My take on the Horizon documentary ‘Sugar v Fat’

Last night a BBC documentary aired called ‘Sugar v Fat’. If you’re in the UK, you can watch it here. The show charted the experiences of identical twin doctors in their (I think) mid-30s, who were put on very different diets for a period of 30 days. One ate a very fat-rich diet, while the other ate on rich in carbs (sugar and starch). From now on, I will refer to them as ‘High-fat’ and ‘High-carb’ for ease.

A basic premise behind the show is that identical twins have identical DNA. So, having twins eating different diets is akin to testing two diets in the same person at the same time.

The twins underwent experiments over the course of the month. At one point, for instance, the twins’ mental powers were put to the test through a simulated stock trading exercise. ‘High-fat’, apparently, fared much worse than ‘High-carb’ here.

The men were fed breakfasts consistent with their new diets, and equal in calories. 3 hours later ‘High-carb’ seemed hungrier than his sibling, and ate more at a free buffet too.

The men were exercised on bikes and then made to race up a hill. ‘High-fat’ was given a pat of butter before the race, while ‘High-carb’ got a carbohydrate gel. ‘High-carb’ won the race by a country mile.

At the end of the experiment, ‘High-fat’ had lost about 4 kg, about 1.5 kg of which was fat. ‘High-carb’ lost 1 kg in weight, about half of which was fat and half lean tissue (muscle).

Finally, the men underwent a ‘glucose tolerance test’. From what I could make out, ‘High-carb had maintained blood sugar control as a result of increased insulin secretion. ‘High-fat’ was told his glucose tolerance was worse, and that he was not far from being ‘pre-diabetic’. Much was made of this.

In the end, the conclusion was (basically), that it’s not either fat nor sugar that causes obesity, it’s overeating. We were told that foods with a combination of fat and sugar that are highly palatable and rewarding that drive people to overeat.

The fundamental problem with this programme is that it essentially dressed up anecdote as science. It’s not a good idea to judge the impact of different diets by testing them on a limited number of people in this way. It’s not much different from someone could claiming that ‘smoking never did me any harm’. And they might be right, but I’d hesitate before using that observation as the basis for advice I might give about the health effects of smoking.

The programme did point out that we cannot necessarily extrapolate the twins’ experience to the general population. That’s right, but unfortunately, I expect that is what literally millions of people may do as a result of viewing this programme.

Even the idea that testing different diets in identical twins is especially insightful is flawed. That’s because other factors beyond the twins’ DNA may have impacted on their physiological functioning. For example, ‘High-fat’ underwent mental testing in New York, while ‘High-carb’ was in London. A ton of potential factors that have nothing to do with ‘macronutrient ratios’ in the diet may have accounted for any differences in performance, including jet-lag, hydration status and the type and amount of light in the room.

‘High-carb’ stated with absolute certainty that it was his carb-fuelled breakfast that gave him the edge over his fat-munching brother. In reality, though, there is absolutely no way he could know that at all.

After the glucose tolerance test (about 38 minutes into the show) ‘High-carb’ is told he he’s making more insulin and handling sugar better. When the person officiating over the tests (Dr Richard Mackenzie from the University of Westminster in London) is pressed (by ‘High-fat’) as to whether this is a good thing, he conceded that in the long term, this could lead to problems. Of course it could, because producing more insulin to regulate blood sugar sounds likes ‘insulin resistance’ is here or on its way. Insulin resistance, by the way, is usually the key underlying factor in type 2 diabetes.

Yet, the boys end up almost rejoicing in this result, somehow. And Dr Mackenzie gives ‘High-carb’ a clean bill of health.

He had stern words for ‘High-fat’, though. He is told he is dire straights and close to being ‘pre-diabetic’. Why, because his fasting blood glucose had gone from 5.1 mmol/l to 5.9 mmol/l. But is this difference statistically significant? And could anything else have caused the rise? Stress? Running down the street on the way to the appointment? Being a bit sleep deprived?

But none of this could stop Dr Mackenzie telling ‘High-fat’ that he must stop his diet and that if he continues his pancreas is going to stop producing insulin.  Curiously, ‘High-fat’s glucose tolerance test results were not described at all. If he seemed to be in such bad shape, how come we only got to hear about his fasting test result?

I have to say, I got more of a sense of anti-fat bias through this show. The glucose tolerance testing episodes is a case in point. Also, when nutritionist Amanda Ursell was talking the boys through the diets at the start, we heard all about the bad breath and constipation ‘High-fat’ would inevitably suffer. In contrast, we heard not a peep about the potential adverse effects of a diet rammed full of sugar and fast sugar-releasing starches (such as blood sugar dysregulation and its tendency to induce mood instability, fatigue, sweet cravings and to disrupt sleep).

If the twins and the producers and Dr Mackenzie wished to genuinely gauge the impact different diets have on health, they could have looked to an abundance of published studies. This review of 23 relevant studies show quite clearly that, overall, low-carb diets produce better results regarding weight loss and disease markers (including those for type 2 diabetes).

This programme did not draw on this research, and was essentially a piece of theatre. While I found the twins very funny at times, I reckon the show was actually a tragedy.

225 Responses to My take on the Horizon documentary ‘Sugar v Fat’

  1. Jose 30 January 2014 at 5:08 pm #

    Totally agree with you was a tad disappoint. Because so many folks are doing great with LC.

    What I say to folk now to keep me getting too upset.

    Is do it for yourself for one month fully and if you don’t feel better then chuck it

    • Emma 10 February 2014 at 10:14 am #

      Just one more point… The high fat twin seemed to be eating a very high proportion of proteins to actual fats therefore digestion would be totally out of kilt as would his kidneys. Is this why his readings were high and pre-diabetic or was he in a state of ketoacidosis. Also in my limited scientific knowledge do proteins break down into amino acids then glucose? The test would have been better if both twins had the same protein and vegetables but one eating more sugar and the other fats. What confused me was that it was stated by Chris or Xand (can’t remember now) ” it is now recognised that fats are not so demonised as previously thought” however by the end of the programme you were left thinking fats are bad and sugars okay.

  2. David 30 January 2014 at 5:10 pm #

    I don’t thing less than a month was long enough to truly “keto adapt” before testing athletic performance. I suffered a brain fog in the first 2 months of a ketogenic diet but as I had read Phinneys and Voleks papers and books I pushed on and between 6 weeks and 2 months I had boundless energy and mental clarity. I agree with you totally on this programme.

    I actually tried to open a dialogue with the twins on twitter but all they do is retweet all the comments about how good looking and amusing they and the rats were!

  3. Stuart 30 January 2014 at 5:18 pm #

    Good write up John. Not sure if it was a tragedy or a comedy?

    • Emma 10 February 2014 at 9:04 am #

      I think a bit of both. What a shocker that these doctors are so ignorant with regard to diet in relation to health. Whoever has been fortunate enough to read the brilliant work of Weston A Price (nutrition and physical degeneration), Sally Fallon (nourishing traditions) and Sarah Wilson (i quit sugar) will know the profound effects that sugars have on the body. Come on Horizon – if you want to show some good scientific research please actually DO some and back it up with research already done as there is plenty out there. AND I think everyone with half a brain already knows that cheesecake, trans fats (which incidentally the high carb twin had plenty) is not a good thing and what about the source of the foods. Was the meat organic from grass fed produce? I think an opportunity has been sadly missed to overturn the myth that properly sourced saturated fats are a necessity for well being. People will now think sugar is okay…. So sad…

  4. Dr Mackenzie 30 January 2014 at 5:40 pm #

    You write very interestingly. I assume this is for impact to ensure people read your work? All 3 of us within the show do publish work with myself specifically in diabetes – maybe you should check this out first before writing this stuff. A note of worth – insulin resistance, why key to diabetes development, is not proved to be the key factor and it is more likely that hepatic insulin resistance is the fundamental in this development. From what I can tell for reading this is that you feel glucose is an issue? That’s interesting. Have you published anything recently around this – i would be genuinely interested to read it if so.

    • Garry Lee 4 February 2014 at 5:41 pm #

      You cast serious doubt on the safety in Diabetes of this diet, when in fact, the exact opposite is true. Patients do better on LCHF than on any other diet and in one series, 47% got off their oral medication compared to 11% on a diabetic diet. On very criterion they do better, weight, HBA1c, resting blood sugar and blood lipids. I’m afraid you’re looking at a small theoretical picture when there’s a huge one staring you in the face. Publishing scientific papers is to be praised, but having an overall view of a topic is something even more valuable.

    • ivor 9 February 2014 at 4:49 pm #

      Hi Dr Mackenzie

      Congratulations for being part of producing the most risible trash I’ve ever seen masquerade as science – I used to watch Horizon many years ago, and am shocked at what it has become, based on this twaddle.

      Considering the literacy and content value of your message above, commenting would not be worthwhile; however, to suggest that

      However:

      * Why was the “Fat” twin only 4.7mmol/L in the time=0 blood glucose before the cycling test??? How did you get him up to 5.9 in the fasting state – late night maybe? Or the many other ways this can occur?
      * What were the full OGTT results for the Fat twin? (we know the other guy is on the way to IR as expected – your dancing around the “body is better at producing Insulin” anti-science was high medical farce)

      I recommend some further studies in biochemistry and endocrinology before you grace the screen with your presence again…

  5. Jeff 30 January 2014 at 5:44 pm #

    How ridiculous. Maybe it’s possible that it takes longer than 30 days to become fat-adapted? How about doing it for 6 months and testing? I can’t believe they call this kind of thing science.

  6. Jennifer 30 January 2014 at 5:51 pm #

    John, you have described the pantomine succinctly. The conclusions frightened me into thinking I have been doing the wrong thing for the last year i.e. Very low carb, high fat, moderate protein. It took my husband the rest of the evening to talk me through the idiocy of this very poor BBC documentary.
    1) Lustig’s contribution was trivialised…..located in a fun fair with silly music. ( so he must be barmy)
    2) Jebb was shown as a white-coated academic in a university setting. ( so she must be sensible)
    3) there is much psychology in the tactics of a bike race, having far more impact than just diet….and how many of us race around on bikes!
    4)the theatrical effects of ‘researchers’….e.g. whispering into the camera, were laughable.
    5) we were denied actual statistics, and the ones used were unrealistic anyway.
    6) the contributors entered the zone with pre-conceived perceptions, none of which were accurate.
    7) as a school science experiment, my teachers would have scored me nought out of ten for the stupid conclusions, which were inaccurate, being ‘mere hunches’.
    8) these ‘academics’ showed very little up to date knowledge about physiology.

