A Brief History of the Science

If the so-called evidence-based advice that we are being given is obviously wrong, how did it become the dominant dietary ethos? Dietitians and their associations are fond of pointing out that their professionals are university trained in evidence-based science for 4 full years. If this is the case, how can they be wrong about everything?

They're not wrong about everything, just about a lot of fundamental things. And it is because the science they cite is based on older science that is so well-established that it is no longer questioned. There exists an almost religious conviction that the facts are established. Thus it never needs to be reexamined, the curricula need not be overhauled.

"Big pharma"  likes it this way too. It has invested billions into research into very lucrative drugs that it promotes constantly. It advertises heavily, spending millions each year, flying medical professionals to their conferences. There, doctors and their assistants are wined, dined and influenced to prescribe the latest drug, given promotional materials, charts and generally made to feel obligated to support their benefactor(s).

The Accepted Science

The basic science that is accepted by dietitians is the so-called "Lipid Hypothesis." The lipid hypothesis was largely conjured up by a physiologist named Ancel Keys.

In his famous "Seven Country Study", Keys purported to show that nations which consumed the lowest amounts of fats (lipids) also had the lowest rates of cardiovascular disease. The seven selected countries Keys included in his report all lined up with his hypothesis that increased fat consumption correlated to increased CVD (cardiovascular disease). This eventually, despite a great deal of initial opposition, became the accepted view on the relationship between fat and heart disease upon which much of our food pyramid is based.

Eat less fat and save your heart.

An Inconvenient Truth
(apologies to President Gore)

Unfortunately for the world, and fortunately for Keys, this led to vast changes in what foods were promoted as "healthy". Fats, particularly animal fats, were to be avoided at all costs. Butter was replaced with cheap-to-produce margarine. Lard and Tallow were replaced with seed oils such as rapeseed, canola, safflower and peanut oils. Meat was to be reduced to 2 serves per week.

What then was left for consumers to consume?

Industry to the rescue. Low-fat foods were devised, all the fat was chemically or mechanically removed from foods and sweet, safe, satisfying sugar was added. Skim milk, margarine, low-fat foods proliferated. As did obesity, metabolic syndrome (syndrome X), type 2 diabetes, heart disease, cancer, and Alzheimer's disease.

Somehow, it wasn't clear that the change to low-fat foods and seed oils were the cause of this decline in health. Rather, it was seen as a decline despite the overwhelming evidence that the dietary advice was correct. Another culprit was sought and found.

People were just plain lazy. People were becoming fat and sick because they lacked the self-control to eat less, and the will to exercise enough: their energy expenditure was less than their energy consumed. The food pyramid and advice were fine and dandy, but people were becoming more sedentary. That was the problem.

How Did We Get Here?

So, we know that there must have been a mistake made somewhere, but where?

Ancel Keys published his Seven Country Study. This was proof that fat consumption correlated with heart disease. The seven countries that Keys chose to represent his data were not the only countries in his study - they were the seven of 22 countries that fit his prior hypothesis. Keys cherry-picked his data.

What the Science says

What the science says

There is a war going on around us, and the health of type 2 diabetics is the battleground. One side will insist that conventional wisdom and orthodox dietetic advice is world best practice. It's the best we can do. Diabetes is a progressive disease in which the symptoms and outcomes become progressively worse.

The other side, my side, challenges the narrative that diabetes will cost us our feet, our eyes, and our lives. We challenge conventional advice to consume large amounts of the carbohydrates that we know to make us sick, and the conventional wisdom of "Calories in, Calories out" - CICO. This is the belief that obesity is due to an imbalance of calories - too many consumed and too few expended.

Healthy Carbohydrates

First, let me be clear, for non-diabetic, non-insulin-resistant people, some carbs may be healthy. But there is a cost. Carbohydrates stimulate the production of insulin in the body. [carbohydrates and blood sugar]

Normally, in healthy individuals, insulin is produced in a pulsatile manner, meaning that some is produced every 3 to 6 minutes. This allows the cells to remain insulin sensitive.

However, when large amounts of carbohydrates are regularly consumed, insulin is produced constantly in order to signal to our cells to store the glucose in the bloodstream. The longer this large amount of insulin of produced, the more resistant our cells become to the signal. For some years, the increase in insulin production and resistance goes unnoticed.

For some of us, we reach a threshold where the cells' resistance to insulin becomes so great that we can no longer effectively control our blood glucose levels. This is usually when we are diagnosed with diabetes. The reality is that by the time we realise we are diabetic, much damage has already been done to our vascular system by insulin itself.

Calories in, Calories out

There is a pervasive belief that the laws of physics dictate that obesity is due to an energy imbalance. Proponents argue that the laws of physics always apply and for people to lose weight they have to reduce their intake of calories to below their expenditure. [caloric balance]

This may seem quite pervasive, and in fact, many can't see any way that this can be wrong.

