere better, and control blood glucose and insulin better on low carb high fat diets than other diets.  Much of the reason for this (expanded below) is that when you become insulin resistant then a lower fat diet will provoke high insulin which only adds to the problem. Here is an excellent summary of the 23 RCTs on low carb high fat
  5. More on long term safety – Jim Mann’s main point on the stuff.co.nz article and media release about low carb high fat was around long term efficacy and safety. He does have a point – you can study this through RCTs, but the long term epidemiology isn’t there for eating actual whole plants and animals (short of the work on healthy indigenous populations, and that this is the sort of diet humans have eaten for 99.9% of the time they have been on the planet). There is certainly no evidence of harm – some people like to quote the Swedish women’s study to show there is harm of a high fat, high protein diet. I am not promoting this combination of eating. The epidemiology in this study is woeful because the lowest decile of population carb eaters was still getting 40 percent of their calories from carbs who also had to be in the highest decile of protein eaters – again not what I suggest – had poorer health outcomes.  Again if the cardio- metabolic risk factors are worth anything – then people do better.  Here’s a good dissection of this Swedish paper.

     I think this shows how epidemiology sometimes gives us what we want to see.  I agree that more work needs to be done.  My starting hypothesis is to look at human nutrition through an evolutionary biology lens – what food environments are humans adapted to? And what is the physiology around this?   I think we have to understand how and why insulin resistance happens and how that relates to chronic disease through inflammatory processes. I particularly recommend to you this paper which has a brilliant and comprehensive take on the evolutionary nutritional biochemistry and chronic disease development.  BTW – the 40% CHO diet and high protein combination in the Swedish study showing the highest CVD is very much the type of mix Professor Mann has advocated (to me at least) he would support.

  6. Some longer-term data on Type 1 diabetics and low carb high fat diets – good efficacy and safety.
  7. Mechanistically high SFA doesn’t translate to high plasma SFA in the context of low carb diets – see reference.
  8. I agree that people respond differently to different diets. Insulin resistance is important as to what diet we can tolerate.  Hyperinsulinaemia induces the direct and indirect effects for the major chronic diseases.  Impaired glucose tolerance doesn’t catch this until end stage.  Many many people get glucose into their cells at the right rate, but with hyperinsulinaemia.  Complex carbs may not help, and in fact be even worse because the carbs are digested slowly provoking longer hyperinsulinaemia – a reference. We will publish our analysis of this soon. But in the meantime see the work of Dr Joseph Kraft.
  9. The only way to diagnose this is a dynamic glucose tolerance test measuring insulin.  We have a database of 15,000 of these with insulin for up to five hours post OGTT. You will see the pattern of hyperinsulinaemia with normal glucose tolerance decades before impaired glucose tolerance.
  10. I contend that virtually every CVD risk factor either causes insulin resistance through inflammatory or other processes e.g. Sleep, stress, sugar, alcohol, smoking, pollution and so on.  Obviously some have other effects too (e.g. smoking). But also that age and ethnicity affect Insulin sensitivity – Maori and Pacific are likely to be more prone to the above.
  11. Here’s the kicker for me – in terms of health inequalities the current dietary guidelines probably perpetuate health inequities because the least at risk do the best and stay healthy. So even if the two types of dietary guidance are efficacious – which they are – albeit not equally distributed in their efficacy AND there seems to be no evidence of harm from a lower carb high fat – then we have no option but to go the high fat route because of the inequalities – although I acknowledge we need more work to understand this. That’s the reason I am pursuing this.

Extra references to 23 RCTs showing good outcomes for low carb diets compared to other diets. Actual data summarised here very nicely too

1. Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 2003.

2. Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 2003.

3. Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics, 2003.

4. Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism, 2003.

5. Aude YW, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat. Archives of Internal Medicine, 2004.

6. Yancy WS Jr, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Annals of Internal Medicine, 2004.

7. JS Volek, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism (London), 2004.

8. Meckling KA, et al. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. The Journal of Clinical Endocrinology & Metabolism, 2004.