    Where do we go from here? I have been telling my lovely family how my husband and I have reached the wonderful state of good health we enjoy now. They must all have doubts now as to whether we are doing our selves more harm than good, despite me coming off all medications for diabetes, hypertension and raised cholesterol levels, and between the 2 of use, shedding 5 stones in a year.

    The impact of the good old BBC cannot be dismissed. It will have done immeasurable harm.

  7. Jeff 30 January 2014 at 5:56 pm #

    Impaired glucose tolerance in low-carbohydrate diet: maybe only a physiological state

    http://ajpendo.physiology.org/content/305/12/E1521

    “For that reason, it should be common in clinical practice that patients submitted to oral glucose tolerance tests not be under severe carbohydrate restriction, since this could alter the response to the glucose overload. Thus, we suggest that the results from Bielohuby et al. (1) can be interpreted as a unique and not necessarily harmful metabolic condition, which is characteristic of this state, besides being transitory. As demonstrated by Kinzig et al. (4), the glucose intolerance and the peripheral insulin resistance are rapidly reversible with the reintroduction of carbohydrates in the diet.

    Additionally, the condition of induced insulin resistance is different from that induced by mitochondrial dysfunction, caused by oxidative stress generated by the glucose overload (3), which evidently does not occur with the carbohydrate restriction. In that context, ketogenic diets have not yet demonstrated adverse effects in the mitochondrial function; on the other hand, in vivo and in vitro physiological concentrations of β-hydroxybutyrate, a ketone body, increased the resistance to oxidative stress, according to a recent publication (9). It has also been demonstrated that ketogenic diets have the capacity to increase the concentrations of adiponectin, which is an important anti-inflammatory agent (5), whereas β-hydroxybutyrate stimulates the secretion of adiponectin through the activation of the hydroxycarboxylic acid receptor 2 (6).

    Therefore, we conclude that the work of Bielohuby et al. (1) is a good example of the malleability of the in vivo response to insulin, which can be modulated to benefit the current metabolic state, and that the results found are not necessarily equivalent to those found in pathological processes.”

  8. Dr John Briffa 30 January 2014 at 5:57 pm #

    Dr Mackenzie

    No, I haven’t published anything in the scientific literature about this. Does that preclude me. somehow, from having an informed opinion?

    Do you think that because you publish in the area you MUST be right, and are somehow immune from having your views or (I think) bias challenged?

    While I have not published in this area, I do have some clinical experience. Here’s what I find: When individuals with type 2 diabetes or pre-diabetes scale back on carbohydrate, almost all of them see very improved glycaemic control and much lower requirement for medication. Some are able to come off it entirely.

    What’s your clinical experience with these conditions? Do you treat individuals with diabetes and pre-diabetes? Have you ever tried carbohydrate controlled diets in such people, and if so, what were the clinical results you saw?

    Do you think the twin on the high-carb diet was at risk of developing insulin resistance?

    What were the glucose tolerance test results for the other twin? It seems your opinion in the programme was based solely on his fasting glucose level. Do you accept this can be affected by factors other than diet?

    p.s. I’m not sure what point you’re making about me writing ‘interestingly’. I write to inform, not for impact. Just because I can perhaps string a sentence together does not invalidate my arguments or mean I have forsaken substance for style.

    • ivor cummins 9 February 2014 at 4:30 pm #

      Hi Dr. Briffa

      Excellent post, the glucose segment in the “documentary” was particularly disgraceful, and I have posted elsewhere on it particularly.

      One thing I only realized later was that the cycling test had a hidden gem in it – they showed both twin’s time=0 glucose level. Sugar Boy was 4.8 and Fat Boy was………..4.7 !

      With 3/4 hour pedaling Sugar Boy was 3.3 and Fat Boy was 2.7

      How did they get Fat Boy up to 5.9 in the fasting test – I noticed his eyes were a bit black looking, maybe they got him to have a late night to facilitate their anti-science?

      Rgds
      Ivor

  9. Mike 30 January 2014 at 6:04 pm #

    I had seen something posted on another site earlier about this program. They quoted a nutritionist who was working with the twins saying that if people go too low carb that they can go into ketosis and the ketones can cause liver damage. That told more than enough about the bias of the people involved and gave it the credibility it deserves.

    Dr. MacKenzie, from what I have read that it is fructose, not glucose, that is deeply implicated in the development hepatic insulin resistance, fatty liver, and non-alcoholic liver disease.

  10. Jennie McGinlay 30 January 2014 at 6:08 pm #

    I was so annoyed by the programme that I wrote to the Radio Times, mainly because the low carb diet presented was, I thought, deliberately extreme – masses of protein/fat was stacked on the plate. I suspected they were just trying to sensationalize a supposedly “faddy” diet, to entertain at the expense of informing. To be fair, they did the same with the low fat diet – surely even the most enthusiastic advocate of low fat diets wouldn’t be recommending unlimited sucrose.
    I don’t think viewers would have learned anything – it was hardly a surprise that fat and sugar are delicious together!

  11. Norm 30 January 2014 at 6:47 pm #

    The way Dr Meckenzie approached the issue in the programme clearly makes me suggest him that he needs to improve his understanding A LOT of how insulin works in the body and the key role it plays in how other hormones work. He must know that what matters is how much insulin is being released to control blood glucose levels. It was obvious that high carb twin was releasing too much insulin. High fat twin would show a lot better insulin levels despite the fact that his glucose was a bit high because he was too much low on carb and in such a state insulin leaves the glucose for the brain to take up instead of shunting it to other cells. I really feel sorry for Dr Meckenzie’s patients if he has any. I was stunned at the sheer ignorance of both twins regarding nutrition and metabolism. The conclusion was that it is fat and sugar combined that makes us eat more whereas we did see that haigh carb twin had hardly any fat but was hungrier and ate more. No key markers of heart health were measured: CRP, TRIGLYCERIDES/HDL ratio, APO B etc where the high fat twin would have clearly won. Reaching the wrong conclusions with bad science is a massive problem with the mainstream health gurus. I have to agree with Dr Briffa that this documentary was really a tragedy.

  12. Dr John Briffa 30 January 2014 at 6:53 pm #

    Norm

    Have you taken leave of your senses?! Dr Mackenzie has published in this area and is clearly beyond reproach.

  13. Kate Holland 30 January 2014 at 6:55 pm #

    I read enough about this beforehand that I didn’t bother to watch it. I’ve been low carb for over a year and am completely off my metformin and BP meds. My blood tests are perfect. I had been diagnosed as type 2 and followed the Diabetes UK guidelines and took metformin for 3-4 years.
    After reading this article and comments, I’m very glad I didn’t waste an hour of my life watching it! I have enough aggravation shouting at the Change for Life adverts!

  14. Dawn Waldron 30 January 2014 at 7:11 pm #

    A great analysis as usual Dr Briffa. There is more analysis and comment on this frustrating and damaging programme here. http://t.co/t5ZJ7Fp1NW. It’s a worry that the BBC can’t muster the resources to develop a rigorous small-scale diet trial.

  15. Greg 30 January 2014 at 7:17 pm #

    Agree, and to add to this, High Carb was Low in Fat and Protein. High Fat was low in Carbs, but high in Protein. only 2 subjects and only a month? I switched it off after couple of minutes.

    • Laura 4 February 2014 at 8:51 pm #

      YES! and High Fat didn’t show any vegetables whilst High Carb showed loads (including the Low Carb varieties!!!)

  16. Phil Woodrow 30 January 2014 at 7:21 pm #

    Horizon sugar v fat.This programme was as scientific as The House of Fools on bbc2 and not nearly as entertaining.They did try to entertain,but some doctors will never be Harry Hill.
    What they did do was make out that sugar is a healthy and essential product that our bodies need to survive.Fat on the other hand is still the killer it always has been.Especially TRANSfat which the high fat diet didn’t have,so why mention it then.?Not a mention of TRANSfat on the sugar diet where there would have been loads,considering most of the food was man made.
    To win the Tour de France all we need is,a good bike,porridge oats and sugar.Does that go for cricket as well,minus the bike of course.The poor doctor at risk of being prediabetic if he stayed on the high fat diet,should have a few words with a real expert Jimmy Moore.He was on a high fat diet for over a year wasn’t he? and still quite healthy I believe.The doctor on the sugar diet “On this diet I can still eat to shame” let him carry on that diet for six months and let us see if he is still smiling.

  17. Michael Allen 30 January 2014 at 7:44 pm #

    I thought in advance that this programme would be a complete waste of time, and would raise my blood pressure considerably, so thanks for demonstrating in two minutes flat that I don’t need to waste an hour watching the recording I made.

  18. John Read 30 January 2014 at 7:46 pm #

    John, I referred Amanda Ursell to the research contained in your books, after a press article she’d written. It seems that she might not have got round to reading them!

  19. David 30 January 2014 at 8:10 pm #

    Zoe Harcombe has pointed out that interestingly the twins did a documentary on channel 4 which was called “medicine men go wild “. Episode 3 of that series was a comparison of the traditional Inuit diet and the western diet. Apparently they came down very much in favour of the Inuit diet. Nothing like being consistent!

  20. Catherine Graham 30 January 2014 at 8:11 pm #

    I was so pleased to see your comments after I watched this programme (wish I hadnt)). I did not like how extreme they made the 2 diets, just for telly! I have followed your guidelines for over a year now, my life limiting IBS is a thing of the past, I sleep well, my weight is stable.

    I include green vegetables and berries, not cheese really, but yoghurt. I dont understand how a diet of jelly babies and meringues could be thought of as good which is the impression I got.