In opposition to this view, I maintain that the body is a complex biological system with many degrees of homoeostasis that invalidate simple assumptions about its ability to balance itself. Simply put, when the body senses an imbalance in one or more inputs, it works to correct that imbalance - even if there is a metabolic cost. This is why weight loss from calorie reduction alone always slows and eventually, reverses.

What is true?

The perfect (I think) refutation of the CICO hypothesis espoused by dietitians and Jillian Michaels and her "Losers" is the sudden effect of insulin deprivation on the adiposity of T1 diabetics.

Usually, everything remains the same - activity levels don't change. Calories consumed don't change. Nothing changes, except that insulin drops off to zero or nearly zero and weight just falls off. This is usually the first sign that a person has T1 diabetes.

Are we then to believe that there are calories associated with insulin?


If not, then the insulin hypothesis that we espouse is proven!

The Ketogenic Diet (Way Of Life)

While the paleo diet was having a profound effect on my glucose regulation, I still required all my medication to keep me well. I was taking Diamicron and Diabex for glucose control and Tritace for hypertension. Tritace, in particular, was giving me a number of undesirable side-effects.

I needed to refine or replace my paleo diet to somehow ameliorate the terror I sensed when I would think about my future. The future as described by my GP and dietitian was not a pleasant - or long - one; a quick descent into increasing decrepitude.

Dr Google was pressed into service and I was soon inundated by a torrent of pop-ups and ads for spurious and expensive diabetes "cures". However, while trawling through facebook, I stumbled on a discussion on the ketogenic diet and the efficacy and ease with which it could resolve metabolic diseases, including type 2 diabetes!

I now had a search term for Google that returned real information, real plans, and real solutions. ref 1  ref 2  ref 3

The first hurdle most people have to jump when beginning ketosis is the realisation that bread, potatoes, rice and starchy vegetables, sugar, soft drinks and most fruit were now out-of-bounds. Having already started paleo, keto was but another step toward real food and real recovery.

I read and researched the ketogenic diet for two days, working up the courage to face the keto flu that everyone said I would have to go through when becoming keto adapted. The process is now called carb-withdrawal. This occurs because your body is changing from burning primarily glucose for its energy to burning mostly ketones. The brain requires a small amount of glucose to function optimally and this is supplied by the liver using a process called gluconeogenesis - you don't need to consume any. However, the liver needs a few days to "learn" how much glucose to produce for the brain, and during this period, the body essentially experiences a prolonged hypoglycemia.

The dreaded keto flu.

This hypoglycemic "keto flu" is the source of much of the medical and dietetic communities' aversion to the ketogenic diet as impractical. Their claim is that ketosis leads to brain fog, muscle aches, dizziness, and other discomforts.  The keto flu was mild as it took me almost a month to adapt and it was over almost before I knew I had it.

Immediately, my blood glucose was better. Who would have guessed? Removing the sources of glucose from my diet led to less glucose in my blood! My energy levels grew and my mind sharpened considerably.

Astoundingly, my GP was worried. He confounded my ketosis with a dangerous condition known as ketoacidosis. I had to explain to him the difference between the two.

Ketoacidosis.

Ketosis is a state where your body's glucose remains low and your liver produces ketone bodies to fuel itself. This is what happens in the womb, in Inuit communities and tribal societies all over the world, it is a normal metabolic state.
It also occurred naturally in primitive human societies when the carbohydrate feast of summer ended every year and throughout the ice ages.

Ketoacidosis is a dangerous state that occurs primarily in type 1 diabetics but also in type 2 diabetics who no longer produce any insulin. It is characterised by very high levels of blood glucose and very high levels of keto-bodies at the same time. Ketoacidosis

What do I eat then?

The best thing about nutritional ketosis (keto) is that the food is delicious! Not only that but that hungry beast that continuously compels you to eat is tamed. Your appetite is now under control. Make sure you have plenty of eggs, cheese, cream, bacon, ham (not sugar or honey cured, though), fish, chicken, leafy green vegetables.

Drink plenty of water and don't skimp on the salt, especially when you are becoming keto adapted. Also, take a multivitamin and a mineral supplement for the first month or so to avoid cramps. After that, you won't need to. Salt is important, when your body is adapting to ketosis, you will lose a lot of water and minerals. Once you are properly adapted, your kidneys will conserve your electrolytes much more efficiently.

DO EAT

Real food.
The cheaper, fatty cuts of meat, lamb, pork, beef.
Chicken with the skin on.
Oily fish.
Deli meats.
Full-fat cheese.
Cream cheese.
Eggs.
Full-fat cream.
Grass-fed butter.
Water.
Tea & Coffee - sweetened with Stevia (an acquired taste, but worth it).
Olive oil.
Coconut oil.
Macadamia oil.
Lard.
Dripping.
Rendered duck fat.
Green leafy vegetables.
Broccoli.
Cucumber.
Cauliflower.
Avocado.
You can have a small amount of either nuts or berries, but it's really easy to get carried away with them.