9. Nickols-Richardson SM, et al. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet. Journal of the American Dietetic Association, 2005.

10. Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes. Diabetic Medicine, 2006.

11. McClernon FJ, et al. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring), 2007.

12. Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study. The Journal of The American Medical Association, 2007.

13. Halyburton AK, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. American Journal of Clinical Nutrition, 2007.

14. Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabetic Medicine, 2007.

15. Westman EC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism (London), 2008.

16. Shai I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. New England Journal of Medicine, 2008.

17. Keogh JB, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. American Journal of Clinical Nutrition, 2008.

18. Tay J, et al. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. Journal of The American College of Cardiology, 2008.

19. Volek JS, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids, 2009.

20. Brinkworth GD, et al. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months. American Journal of Clinical Nutrition, 2009.

21. Hernandez, et al. Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet. American Journal of Clinical Nutrition, 2010.

22. Krebs NF, et al. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. Journal of Pediatrics, 2010.

23. Guldbrand, et al. In type 2 diabetes, randomization to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia, 2012.

Those sausages…….

Me, Grant Schofield standing up for the high fat diet and good science
Me, Grant Schofield, standing up for the high fat diet and good science

There’s been a lot of talk about me and these sausages, maybe too much talk…..

Ever since AUT University published the PR material for my upcoming public lectures with me sitting in front of a plate of relatively revolting sausages, I have copped a bit of flak.  So now it’s time to respond.

Let me ask a few (rhetorical) questions:

  1. Does anyone seriously think I am contemplating or actively promoting a single person eating a plate of a dozen sausages?  Answer – these sausages are more or less disgusting.  They were bought by the photographer, cooked with a hair dryer, and in fact are a prop.  They are also likely to be high carb and highly processed for the meat part.  In New Zealand, these sorts of sausages are typically 50% wheat or rice or sawdust filler. Yuck. To be fair, I do like sausages made form bits of whole, healthy animals.  I buy a good load of fresh, whole meat sausages from my local butcher every week. They have organ meats, brains, and all sorts of other bits modern humans have given up eating and are likely to be highly nutrient dense.  I usually eat two or three of these at a time. 
  2. Does anyone think a single poster, even if advocating for such, would change the word’s eating habits in any meaningful way? Answer – social marketing campaigns which have lasted years have no no detectable impact on population eating habits.
  3. What is good PR? Answer: Good PR is PR that gets noticed.  Judging by the reaction to the posters and this picture in particular this is therefore good PR. I am trying to draw some attention to what we are going to talk about and a plate of salmon and vegetables, as healthy as they probably are, doesn’t attract the same attention – or controversy.
  4. Does sitting in front of a plate of sausages mean I don’t support eating whole foods?  Answer – not as far as I know, and I am the only one who has direct access to my own opinions.  I still support eating whole foods, whenever and wherever possible.  I try and avoid the word “paleo” because I think its too fringe, and too easy for people to dismiss.  I don’t think those who dismiss have much of a point, but they are going to continue with those points for the foreseeable future. Why not simply say – like every other biological scientist in every other field that we use the lens of evolution by natural selection as one to view human structure and function? I don’t see a reason why everyone who does that needs to be known as “paleo”.   Paleo is also more or less a trade name for good guys like Robb Wolf and Dr Loren Cordain – that’s great, they started a movement and sold books, but they more or less own the name. I also think the major win we can have in population health is to understand the role of processed dietary carbohydrates and inflammatory industrial seed oils on human health.  Myself and my family eat a whole food diet – here’s Sunday nights family dinner laid out for you all to see…..

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OK enough ranting.  I seem to be attracting the attention of a lot of criticism from the very people I support.  So sorry if I offended you.  None meant.  As is my custom, I shall proceed on my terms, and hopefully make a difference.