    Thank you for your sane words amongst so much madness!!

  21. Nads 30 January 2014 at 10:39 pm #

    Did it actually say how far thru the experiment the tests were done? Ie time to keto adapt?

    It is well known that a low carbers glucose tolerance test is not going to be good, unless they high carb it for a couple of days before. Also, physiological insulin resistance would explain the higher fasting blood sugar. It happens to me on fasting, yet my post pradial bg’s are great!

  22. Ted Hutchinson 30 January 2014 at 10:58 pm #

    Hannah Stutter has her say about How the TV bout Sugar vs. Fat was rigged at Health Insight.

  23. Steve Ward 30 January 2014 at 11:09 pm #

    Dr Mackenzie,

    As a type 2 diabetes sufferer, I would like you to respond to Dr Briffa’s comments re: clinical experience. I have followed the dietary advice that Dr. Briffa gives (in his book) and have been told by my endocrinologist that the various markers for disease have all improved in ways that other people do not usually manage without insulin and drugs (such as metformin).

    Also, is it not true that fluctuating blood sugar has been linked to inflammation, which in turn has been linked to a whole raft of other problems? Wouldn’t it have been better to measure hba1c and conduct an experiment over a longer period?

    Is it your contention that there are no studies that suggest that a high fat diet may in fact be safer than high carb? If those studies do exist, is it also your contention that those studies are less reliable than the 2 person, 1 month study in question?

    I am desperate to understand this as I am potentially facing a reduced life span and am struggling to reconcile how following conventional dietary wisdom was not as effective as following a low carb and fairly high fat diet. Indeed the only time I have seen almost normal blood sugar values has been to severely limit carbohydrate intake (despite advice to the contrary).

    Dr Briffa, perhaps we should do some fund raising for a study, given that most people struggle to follow arguments for themselves and generally seem to use a “top trumps” of status to determine who it believe.

    We really need to sort this out. My instincts, are that refined carbohydrates are the real killers (based on what I have been able to read and understand and what I have experienced for myself) but I feel that we need a way to try and settle this.

  24. Afifah 30 January 2014 at 11:25 pm #

    Hi John,
    Your analysis of this disgraceful programme was good, and I would like to suggest that anyone who has seen this travesty should stop paying their BBC license fee. They are clearly in breech of their remit of being informative, educational and entertaining. It was ill informed, counter enducational and not entertaining. If you pay by direct debit you can instruct your bank to stop paying them and take back any number of payments already made depending on where you place the date at which they broke their contract with you (to educate, inform and entertain). In my case I got back six months worth of payments and continue to be more than happy to have no tv. The bank cannot demand to know your reasons or challenge you. You will no longer be able to watch live tv but can watch
    the iPlayer when it suits you. This is what the Direct Debit guarantee is for. Use it.
    The point is, this programme, and lots of others like it, are being used specifically to misinform, obfuscate, confuse and, effectively, cause harm to those who have paid them not to. Goebbels would have recognised this sort of clever propaganda for what it was, i.e. an attempt to make people doubt the obvious truth that excess carbohydrates (all of them, starches and sugars) derrange the metabolism. Since we were all persuaded to reduce our fat intake for fear of heart disease, we have done so, and in the process have increased our carb intake. The effect has been obesity, diabetes, just as much heart disease, more cancer and a massive increase in dementias and neurodegenerative diseases, oh, and auto-immune diseases. Thanks a bunch.

    ——————————————————————————–

    • Marc 2 February 2014 at 3:03 pm #

      If you watch using iplayer you are legally required to pay licence fee

      • Thomas Murphy 2 February 2014 at 3:58 pm #

        Marc:

        You’re not actually correct. The legal position is that you are only required to have a TV licence in the UK if you watch or record television programmes as they are being broadcast. It doesn’t matter what device you use to watch such programmes.

        If you only ever watch TV via catch-up services such as iPlayer and never watch them as they are being transmitted, you are under no legal obligation whatsoever to have a licence.

        In fact, the Daily Mail, amongst others, has carried a number of stories spelling out how worried the BBC is by this loophole. More than 400,000 people (including me) have not paid for a licence for years.

        See http://www.dailymail.co.uk/news/article-2304280/BBC-silence-licence-loophole-Corporation-refuses-say-households-need-catch-online.html for one of the stories and see the official TV licensing website for proof that a licence is not needed if all you ever watch is catch-up services. That website can be found at: http://www.tvlicensing.co.uk/check-if-you-need-one/

        • marc 2 February 2014 at 4:49 pm #

          Thanks for that correction. I see you are right. Just morally wrong allowing others to pay for your tv programmes!

          • Thomas Murphy 2 February 2014 at 5:01 pm #

            marc:

            Now that opens a whole can of worms! Given that the BBC long ago abandoned any pretence of impartiality or of adhering to its Charter to educate and inform; given its attempt to dominate the broadcast media by venturing into the commercial arena in every direction even whilst claiming still to be a public service broadcaster; given its extravagance and arrogance; given that it no longer produces programmes for intelligent viewers but only ever dumbed doqwn, over-existable and, in the case of its so-called ‘documentaries’ – given all that, I think it is the BBC that actually has a moral case to answer for blanket taxation of the TV watching public.

            As it happens, I watch very, very little TV anyway and none of it is BBC content because I can never find anything satisfying to watch. My conscience is clear!

          • Robert Park 2 February 2014 at 5:10 pm #

            Try not to allow your conscience to get in the way of achievement Marc, it sounds more like being intellectually brilliant! Just a pity that my age exempts me otherwise the temptation might prove too strong! Recall the recent incident in the news where an OAP took up shop-lifting as an avocation as she was bored doing nothing in her retirement. People do not like living in a vacuum; it does not matter what they believe even if it is immoral, illegal, or fattening, so long as it occupies and excites them.

  25. Carol Sayer 30 January 2014 at 11:56 pm #

    I just new it would be biased towards LCHF, and you just can’t argue with stupid, waste of time watching in my opinion.

    Thank you DR Briffa for your wise words.

  26. PhilT 31 January 2014 at 2:19 am #

    I would have found the programme more convincing if :-

    1. The twins had done a crossover onto the other diet, after a washout period in between. That way we would know if it was the diet or if one of them was just crap at cycling and thinking. As twins they may have the same DNA but they didn’t start at the same %fat, to name but one.

    2. The high fat guy had been fully in ketosis, the sharp eyed may have seen the ketone numbers on the flipchart in the cycling part where 0.5 is the highest number. I was at 0.7 watching it and I’m low carbing not zero carb – too much protein in his diet perhaps, or too early in his adaptation to ketosis. Either way the brain’s supply of ketones were constrained by the sub-optimal concentration in blood.

    3. They had taken advice from Volek or Phinney, or maybe Tim Noakes, rather than a carby CW dietitian (see her web site recommended breakfasts) and a carb obsessed cycle trainer. Each side of a comparison should have the right experts on their side.

    4. The BodPod technician had not referred to “muscle” but adhered to the scientifically correct “fat free mass”. A BodPod cannot determine muscle, only fat and other stuff. The “other stuff” will contain a fair bit of water in the high fat case, although he still lost more fat.

    5. The OGTT had been done after a 3 day carb rehab as is recommended for low carbers – see Hyperlipid etc. If you don’t eat any carbs for a month it isn’t a surprise that your carb handling mechanisms are half asleep.

    6. We had been given the full lipid results eg Total/HDL ratio etc.

  27. George Henderson 31 January 2014 at 2:58 am #

    Is there any way to shame them into making public all the test results, etc?

    Isn’t there some new law against hiding information from medical trials? Worth a try.

    To be fair, there is no reason why a metabolically healthy individual has to do better if they change to a diet radically different from the one they were adapted to. low carb diets are for people struggling with whatever they’re eating now.

  28. Neutral 31 January 2014 at 3:15 am #

    I feel your analysis is heavily in favour of high fat being the best diet, picking what is wrong as much as you can regarding defending this diet plan. I do agree this seems to side with “sugar is not that bad for you”

    what should be taken from programme is that neither a diet high in fat or sugar was largely beneficial to weight loss. I will try and give an opinion of someone who is fairly neutral towards diets in that they are not the key to maintaining a small frame or “lean” body.

    What I find highly interesting is that this analysis disregards what they says on 43 minutes, he indicates this experiment is definitely not scientific findings that can be relied on.

    What I find unbelievable is that the analysis did not highlight the main point at the end of the programme, recommendations from a lady who has studied data for the last 10 years, from 56m 30 seconds she states, stop eating processed food that contain high fat and sugar, by doing this and reducing the general calorie intake you will have a much larger chance to attain the frame you so desire from dieting alone.

    The doctors then go on to admit they were very wrong in what they had assumed to be true, they say high fat high sugar food is not good for you, they agree a very imbalanced diet is not good for your body. They say all diets are wrong, and doing exersize is the very important, please note “VERY IMPORTANT”

    THIS IS VERY BASIC PEOPLE

    If your a few stone over weight get up and exercise!
    maintain a set of muscles!
    consume less!

    (excluding lipodemia or any other body malfunctions)

    I exersize and i eat largely what i want, my size is lean because i excersie. NOT because i watch what i eat, If i ate more calories than i burnt off i put on some fat, If i drink a lot i get a beer belly. How can every person want to diet and have a body in healthy form.
    I work for my body not count calories.

    • mich 16 February 2014 at 12:41 am #

      Finally somebody with sense on here. Carbs are also very beneficial to us,however if you are sitting on your backside all day consuming carbohydrates,you are looking for bad health.perhaps you lose weight on low carb diets because you cut calories?

      • paulc 16 February 2014 at 7:57 am #

        No, we lose weight on low carb diets because we’re not producing so much insulin to handle the carbs. Insulin is the fat storage hormone and while you have large amounts of it present while dealing with carbs, it means the carbs get stored as fat and don’t come out of the fat cells because you still have high insulin levels.

  29. Dr John Briffa 31 January 2014 at 6:38 am #

    PhilT

    The points you make are all very good, I think. Thanks for making them.