AVOID

Manufactured foods and so-called low-carb bars.
Margarine.
Polyunsaturated fats and oils.
Trans-fats.
Starchy vegetables.
Root vegetables.
Sugar, molasses, golden syrup, honey, maple syrup.
Bread, pasta, rice, cakes, potatoes.
Beer.
Anything sweet or starchy.

There are plenty of guides like this one or this printable PDF.


Next: What does the science say?

How I got Diabetes

It was back in 2007, I was experiencing some issues. There was a notice on my GP's notice board - "Free comprehensive heath check for over 40s"

It was an Australian government initiative.

It was free and I was over 40, so I asked my doctor for the tests.

I was given a pathology request form and told to fast overnight and come in for the tests the next morning.

The hardest part of the testing wasn't the blood draw, even though my blood vessels are deep and difficult, it was the fast. I was hungry almost as soon as I stopped eating that evening. This was the normal state of affairs for me - I was constantly hungry, so I ate what my doctor and dietician told me was a healthy diet. Lots of "healthy whole grains', whole-grain bread, margarine, low-fat fare and not very much of it, and no saturated fats. I was a vegetarian at the time and very overweight at 5 foot 6 and 93 kilograms.

I was hungry all night and slept poorly. When morning came, I rang my employer to inform him that I'll be having blood tests and would be in later that day.

I was first in line that Friday and as soon as the pathologist opened, I was in.
First I was weighed, my BP was measured, blood was drawn and a small amount of urine was duly produced. Then I was given a vial of glucose to drink. Some hour or two later, more blood was drawn, painfully.

Then I went off to work, glad that the torture of blood, urine and glucose was finally over.

I thought no more of it until I next saw my doctor the next Monday after work.

My doctor looked at me gravely when he announced that he had bad news for me.

I was pre-diabetic!

What does that mean, I asked?

He told me that it meant that my body wasn't producing enough insulin [not true] to keep my blood glucose in a safe range. Plus, it was likely to progress and I would become a full-blown diabetic! But,there was still hope. There were programs available to help people with this diagnosis avoid becoming diabetic.

When I got home, I told my wife about the results and what they meant and immediately enrolled in the pre-diabetic classes. There were 5 weekly classes to teach us how to lose weight and avoid becoming diabetic.

The advice?

Eat less, exercise more. Eat a low-fat diet high in "healthy whole grains", low-GI vegetables and bread and avoid saturated fats at all costs.

This worked so well that I was a full-blown diabetic within six months and had to endure a stern lecture from my doctor about how I should have committed more fully to the regimen recommended to me. I then had to endure the indignity of having my doctor, himself a large man with a BMI approaching 45, lecture me on how easy it is to lose weight. All I had to do is eat less and exercise more. Presumably, like he would do. You know, calories in and calories out!

Eat less and exercise more. That is the mantra of the medical profession.

Eat less and exercise more, and everything in moderation - except saturated fats.

I wasn't to learn for many years that this was completely wrong!

By the year 2015, I had ballooned to some 118kg, HbA1C 12.4, had a BP 195/140, was suffering from a frozen shoulder, peripheral neuropathy and failing vision.

All this, despite religiously following the advice of my doctor and my dietitian. Eating a vegetarian diet, exercising and consuming larger amounts and stronger doses of sulphonylureas, metformin, and Tritace blood pressure medication.

My glucose control was getting worse despite doing everything I was told was correct. All this time, my doctor was telling me that I was doing fine. diabetes was progressive and WILL get worse, we just have to deal with it.

My life expectancy was reduced. My kidneys had begun to leak proteins - a sign of reduced kidney function. My doctor had begun to check my feet for lesions! My vision was getting worse and worse, especially at night. I had pronounced numbness in my fingers and feet. My frozen shoulder was getting worse despite physiotherapy.

My mood was not entirely sanguine. My prospects poor. I was a middle-aged man with young children, a wife, a mortgage, and a very bleak health outlook.

That is until my wife introduced me to the paleo diet and convinced me to resume eating meat. After a few weeks, my glucose control improved. But I was still suffering the effects of diabetes and still taking all my medication.

That was an improvement but more and better was to come when I stumbled upon the ketogenic diet and reversed all my markers of diabetes and its complications.

Next week: Reversing Diabetes.

• Type 1 diabetes is a disease of not enough insulin, as the pancreas is unable to produce enough for glucose control.
• Type 2 diabetes in a disease of too much insulin. When your cells are exposed to too much insulin, they become desensitised to it. That's why glucose gets out of control.