Thanks to all those who have registered for the upcoming public lectures on Low Carb High Fat – the events are way oversubscribed and we probably need to cater for twice the number.  We will video and make them available online.  We will also be tweeting on the night (@grantsnz).

If you have registered and aren’t now able to come, please let us know so we can give the space to someone on the waiting list (email hpc@aut.ac.nz).

Event details here

Low carb high fat lecture full, so we are doing another

NEW DATE due to popular demand 22 October

Thanks to the many who have registered and shown interest in this seminar at AUT Millennium on October 16th.  Its been wildly over subscribed to the point we have decided to do a second seminar.  So please if you are interested, its filling very fast, get registered today.

Event Details
Date:   Tuesday, 22 October 2013
Time:   7.00pm – 8.30pm
Venue: AUT Millennium Institute, 17 Antares Place, Mairangi Bay, Auckland

Free public parking is available

Programme

6.00pm – 6.50pm       Registrations open
7.00pm – 7.45pm       Event commences.  Keynote presentation from Professor Grant Schofield
7.45pm – 8.30pm       Q&A session and open discussion followed by refreshments

Note, we will also be taking registrations on the night for a series of corresponding paid workshops that will be held in November. Details about the workshops will be posted on this site once confirmed.

RSVP to attend the event by providing your name, email, and contact number REGISTER

For those international and out of town, we will video and make available online.

We’re doing a public lecture on Low Carb High Fat

Low Carb High Fat_16 Oct 2013

Click here for the full PDF version of the invite Low Carb High Fat_16 Oct 2013

Join me and my research team to see the latest in the world of Low Carb HIgh Fat (LCHF) research and practice.  We will look at what the research shows, what we are doing, and what this means in practical terms.  We will be discussing both health (weight loss, diabetes, and chronic disease), and athletic performance.

Get in quick to register if you are in Auckland as seats are free but limited.

When: Wednesday October 16th 7-8.30 PM

Where: AUT Millennium INstitute, Mairangi Bay Auckland

Register by emailing hpc@aut.ac.nz

My three boys

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OK got your attention. Look I’m really trying to upgrade this blog and send out relevant (and helpful) material, so please let me know what can be improved and what you’d like to see. I’m also really happy to answer any questions, take your success stories in getting fit and healthy and so forth.

Any success or otherwise in carbohydrate restriction is really likely to help others so don’t be shy,

Just drop me an email grant.schofield@aut.ac.nz and I will do my best.

Grant

From bottom to top that’s Jackson (10), Sam (12), and Dan (3) – all good examples of plenty of potential!

The structure of great communication

This is a great TED talk by presentation guru Nancy Duarte. Her ideas about speaking are what you get given when you are invited to do a TED talk. It’s a really powerful and simple analysis of great speeches in history including Martin Luther King’s I have a dream speech and Steve Job’s IPhone launch speech in 2007.

Great communication is of course essential to changing the world. It is essential to any good idea. Without great communication, great ideas are lost. Mediocre ideas can flourish because of great communication. That’s such a shame on both counts. The good news is that this is totally learnable. I did it myself in my TED talk which I’m pretty proud of.

The basic idea is that great speeches all have the same structure – a shape which describes how the world is, and then switches back to how it could be. It always ends with the “new bliss”. It pulls the audience between what is and what could  be  –  the powerful idea you have of “the new bliss”.

Enjoy the video.

Be the best you can be

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(pic: the entrance to AUT Millenium where I work)

I’ve wanted to start a blog for quite some time now. The trick is to get the technical skills together well enough to actually know how to run one and do it regularly. Well, I’m just about there.

What will I blog about?

I am really interested in the science of how we can be the best we can be. This crosses disciplines such as biology, medicine, pubic health, and productivity management. The cornerstones are nutrition, exercise, sleep, neuroscience, psychology and well-being. I’ll be covering these topics under the broad heading of the Science of Human Potential (the name of this blog).