    John

  30. Dr John Briffa 31 January 2014 at 6:43 am #

    Neutral

    You have completely missed the point, which is this programme gave an impression from the ‘experiment’ that is, I think, misleading and not consistent with the wide body of relevant evidence.

    Your assertion that overweight people need to ‘move more’ and ‘consume less’ is also, I think, very misguided. The evidence does not really support these approaches for sustained fat loss, and neither do they seem to work to well ‘on the ground’.

    I’ve explored all this in my book Escape the Diet Trap. I don’t expect you to read it, Neutral, but the evidence is there, nonetheless.

  31. EVE ROBINSON 31 January 2014 at 8:02 am #

    No mention of thyoid problems causing obesity (underactive).

    • Lisa 16 February 2014 at 2:18 pm #

      Quite!

  32. Wilson 31 January 2014 at 9:03 am #

    The poor performance on OGTT taken by low carbers is called the Randle effect which allegedly normalises after 3-4 days of ‘normal’ carb eating. I have been curious about this and the programme seemed to support my experience. I am fit and thin but a year ago thought I’d give low carbing a go for general health and to lower a slightly high (5.5) fbg. I now notice that I have become extremely carb intolerant and despite introducing more in the way of rice, fruit, yogurt to eliminate the Randle effect I remain more carb intolerant than I was before going low carb. My food choices are more restricted now – has my body ‘forgotten’ how to deal with carbs altogether and how much harm are the high blood sugars seen after say having plain yogurt and fruit doing? Could it me that in my case (and studies only seem to focus on a certain physiology) a high carb diet has done me no favours at all?

  33. Phil Morse 31 January 2014 at 9:09 am #

    Thanks for debunking the high fat diet = borderline type 2 diabetes correlation, which did appear to be strange.

    What I took away from this, though, were two clear bits of common sense:

    1. Processed food high in fat and sugar somehow “overrides” the “no” mechanism, and is a prime driver of obesity. (That, and – in my view as a coeliac – any concentrated carbs, namely bread; try getting fat while avoiding bread, or better, wheat flour.)

    2. Use it or lose it – Resistance exercise is essential for muscle preservation. That was a timely reminder for me, as a 40+ who’s happy to run 3 times a week but finds it harder to motivate himself to do a little resistance training as regularly.

    Both of these items may have made some folk sit up and think, so maybe it wasn’t all bad. Maybe also I was immune to the bias, as a low carb (but not NO carb) diet has worked wonders for me. the programme certainly caused a lot of next-day chat among my friends.

  34. angela woolhouse 31 January 2014 at 9:10 am #

    I too was worried about the programs bias towards sugar. Even using the word sugar instead of glucose give the impression that eating loads of sweet sugary foods is ok. Fat was not given a fair hearing,no mention of the nutrients in the fat or even where good fats could be found. To me it said,eat as many sweets as you like but don’t eat butter or cream. Luckily I know better.

  35. Richard Parkes 31 January 2014 at 9:16 am #

    Dr Mackenzie, while I am glad that this programme was researched by an expert in diabetes, my concern is that I am pretty sure your twins were well aware of both the premise and the conclusions of the show before taking part in these “controlled” experiments. While I would have been happy to watch a programme that aimed to inform the public on the pros and cons of the fat vs sugar debate to present this as rigorous science is both misleading and dangerous and this is exactly what Dr Briffa has issues with. I am pretty sure there is now a significant number of people in the general public that will feel it is perfectly safe for them to keep drinking high sugar sodas, with no risk of developing diabetes as a result. I personally would not want that to be the legacy left by a piece of work I had contributed to.

  36. Bartypit 31 January 2014 at 9:20 am #

    For those who are interested, Sam Feltham has been doing a one man experiment , eating 5000 calories of , firstly, HFLC, then standard High Carb junk , and now a supposedly non junk vegan diet. He has already debunked the calorie formula.
    Zoe. Harcombe has always talked sense, and has an amazing scientific knowledge, and can back up all of her ideas.
    I note with interest that Dr Mckenzie has not replied to the legitimate questions posed here. I think he may be experiencing the phenomenon of us enthusiastic amateurs who are now informed, able to do their own research, and see through the bullshit of ‘scientists’ who have always been able to hide behind their status and present whatever bias suits. ( not all, but definitely some)
    I have learnt one thing since I started eating real food and ditching processed carbs two years ago, that the establishment , for some reason, is in denial and lies. I suspect Big Pharma and Big Business.

  37. Simon Shorrock 31 January 2014 at 9:23 am #

    What really annoyed me about this programme was that Mr ‘High Fat’ was essentially doing Atkins phase 1. I and many others who enjoy a Paleo lifestyle include non-starchy vegetables and a little low GI fruit. Nobody would recommend this diet for the long term unless vegetables and fruit were sparse. My feeling is that the programme had an anti-Paleo and anti-fat agenda. A far better insight into the effects of a high fat low carb diet would be too watch the recently released documentary ‘Cereal Killers’.

  38. Alicia 31 January 2014 at 9:28 am #

    I have to say that I cannot believe the levels of on animosity on this site. It was, at the end of the day, a TV programme and surely no better or worse than the hundreds of other supposedly accurate science or weight loss programmes that populate the schedules?

    All of us who watched or who turned off started with our own preconceptions and we all expected to be proved right or wrong dependant on our standpoint – the fact that most of the comments here are so judgemental appears to prove my suppostion right although I have absolutley no doubt that I will now encounter a huge amount of negative comments for having an opinion!

    For the record my view has been for some time that high carb is a bad thing (and I would suspect that most people who subscribe to Dr Briffa) do so because it is a view they share) but I am perfectly capable of watching/reading other views. I would point out that it is patently unfair to dismiss the scientific views put forward and to criticise what they said or didnt say – it was a TV programme and the producers/editors are the ones to determine what makes the final cut NOT the scientist who contributed.

    And please, it really is beneath you Dr Briffa to take cheap shots at Dr McKenzie and anyone else who doesnt agree with you.

  39. John B 31 January 2014 at 9:28 am #

    I avoided this pseudo-science reality TV because, from past experience, such programmes are made with a bias to confirm.

    And right on cue, as far as I see from Dr Briffa account, we have a doctor with a bias to confirm; there was no control, or testing of the twins on their usual diets; it was not conducted blind; subjects selected according to what criteria apart from identicial twins?

    Sadly, just like what passes for most ‘science’ these days in the area of health, and of course climate, the results lust be valid because I, clever ‘scientist’ with ‘peer reviewed’ papers published say so and others in my clique agree with me.

    You fight the good fight Dr B in challenging these humbugs.

  40. Dr John Briffa 31 January 2014 at 9:40 am #

    Alicia

    “It was, at the end of the day, a TV programme and surely no better or worse than the hundreds of other supposedly accurate science or weight loss programmes that populate the schedules?”

    Does that mean, somehow, that all potentially damaging misinformation should get a free pass and be let go with a resigned shrug?

    “it really is beneath you Dr Briffa to take cheap shots at Dr McKenzie [sic] and anyone else who doesnt [sic] agree with you.”

    What, in what I have written, constitutes a ‘cheap shot’, do you think? I felt I raised some legitimate issues which, as yet, Dr Mackenzie has not engaged with in any meaningful way. He, on the other hand, seems more stuck on the fact that he is a published in the area, and that I am not. Not the best defence on one’s views, I’d say…

  41. Kate 31 January 2014 at 9:46 am #

    The Sugar vs Fat Programme was just that – a piece of television. The main function of this genre is entertainment. I would not expect complete historical accuracy from, say, a Hollywood film about the American Civil War. If I want accuracy, I would have to research the topic myself using learned sources and even then, I would not necessarily find that sources agree.

    It could be argued that as television is a powerful medium, it has a duty to inform in a balanced way, using at the very least up-to-date published and properly conducted scientific research. But mainstream TV channel programme makers are like the popular press – their function is to sell newspapers! Stirring up controversy probably boosts the ratings and the programme should be viewed in this light alone.

    I would no more expect valid information from this genre as

  42. Jules 31 January 2014 at 9:58 am #

    I too found the programme irritating and agree with the majority of comments already posted. However, what I found most concerning was the implication that a high carb diet ( with lots of pictures of sugar lumps) was going to do you NO harm. I think if I were so inclined, I would come to the conclusion that I could eat sugary cereals, chips and crumpets without any adverse effects, and still lose weight! I imagine many people will breathe a sigh of relief and settle back on the sofa with a bag of crisps and a doughnut.

  43. Marc 31 January 2014 at 10:13 am #

    I haven’t seen the show because I live abroad, but here’s what I can say: having followed Dr Briffa low carb diet, I have lost 13 kgs and am in great shape.

    More importantly, one of my Russian friend suffers form Type II diabetes: he started following Dr Briffa’s recommendations 4 months ago. He lost 7 kgs only, but for the first time in 8 years his blood sugar level went under the level when you are considered a diabetic. He had blood tests when he started the diet, and another one mid-January: everything is normal and his MD said it was an incredible result.

    - His wife lost 9 kgs without any hunger. She says she feel awesome.
    - My sister lost 5 kgs and she told me yesterday she is in the greatest shape ever.

    I know it is purely anecdotal and no science at all, but no more than these twins apparently. As for myself, I eat what I want I don’t gain weight and I feel good.

    More importantly, if everything Dr Mackenzie tells us is true, how come obesity is becoming epidemic nearly everywhere ?

    It’s quite interesting to see the rhetoric behind his post here. Mackenzie is using argumentum ab auctoritate, but as Dr Briffa pointed out, the appeal to authority is a common logical fallacy because authorities are not necessarily correct about judgments related to their field of expertise. Then he tries to ridicule Dr Briffa for writing his opinion on his blog, and expresses doubts because Dr Briffa is selling a book.

    It would be interesting to know if Mackenzie received any kind of compensation for this TV show ? If he did his argument above is pointless, if he did not then he was doing a poor service to science just to prove his point.

  44. Sue Gooch 31 January 2014 at 10:13 am #

    I didn’t watch the programme, the quote from one of the twins in the press beforehand was enough to put me off,

    “But here’s the problem: despite being doctors – I also have a degree in public health – neither of us knew much about losing weight and eating ”

    What an admission in a world with obesity overload!

    Neutral, you seem typical of someone who feels qualified to comment on obesity without ever having been fat and therefore never having had to dig much deeper into the “eat less, exercise more” fallacy that I can tell you doesn’t work.

    There are many websites and weight loss “experts” out there: while years ago most of these would have been of the “you must count calories and avoid fat like the plague” variety, they are fast becoming outnumbered by the eat low carb, higher fat sites which carry many testimonials that this approach has improved not just the weight but the health issues, the fitness and just as importantly, the sleep.

    My favourite of the moment is that of Dr. Jack Kruse, an American neurosurgeon, who needed to deal with his own weight problem and did so by taking a very in depth look not just at nutrition but at the bio-chemistry involved. Whilst I’m not a huge fan of his style of presentation, he seems to have gone down many roads, looked at a lot of diverse research and concluded that fat is in fact the most necessary nutrient for optimal health. Not any fat though but animal fats, found in grass fed meats and non-farmed fish. So much appears to take place at micro cellular level that the old equation of move more eat less is shown to be truly outdated. His research into leptin has convinced me that he’s closer to unravelling the mystery of obesity as anyone else I’ve read about.

    The programme appears to have been a bowlful of nonsense served up to a gullible public, it has set the course of nutrition back for years. I’d be interested to know who funds Dr. Mackenzie’s research and who had the idea for the programme? That may shed some light on the content and outcomes.

  45. Ricardo 31 January 2014 at 10:15 am #

    The only mistake made by the BBC was that they should have screened it on the 1st of April.

  46. kevino 31 January 2014 at 10:22 am #

    An earlier poster mentioned Prof. Tim Noakes (one of the world’s foremost sports scientists, trained as an MD and a ‘convert’ to LCHF/Banting). I got the following very intersting link from him. It leads to a very interesting (and unsually balanced) examination of the relative merits of LCHF & carb loading for cyclists. A pity that the cycling expert on the show was apparently unaware of this.
    http://cyclingtips.com.au/2013/08/high-fat-low-carb-diets-good-for-you-and-your-cycling/

    • Ed 3 February 2014 at 12:13 pm #

      Two things :

      1) if you look at the proportion of carb usage as you ramp up the intensity, you’ll see it reaches 100%. If you’ve experienced hill time-trials / climbs during races, you’ll know that you are working at well above your functional threshold power level. In the programme, this was a race, not a gentle bimble. Therefore, they’ll be at VO2 max and relying on 100% carbs. Unless there is some specific knowledge you have about high intensity activity like that which contradicts the article you refer to?

      2) the quote at the end of the article from Joe Friel –

      “Eating a LCHF [low-carb, high-fat] diet has not directly improved my performance. I’m not faster now than I was before. This is common in the research I’ve read on the topic. What it has improved is getting to and staying at race weight without calorie counting or hunger.”

      I’d say that supports the position of the Team Sky coach.

      • David 26 March 2014 at 12:19 am #

        These cyclists had already cycled some distance before the uphill race but fat-boy was held back when I would have expected him to have the advantage in endurance. No surprise that sugar-boy was faster in an uphill sprint.

        So train on low carb and stock up on race day.

  47. bob 31 January 2014 at 10:23 am #

    I wouldn’t make too much of the fairground setting of the Lustig interview. He has been interviewed there before, and probably chose it because it’s close to his workand/or is somewhere where you’re surrounded by sugar.

    The programme’s false division of the UK (fat is bad) and the US (sugar is bad) was odd and unnecessary. Far as I know, both country’s official bodies encourage carb-rich diets…

    • Laura 4 February 2014 at 9:05 pm #

      Oh YES! This was another bizarre anomily I registered, as I was watching!

  48. Caroline 31 January 2014 at 10:24 am #

    I watched the Horizon programme and I feel it was irresponsible broadcasting, leaving the public feeling very confused. It was presented in a style deliberately intended to alarm its viewers without actually giving proper information. Us viewers didn’t ever get to know what it was the twins were eating precisely. Is there a detailed list of what they ate? Did Dr Low Carb eat vegetables and berries because one would normally eat a lot of these on a low carb diet? Broccoli, watercress, aubergines (etc), contain fewer carbs most sausages (I noted he was eating sausages). Why didn’t he eat Melanzane Parmigiana accompanied by a big rocket salad with parmesan shavings and a herby olive oil dressing?

    So if anyone involved in the programme would please be kind enough to publish the precise diet I would be very grateful.

    The programme is probably responsible for lots of people abandoning low carb diets, even though Dr Low Carb was probably NOT eating what’s widely recognised as a sensible low carb diet.

  49. Mrs Christine Margaret Simmons 31 January 2014 at 10:51 am #

    I absolutely agree with every word of Dr Briffa on this issue, and my own personal experience confirms it.

    I’m a bit puzzled by Dr Mackenzie’s introductory remarks. He sounds a little nettled (and defensive?) when he personalises the issue: “You write very interestingly. I assume this is for impact to ensure people read your work?”

    Umm, isn’t that what all good writers – of articles, novels, essays, letters – do?

  50. Jools W 31 January 2014 at 11:07 am #

    I did not watch this program as I knew it would be biased in favour of a high carb diet; my husband said he wouldn’t stay in the same room if I did watch it, as I would end up shouting at the tv!

    I changed my eating habits 8 months ago, and cut down drastically on eating sugar and carbohydrate laden foods. I’ve lost 2 stone and never feel hungry. I suffered from IBS and it seems to have gone. I feel well. Everyone tells me (unprompted) that I look “great”.

    Enough said. I’m carrying on as I am.

  51. Thomas Murphy 31 January 2014 at 11:31 am #

    The programme sounds like a load of rubbish to me. I was diagnosed as a Type 2 diabetic three years ago. I was on insulin for about seven months and have been on high doses of Metformin ever since.

    My partner and I have read your book and also been investigating the Paleo diet. Despite following standard hospital advice, I have struggled to control my blood sugars – which is how we came to know of you.

    We tried the Paleo diet – not very convincingly, if I’m honest – and noticed that, even though we were not adhering to it properly, we felt better in ourselves and were eating less. We also discovered that we rapidly lost our taste for sweet things and processed foods, of which we now eat virtually none.

    This year, we resolved to do the thing properly and – lo! – we have both started to lose weight, something which has eluded us over the last three years.

    I also noticed that my blood sugars were much better controlled than they have been – to the extent that I did not always need to take Metformin with every meal. Last Sunday, as an experiment, I decided to see what would happen if I took no Metformin at all whilst eating a Paleo diet and virtually no carbs (except for salad vegetables and the occasional roast sweet potato).

    The result? I haven’t taken a Metformin since Sunday night (26th. January) and my sugar control has been consistently BETTER than normal. Without any medication whatsoever, I have been recording sugar levels in the high fives and low sixes consistently throughout the day. Earlier this week, I recorded 4.4 mmol/l, something which left me feeling light-headed and shaky. That feeling, by the way, is one I last experienced when my sugars were being brought down from the high twenties to the low teens!

    Confession time: last night, I had a large glass of pear and cardomon juice. It’s delicious but not good for my sugars! But her’s the thing: once ypon a time, that would have sent my sugars soaring well into the mid to high teens. Last night, they only went up to 10.5 mmol / l and, more importantly, they came down again before bedtime and only increased by 0.3 through the night. We’re talking about someone who normally experiences a night time rise of 3.0 mmol / l. This morning, my sugars are still elevated slightly – but they are below 10 and that is still without having taking any medication whatsoever for five days.

    I’m not a doctor and I freely admit that different people are made differently. From my own experience, however, carbohydrates are largely unnecessary and, increasingly, I don’t enjoy most of them. I am now seriously considering for the first time whether I can manage my diabetes long term without medication – just by controlling my diet and abandoning the “low fat / carbs” orthodoxy. Obviously things like stress and exercise come into play as well – but the biggest single change to situation has been the change in diet.

    By the way – it’s true about protein calories being more fulfilling than carbohydrate ones. Now that I have got into the swing of this new way of eating, I am consuming anywhere between 1,100 and 1,500 calories and not feeling particularly hungry until dinnertime.

  52. Dr John Briffa 31 January 2014 at 11:33 am #

    Mrs Christine Margaret Simmons

    I was also a bit puzzled by Dr Mackenzie’s opening remarks, and I think (but don’t know) they were an attempt to suggest that I put style over substance.

    I’m very eager for Dr Mackenzie to answer the questions he has posed here. I’ll be happy, personally, for him to dispense with style as long as he provides plenty of substance.

    I’ve emailed him to encourage him back to the debate.

  53. Tim 31 January 2014 at 11:34 am #

    We have been told that eating saturated fats WILL raise cholesterol levels and will increase the chance of a heart attack . When the twins cholesterol levels were checked at the end of the trial they were pretty much at the same levels as when they started the diets .You would have thought that this would have been pretty shocking to those who believe in the lipid hypothesis for cardiac arrest ( i.e. the majority of the medical establishment), and yet it was pretty much glossed over.

  54. PhilT 31 January 2014 at 11:38 am #

    @Neutral regarding “recommendations from a lady who has studied data for the last 10 years” that would be Susan Jebb who in 1995 co-authored a paper which concluded…

    ” average recorded energy intake in Britain has declined substantially as obesity rates have escalated ” – so her own work fails to back up the notion that “it’s all about the calories, stupid”.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550498/

  55. Edward Taylor 31 January 2014 at 11:43 am #

    If high fat had been allowed low-sugar fibre (veggies) the show would have been hailed a miracle in health and weight-loss. As it is the millions who watched the show will take away from the program that High-Fat is dangerous, High-Sugar will make them perform better (mentally and physically) and they should avoid ice-cream or sugar coated doughnuts without any mention that the deadly 50/50 combination of fat and sugar exists in so much of the average British diet (rice and curry, pasta and meat sauce, cottage pie, sandwiches and breakfast cereals etc..) How helpful was it deplete glycogen and then race up a hill fat v sugar – who does that benefit??