I’ve been interested in human health and performance for my whole career. I started in psychology then into sport and exercise psychology, then into public health especially physical activity then obesity.

There have been some twists and turns along the way which might help to give a view of why I do what I do and where it can go.

About me

Sport and exercise has always been a massive part of my life. From an early age I played rugby union, learned to sail and race, and eventually ended up in the high school rowing squad. Rowing at my high school had no room for anything but high performance. So I was introduced to this at age 13. From there we won national championships most years. The combination of the sheer physicality of the sport and the team work and individual excellence required both mentally and physically really defined my teenage years and who I could become as an adult.

Being fit and involved in some sort of high performance activity has been part of my life since then.

I finished bachelors, Honors, and doctoral degrees in psychology at the University of Auckland by 1994. At the same time I had got into triathlon as a sport. I ended up racing semi-professionally. That’s code for “was never quite fast enough to earn a decent living, so had to supplement prize money income by working“. In the end I raced professionally in several world championships in long course triathlon, ironman and duathlon. That was great fun, and the skills and work ethic I have learned from triathlon are important to me.

The extra benefits from the high performance sport world, especially triathlo,n include:

  • I met my wife Louise because of triathlon. She ended up also as a professional triathlete, a better athlete than me. We’ve been married since 1995 and have three boys – Sam, Jackson and Daniel. Louise also started Vitality Works, a workplace health company acquired by Sanitarium in 2012. Vitality Works has allowed both of us to benefit from a huge amount of professional and personal development in health and well-being.
  • I figured out early that a high performance life is just as much work as a low performance life, so you may as well take the high performance life. It just requires a bit more work up front, but frankly you avoid work later and you get more choices.
  • I have the skills to stay fit and enjoy maximizing my biology for my own personal peak performance.
  • I still get to compete at a reasonable level in triathlon and running. This is cool because the age group triathlon and running groups are really fun, and you get to hang out with people of a similar performance, health, and happiness mindset.

My academic career began with part-time teaching in the Psychology Department at The University of Auckland during my PhD tenure. I moved to Australia (Central Queensland University in Rockhampton) and worked in the School of Psychology there for nearly 10 years. Most of our spare time then was dedicated to triathlon training and racing with Louise. I wasn’t going fast or far in the academic world at that point. Enter Kerry Mummery.

Kerry Mummery is now the Dean of Physical Education at the University of Alberta. He really mentored and started me on the journey to becoming a decent academic. We worked on several physical activity and health projects together. The most notable was 10,000 Steps. This started as a whole community project and morphed into a nationwide program which is still running successfully today.

This was the entrance into public health proper for me. I started at AUT in 2003 after the birth of Jackson our second son. Back in Auckland and into a new country with plenty to do. That’s when things really took off. I had the good fortune to have several great staff members and PhD students under my guidance. Almost all of these are still with me.

The highlights in the last decade are:

  • Working with dozens of talented doctoral and masters thesis students
  • Being highly successful in obtaining research grants and funding. This is the life of an academic and you live and die by this success. We are up over $20 million in funding.
  • A solid and respectable publication record. Ditto above. Important for gauging success. But by itself is unlikely to put much of a dent in the universe.
  • Being involved in Vitality Works. This has put a dent in the universe and allowed me to develop more formally into peak performance, well being and neuroscience.
  • Being the youngest full professor around for a while. That wore off as I aged!
  • Moving our work beyond physical activity into obesity, well-being, productivity, and nutrition/weight loss. Most recently the work we are starting in metabolic efficiency and weight is likely to put the biggest dent in the world.
  • Starting the Centre for Physical Activity and Nutrition and eventually morphing that into the Human Potential Centre at the new Millennium Campus.

So that’s where I’m at. Where I want to go now, and with this blog, is to explore the science behind what helps us “be the best we can be.” It’s an emerging and multidisciplinary science. Let’s go!