    • Laura 4 February 2014 at 9:11 pm #

      YES! YES! YES! I’m beginning to sound like Sally in that famous film but I’m so relieved to read that other people were summising the same things as me as they watched this programme. I had a terrible 24 hours after watching it, overly anxious that I had somehow done myself irreprable harm by adopting a LFHC diet 2 years ago even though I lost 4 stone and have never felt better after living miserably fat and hungry on a low fat diet for nearly 20 years. I admire and respect the BBC and would never ever have a go at the whole institution for the broadcast of this one show but I have to agree, the irresponsibly presented and inaccurate information contained therein should be debunked publicly for the sake of the health of the country and the sanity of anyone like me!

  56. Jennifer 31 January 2014 at 11:50 am #

    I am elated with the responses that your blog is attracting re a LCHF eating regime, considering the thrashing it seemed to get on that dozey Horizon programme. As I said yesterday, the conclusions initially alarmed me….but the proof of the pudding is out there..judging by the stories being reported here.
    I have no intention of eating carb rich food ever again….I am more than convinced that carbs are not essential, althogh I concede, LOW carb is the norm for me, and certainly not NO carb, which is almost impossibel to achieve, and not even necessary in order to achieve optimum health benefits.
    Off to make my liver and onions, followed by home made Greek yogurt and 20g raspberries. I.e. Quality protein, animal fat and a few carbs to add interest.
    Fibre? Poo…I .don’t give it a thought these days…..low carb does NOT cause constipation. And as for bad breath…..we all fast overnight, and generally can’t wait to brush our teeth 1st thing. What’s the problem?

  57. Dawn Waldron 31 January 2014 at 12:06 pm #

    Perhaps the biggest irony of the whole debate is that they weren’t actually testing high carb vs high fat because the US twin’s diet was so badly designed that it was, in effect, a high protein diet. Sufficient to hamper lipolysis and ketosis and render any results totally meaningless. What a waste of BBC budget!

  58. Chris Young 31 January 2014 at 12:09 pm #

    One massive are that wasn’t even touched on was how important our gut biome is. It is highly likely that the twins have very different bacterial colonies and therefore there response to food would be very different even if they were on the same diet.

    Then you have quality of sleep and exercise (high intensity weight training would have put a stop to that muscle loss). Neither of those were mentioned either!

    Oh and how about the source of the food – grass fed?

  59. John Walker 31 January 2014 at 12:19 pm #

    To Neutral,

    I have lost three stones (42lbs – app 20 kilos) in fourteen months, by following most of Dr. Briffa’s recommendations. I agree with where processed food is concerned, but dispute that it is the ‘high-fat’ that is the problem; also that it is simply the combination of sugar and fat combined that makes such foods palatable. I believe that sugar is addictive, and therein lies the problem. The lady professor, I have seen two or three times on TV, extolling the virtues of low-fat, whole-grains, high fibre and serious, gym-style exercise. I think she is hidebound by ‘conventional wisdom’, So regardless of her qualifications, and her experience, I can’t take her seriously.

    Why don’t you try a month’s experiment? Cut out bread and other starchy foods. You can get ample carbs from fresh, green vegetables and fruit. (Easy on the fructose though) Take a brisk walk every day. Also indulge in some activity that pushes you for short periods; such as gardening, hand-woodworking. Anything that requires you to use energy. Why waste valuable time, huffing and puffing around the streets, oblivious to all that is going on around you, and obsessed with the idea that you are burning off calories? You might be, but you are also wearing out your hips and knees, and you will find out, as did I, that the game isn’t worth the candle. I just wish I’d heeded Dr. Atkins advice in the 1970/80s! I might still have my own knees, instead of titanium and plastic joints! They are adequate, and I am grateful to be free of pain, but I’d sooner have bone and gristle, thank you. As to fat versus carbs, to my mind, as long as you are sure of a beef-burger’s origins and ingredients, it isn’t the meat that does the damage but the bun.

  60. SueG 31 January 2014 at 12:19 pm #

    Just a small addition to the debate. My husband and I are both several stones overweight and gave up carbs nearly two years ago.(he’s a type ll). Initially we both lost weight. Since then we have both yo-yoed up and down with the most weight loss following the 5:2 fasting style, still sticking to low carb.

    Since then we watched Dr. Lustig’s video and decided that sugar/sweetened food had to go too. I’ve kicked it completely, he still has the odd cake and we both have porridge about once a week. I’ve done this now for over a month, I still haven’t lost any weight over and above the 7lbs that remains of the no carb weight loss. We’re both reasonably active, we spend an hour a day walking the dog.

    My husband is despondent although he isn’t quite so good at avoiding carbs (he has water biscuits with cheese on a Sunday after dinner), now he thinks he shouldn’t eat an English style breakfast because he thinks it’s too much! I have taken to eating more fat in the form of coconut oil and raw butter, I haven’t put any weight on but neither is it coming off. We eat only 2 meals a day, we don’t have huge portions because I prefer quality over quantity. So if Neutral was right, we should be slim as anything, we aren’t. I personally feel better, more energy and motivation but I still feel there is a missing link, possibly the Leptin resistance theory favoured by Dr. Kruse.

    I don’t lust after carbs at all and more surprisingly, sugar. Very little of our food comes out of tins or packets, we cook from scratch and invest time in making our own stock from bones etc. It’s really not a straightforward eat less move more equation.

    One thing we won’t be doing is slipping back into just eating anything we fancy, that way lies certain failure for any sort of a healthy life.

  61. Sue 31 January 2014 at 12:20 pm #

    Eve
    Once controlled underactive thyroid does not cause obesity.

  62. Bodil Mjoelkalid 31 January 2014 at 12:54 pm #

    It is scary to have displayed with no shame how little standard medical doctors know about insulin and diabetes. And God help us, they treat it!! The researcher displayed the same lack of knowledge. If I cannot get my patients on to a low carb, high vegetables/protein/fat with all meals, they will not get well.
    A pre-diabetic situation was diagnosed by doing sugar tolerance test and measuring blood sugar only, on somebody whose insulin was low because he has had no or little carbs for a month. Long term sugar-effect, HbA1c, would have given a totally different result; high for sugar-twin, low for fat-twin! HbA1c and Insulin should be used, not blood glucose.
    Insulin is anabolic. You will not build muscles without insulin. Sugar-twin lost 50% of muscle mass in his weight-loss (only 1 kg). Fat-twin lost 62% of muscle mass in his 4 kg weight loss. I am amazed the difference was not higher considering there was not much insulin being produced.
    Only short term effect of sugar/ fat for energy was measured. Up on hill, and sugar won. Of course! Sugar is for short spurts of energy. Fat is used for stable long-term energy. Go for a long run on sugar and carbs only, and you will have to use sugar all the way round. Go for a run on a mixture of carbs and fat, and you will last!

    The sad fact is that this program will now have the less informed think that sugar and carbs are better than fat, esp. saturated – heading for type II diabetes.

    When will journalists and producers start feeling responsible for the way they make money?
    To me, the “information” or lack of such, in this program is potentially suable.

  63. Brian Fullerton 31 January 2014 at 1:16 pm #

    Lets see now fat and sugar combined are very addictive….Shock never saw that one coming (LOVVL)

    The question is which of the two is the bad guy ?

    Fat:- Eaten from (and before) homo-sapiens inception 2 or 3 million years!!
    Produces satiety and is full of soluble vitamins and nutrients.

    Refined Sugar (and other starch [sugar] rich foods i.e grains):- eaten as a staple only in the last 10 to 12 thousand years (along with the introduction of diseases of civilization)!!
    Produces almost instant high blood sugar with a resultant spike in insulin to compensate followed by a blood sugar crash and ravenous hunger for more carbs and has ZERO nutritional value.

    Such a difficult one (unless I’m a giant “food” processing company)

    Staying with common sense gene for a mo
    Q. If I was to enter a up hill bike race would I choose to eat:-
    A: an almost instantly utilizable glucose jell “drink”
    B: a small piece of (disgusting on its own) butter fat that will take probably a couple of hours to fully digest.

    Go figure

  64. Amanda Smith 31 January 2014 at 1:24 pm #

    It depresses me that so many people will have viewed this with interest and extrapolated what has been said as fact. There is such an enormous amount of mis information out already about ‘diet’ surely the BBC have a greater duty of care to ensure what is put out as a serious documentary has a truthful message. Or at the very least one that isn’t so biased from the off.

    Excellent write up from Mr Substance!

  65. SueG 31 January 2014 at 1:53 pm #

    Well, if you thought that was dodgy research and poor summation, try this from today’s Daily Mail:

    http://www.dailymail.co.uk/femail/article-2548807/A-Burger-King-Whopper-calories-restaurant-salad-How-fattening-eat-meals-NOT-fast-food.html

    Words fail me!

  66. Gary 31 January 2014 at 2:16 pm #

    I doubt Dr Mackenzie has the balls to rejoin the debate, I think the point of the programme was to stifle debate and support the status quo of the existing paradigm of ‘lack of self control’ causes obesity and saturated fat causes heart disease, he’ll probably hide behind the university walls and the TV camera and refuse to enter into a discussion of scientific evidence in public, this is the nature of dogma, his work is finished.

  67. Rosie 31 January 2014 at 2:41 pm #

    Please please Dr Briffa keep up the good work for the ordinary people (Joe public) who need you to keep them informed. Thank you very very much

  68. Colin Hardie 31 January 2014 at 2:43 pm #

    They should have just shown Fat Head https://www.youtube.com/watch?v=evcNPfZlrZs&list=TLpw2-ts-jiWQ instead. Does a much better job of explaining the ‘science’ going on for the ‘typical viewer’. Expected more from Horizon to be quite honest!

  69. paulc 31 January 2014 at 2:43 pm #

    Any Glucose Tolerance test result is ONLY valid if you have been eating at least 130 grams of carbs per day in the three days immediately beforehand. To inflict an OGTT on someone who is not eating carbs at all is pointless and makes the result invalid.

    Also the protocol requires a blood glucose check using a meter and test strip immediately before administering the glucose load. If the reading at that test is 11 mmol/l, then the OGTT is to be abandoned as the patient is clearly already diabetic. Was this done beforehand?

    The entire exercise by this program appears to have been devised exclusively to demonise the high-fat diet as dangerous.

  70. bob 31 January 2014 at 2:45 pm #

    So, to get bigger muscles, you need carbs? Or protein in sufficient amounts, in order to get an insulin response?

  71. Neutral 31 January 2014 at 3:30 pm #

    I agree refined sugar is not a great benifit to our health, but I will also say sugars from natural sources are NOT the cause to obesity, you eat more than you burn off you get fat, the basic the most obvious solution is more often than not true,

    everyone is making money out of diet fads, get up and burn off calories.

    Howcome you never see overweight sports people? they play sports they dont get fat and they eat what they want. The point of the show was reducing overweight people. not the inner damage you are doing from eating sugar.

    A balanced diet is what you need, and not too much sugar or fat from cheesecake and ice cream. you exersize and your body works like a clock….. why are you all bias towards high fat diets.. you take from the show it was slightly bias and not the MAIN POINT

    eat less cakes, be fit, exersize and you wont have a big belly….

  72. Jonathan Bagley 31 January 2014 at 3:39 pm #

    I was disappointed that the two diets chosen were so extreme. I was expecting a low carbohydrate diet with plenty of fat, but including, for example, carrots, salads and green vegetables; and a high carb (normal UK) diet including lots of bread and pasta. I just cut down on bread and potatoes a little, cut out biscuits and ate more eggs, cheese and nuts, losing 2 to 3 inches from my waist. This is what Fat vs Sugar brings to mind with most potential viewers – not one person living off meat, cream and lard and the other not touching fat at all.
    The brain test was a joke. There are plenty of standard psychological tests available. Don’t patronise us. Same for the cycling test. They should have been wired and tubed up on a stationary cycle, testing change in fitness, from their pre dietary states. Also, this fixation on “processed food” annoys me. These people should look up a few cake recipes. Homemade cakes are little different to the doughnuts. Victoria sponge, butter and sugar in equal measure. Have a go at the BBC baking programmes for a change.

  73. Neutral 31 January 2014 at 3:45 pm #

    To john walker:

    your joints may be worn out due to your size and body frame not being capable to withstand the additional weight. I play tennis and my job is a gardener, I will never be overweight unless i stop being active.

    congratulations on your weight loss however sugar in its natural form is not addictive, sugar cane is refined sugar and readily available, I am not addicted to apples which contain high amounts of sugar, so your point is majorly flawed. sugar is addictive because it is a high source of enegy, how would you expect to burst out energy without sugar ??? IE honey…. natural sugar is not bad for you…..

    The information from the lady doctor was based on findings from scientific experiments over the past ten years, she was very fair in what she said and highlighted the commonly known problems of obeseity, she said reduce your calorie intake and you will loose weight, dont eat cakes, and I find it very entertaining you claim you cannot trust this information.

    Why would i need to try out a diet if I am not overweight???? I do not want to lose weight i want to gain muscle mass thanks…

  74. Dr John Briffa 31 January 2014 at 3:47 pm #

    Neutral

    “everyone is making money out of diet fads, get up and burn off calories.”

    Have you looked at the research into the impact of exercise on fat loss? If you have, you’ll know just how ineffective it tends to be. If you haven’t, then your opinion is just that – an opinion (and an uninformed one at that).

    “Howcome [sic] you never see overweight sports people?”

    You’re making the assumption that exercise leads to weight loss. It fits with your bias, but how about the idea that people are more likely to athletes if they are naturally thin?

    Plus, the idea that overweight sportspeople do not exist is utter fallacy. Watch the rugby union internationals at the weekend and look for players wearing 1 or 3 on their back to see very fit and strong men running around while likely carrying around body fat that might be classified as ‘overweight’ or ‘unhealthy’.

  75. Thomas Murphy 31 January 2014 at 3:54 pm #

    Neutral:

    Life seems so simple for you!

    My partner has very low iron levels and has to supplement simply to bump along the bottom of the scale. In no sense can she be called a glutton and she exercises every day – yet she struggles with her weight. You name the diet and she’s tried it. Most of them haev been variations of low fat, high carb “healthy” diets. They have left her lethargic and constantly hungry without ever meeting her real nutritional needs.

    Two things happened which are beginning to turn things around. The first was that a friend recommended she move off the iron ferrosulphates on to iron glycinate; the second was that we read Dr. Briffra’s book and started learning more about how the realtionship between food and weight is about so much more than your, if I may so, highly simplistic and simply wrong mantra “eat less, move more”.

    As to your point about sports people, my understanding is that they DON’T eat what they want. They eat very specialised diets to help them to perform at their best within their chosen discipline. The ones who need speed eat differently from the ones who need strength.

  76. PhilT 31 January 2014 at 4:01 pm #

    @Neutral “Howcome you never see overweight sports people?” – you do, if you look. Several members of the Australian cricket team were overweight and adopted a low carb high fat diet to address it – see http://www.youtube.com/watch?v=JMuD4Z-Oxys&feature=youtu.be

  77. Jennifer 31 January 2014 at 4:37 pm #

    In response to all those doubting the physiological processes of food digestion.
    If global calorie consumption has reduced….simply look at the calories in a gram of sugar, compared to those in a gram of fat….approx 2:1.
    This would account for a total calorific reduction if sugar replaces the fat….as has been pushed at us for the last 40 years..
    But those calories of SUGAR are laid down as FAT, causing metabolic problems. I don’t count calories…they are a red herring…I count grams of non-essential carbs from all sources…because the majority turn to glucose after digestion, and our systems are unable to cope with a high volume of glucose continually bombarding them. Excess fruit sugars damage our livers, in a similar way to excessive alcohol. Dietary fat is metabolised in a different way, and our body systems have evolved to cope with this essential macro nutrient.
    Until this message gets understood and accepted…..I pray that these blogs will keep going….but some people will just not learn.

  78. Pete Grist 31 January 2014 at 4:42 pm #

    I didn’t watch the programme as it looked far too gimmicky. But it would seem to indicate the beginnings of a shift from fat is the evil one to sugar taking on that role (not before time). However a lot of medical opinion is still in the fat camp, and the BBC is mainly going to reflect the mainstream, though I do detect a gradual increase in alternative views, particularly on the radio.

    I’m not surprised that the doctor has not replied as he clearly is not going to be believed. I enjoy Dr Briffa’s posts almost as much as a fresh slice of good bread (evil) with butter (good?).

  79. Mat 31 January 2014 at 4:44 pm #

    @Neutral

    I’ve been playing basketball now for 5 years… I haven’t grown an inch..

    It is so frustrating to see all these really tall basketball players.. Playing basketball *must* make you grow taller as all basketball players seem to be tall…

    Or is it that you generally only see slim athletes because generally slim people go into athletics..

    I think they call this the difference between association and causation – You’d do well to look it up!!

  80. Anthony Graham 31 January 2014 at 4:59 pm #

    Is there any reason why their physical and mental skills should be comparable? Is being fit 100% hereditary and indeed is intelligence? The programme also failed to mention that NY twin’s weight once ballooned to 17.5 stone…. the UK twin’s did not… They may be identical in DNA terms but that is only part of what makes a human.
    Thought the programme was shallow, bad science, dangerous and misleading.

  81. Robert Park 31 January 2014 at 5:00 pm #

    Tell me the old, old story! Biased, poor science, propaganda, was the resounding tinkle that came across from this tv programme. What was appalling was the disgusting eating habits of those twin doctors.

    I subscribe to Sue Gooch’s view (above) on the benefits of saturated fats. When plaque was analysed it was found to contain a massive 70% made from PUFAs, 23% from saturated fats, and 7% from other sources. When it is considered that saturated fat also contains in its structure both poly and mono unsaturated fats it can be reasonably deduced that saturation by itself is not the problem.

    When organ transplant surgeons were searching for an effective immune suppressant the most potent substance found was vegetable oil (need more be said)!

    Monounsaturated fat (olive oil) requires to be kept in dark containers to slow its deterioration which when it enters the body creates masses of those nasty wee free radicals (the science is out there) which are harmful at the cellular level to the body.

    Bacon, these days, often has water pumped into it and what does this create? It creates transfat which, as is recognised, is harmful; the same applies to whipped cream but the science has not yet caught up with the obvious.

    Traditional Inuits lived on a diet which principally consisted of PUFAs and were relatively free of cardiac problems but they looked older than those on a Western type diet and failed to live longer so what caused those problems? Their deaths were due to aneurysms caused by thin arterial walls. When injured, bleeding to death was common owing to their thin blood.

    When Captain Scott was preparing for the Antarctic expedition he took the advice of the best medical authorities (big mistake) and ignored the experiences of other Arctic explorers. He was advised not to add fat to the pemmican. This lack of fat was probably what brought about the demise of his team yet we British seek to make a folk hero out of a failure.

    Saturated fat creates cholesterol which creates those essential hormones which maintains health and gives the feel-good factor to our lives so why reduce it? Even LDL has beneficial effects otherwise why would the body require it? My own experience since the 1950s (unscientific) is that lashing of saturated fat in the diet is a buffer to ill-health.

    Currently, my interest is in the effect of glucose as it appears to be the only sugar substance from which all organs of the body utilise and seem to benefit.

    Finally, the twin that was on the low-carb diet complained twice of feeling unwell and it would therefore have been interesting to know the breakdown of the fats he consumed.

  82. Dan L 31 January 2014 at 5:57 pm #

    Watching the second half only of the program I got a completely different message – some useful information describing a 10 year study on diet which shows modest-to-none improvement irrespective of low fat, high GI, high carb, fibre-based diet etc.

    The point made in this second half was that our body automatically self-regulates if given high fat or high sugar separately.

    But the real killer is the combination of fat and sugar together, since it suppresses the automatic self-regulating but stimulates the rewards system (hence by implication making us vulnerable to over-ingestion of calories – my words not theirs).

    A 50/50 blend proves to be the most rewarding – yet also the worse for self-regulating. Curiously this is particulaly prevelant in ‘favourite’ processed foods.

    The article and comments mostly appear to be totally annoyed by the first half of the program – what sounds like a unhelpful twins experiment.

    Some valid science it seems, but perhaps has to be filtered from the ‘hype’.

  83. Michael 31 January 2014 at 6:36 pm #

    Thanks for a great review – I agree with all your sentiments here. One important point that you may have missed is that the “high fat” diet he was on looked far like “high protein” to me. To compare high fat versus high sugar diet without keeping protein constant is a major flaw. How do we know that the effects are due to high fat and not high protein? I always feel sick when I eat too much dense proteins – especially chicken and this seemed to be his main dish.

  84. fennel 31 January 2014 at 6:38 pm #

    It is difficult enough battling with the medical profession to keep healthy and to keep off all the dangerous drugs that are proffered as solutions for all problems. Patients don’t want to be a receptacle for nasty chemicals and to prop up the profits of Big Food and Big Pharma. Some of us pay with our lives or are left crippled.

    The diet and supplements is a good choice and it takes courage and dedication to take this lonely path. This program is intent on further confusing the very confused, and preventing people from discovering how to eat by featuring two very silly diets that are going to make anyone ill. What a pity they did not show us how to eat to keep well instead.

  85. James 31 January 2014 at 7:02 pm #

    The reasoning for this is simple.

    The body senses low glucose and down-regulates insulin sensitivity in the muscles to ensure the scarce glucose is utilised by the brain. Insulin sensitivity in the brain remains the same.

    It is a completely natural response to a low-glucose environment.

  86. TA Greenwood 31 January 2014 at 7:04 pm #

    I had a feeling that the programme was going to “toe the NHS guidelines” when the dietician wheeled out the top 5 ‘celebrity’ diets that the British Dietetic Association say you should avoid: Dukan, Breatharian, Alcorexia, Biotype and Gluten-Free. They wasted a chunk of airtime discussing and dismissing all these ‘fad’ diets, yet none of this info added anything valuable to the “Sugar V Fat” showdown.

    And apparantly – according to one of the Drs – none of us would think of drinking double cream on it’s own or eating spoonfuls of sugar…oh really? I can easily eat/drink double cream – especially if whipped – as though it were yoghurt, and when I was a lot younger I had awful sugar cravings and would eat sugar lumps or sugar from the spoon just to get a “hit”. Just because the good Drs couldn’t imagine it, that doesn’t mean it can’t/doesn’t happen,

    I too would love to see the Drs’ starting and concluding test results, a breakdown of how they felt during each day of the ‘study’ (because their video diaries were seriously lacking in substance and quantity!), and a list of exactly what was eaten and when.

  87. Jennifer 31 January 2014 at 7:32 pm #

    Oh, my maths got the worse of me…..1:2 ratio, of course.

  88. Sue Gooch 31 January 2014 at 7:34 pm #

    Neutral I’m sure it’s a truth that if you exercise like an athlete you’ll be as fit as an athlete and likely as slim. The other truth is that only athletes train like athletes the rest of us try to fit exercise round everything else in our lives. Some manage way more than others probably in the misguided notion that it will aid weightloss, the simple truth is that that theory has been disproved many times over.

    Consider, one lb of weight equals 3,600 calories. Most exercise burns approximately 450 calories per hour at medium intensity, that’s equal to 7 hours of exercise to burn off one pound. That’s an hour 7 days a week or whatever multiples you like. The only other thing you can do to aid weightloss in this situation is to also cut back on your calorie intake which is where it starts to fall down because once you stop, the weight goes back on and as the majority of “diets” restrict fat rather than carbs then hunger becomes an issue.

    Don’t take my word or Dr. Briffa’s, google can confirm it too. I, personally, am getting very fed up of this constant mantra especially when it’s being promoted by so called diet experts both on TV and in other media.

  89. George Henderson 31 January 2014 at 8:01 pm #

    We are told how much fat and how much muscle each twin lost, but (I’ve not seen the program, only read the analyses online) is there any mention of water weight loss?
    Couldn’t this be the non-fat weight lost by “fat” twin?

  90. Curt 31 January 2014 at 8:32 pm #

    Hey! Didn’t this whole sugar vs fat thing play out in the 1960′s between a couple of scientist…Ancel Keys from America, who put the fear of fat into everyone, and John Yudkin from Britain, who tried to correct Ancel and warn everyone about the dangers of sugar. Oh wait a minute, the twins said the Brits thought the problem was with fat and the Americans thought the problem was with sugar. Ahhh, a little role reversal now. Hmmmm, I’ll go with Sweden…at least someones government and scientists are finally on the right track.

    I’ll also stick with my low-carb life style so that I don’t have to give my self insulin injections anymore.

    The twins confirmed at the end of the show that doctors don’t always know much about diet and nutrition. If you want something done right, you gotta do it yourself…being healthy is a do it yourself project!

  91. Angelo 31 January 2014 at 9:19 pm #

    I just went thru 92 comments looking for a rebuttle from Dr McKenzy after Dr Briffas comment in a reply to Dr McKenzys comment. I found nothing. I guess Dr. Briffa told him eh.

  92. Allen 31 January 2014 at 10:20 pm #

    If its not enough for the NHS to be filling our lives with poor advice, we now have the BBC wading in as well with a quite frankly ridiculous slant on what could have a really informative study.

    Worse part is it doesn’t end there – has anyone questioned or looked at what were are teaching our children about nutrition in schools.. Am quite simply fed up with the level of misinformed misinformation that is peddled by these snake oil folk who are being paid by use to keep us unhealthy and obese.

    So come on then Dr Mckenzie – stop hiding away – where are you now to defend your published expertise in the face of those people who have something better – its called real life hands on experience

    Power to your Blog “Dr B and thank you once again for being the champion of the vast unheard and growing number of people who know better than a published (probably entirely academic) Doctor.

  93. Lesley 31 January 2014 at 10:27 pm #

    Thank you for this nice review of the programme. I was hoping you would do a post on this. Like many who have responded I have been successful in losing weight and maintaining weight loss by limiting intake of refined carbs and starchy foods and i think your books are excellent summaries of the science supporting this approach to diet and health. It saddens me to see overweight people still struggling along on low fat, low calorie regimens and this Horizon programme will only set back public understanding of the compelling carbohydrate hypothesis of weight gain and ill health. Before seeing it I was hoping that the Horizon team would bring this to wider public attention, as they recently did with intermittent fasting, but the programme was simply bad science, very badly presented, and dangerously misleading. The BBC, if it believes it plays any role in public health education, should be ashamed about this.

  94. Brian 31 January 2014 at 10:50 pm #

    What surprised myself about the test study was the high fat dieter was told not to eat vegetables? The high sugar dieter was told to eat as much fruit and veg and they wanted? No greens – where’s the healthiness in that?

    Also the programme featured a New York to London comparison test which just seemed to be a holiday opportunity at BBC taxpayers expense.

    I finished watching thinking that the twin doctors are smugly comfortable living off their novelty value.

  95. Liz 31 January 2014 at 11:01 pm #

    Dr B, thank you thank you thank you once again. I love your article, totally agree, and love, just love reading the comments. Some heart warming, some heartbreaking , some funny, and some frustrating. I feel like I’m inside part of a snowball, the tide is turning, but it is so sad to realise this programe could’ve saved some lives, but instead has trotted out the party line – again. It was to be expected, but I continue to live in hope. Our day will come, but saying “I told you so” holds little satisfaction when so many will have suffered and fallen because of the wrong information they were given from the very people they trusted to keep them safe and healthy.

  96. Tim Norton 31 January 2014 at 11:08 pm #

    It’s only a television programme, not serious sconce. Watch it as the challenging entertainment it was designed as! Then study the literature at your leisure

  97. Robert Park 1 February 2014 at 1:04 am #

    Addendum: in my comment above on the research done on plaque it should have been added that fat furrs the arteries only in the presence of carbohydrates similar to the glycation effect but I am unaware of supporting science on this particular and obvious feature. The take home message would appear to be, mix fat with carbs and become a burden health wise from middle age onwards.

  98. Gregory Barton 1 February 2014 at 8:31 am #

    The whole premise of the show was false because they tested two young healthy people. Carb restriction is a therapy for those who are metabolically challenged. There is no point testing a therapy on people who are otherwise healthy.

    The comparison might have made sense if they had chosen two middle-aged, obese, prediabetic or diabetic twins. And if they monitored the diet and results properly.

    In the absence of that, the implication that all people, whether normal or metabolically challenged, would do better eating high carb diets, is irresponsible.

    Shame Dr McKenzie didn’t come back to rejoin the fray. It would have been most amusing to have seen (read) him being thoroughly trounced.

    Keep up the fight, Dr John. You are a beacon of reason in a world dominated by myth and dogma. Judging by the number of comments to this post, I am not alone in my appreciation.

  99. Pete 1 February 2014 at 9:33 am #

    Does the BodPod even measure muscle mass? As far as I can gather it only measures fat and “non-fat”. If that is the case then obviously the body comp changes are invalid as a low-carb diet tends to take off a fair bit of water.

    This doctor McKensie or what his name was seems totally clueless. Even as a layman, it was quickly obvious that he didn’t have the first clue about insulin (resistance, sensitivity etc) or ketosis.

    But the high point for me, was when he needed to have the test subjects’ BMI to tell them if they were overweight (although both of the twins were clearly fat). A doctor with a brain should know that BMI tells us NOTHING about the health of an individual (although I might have some benefits on an aggregated population level).

    Overall, the attitude to sugar in this country is outright scary. When I go to my kids schools I see fat kids everywhere, most of them with a sugary drink or a chocolate bar in their hands. We are letting these children down, and now we have the BBC to back us up.

  100. Cat 1 February 2014 at 11:14 am #

    Dear Dr John

    I have been following and enjoying your work and writings for many years. I also watched the Horizon programme and agree wholeheartedly with all you have said. In a nutshell; it was television at its worst.

    As a health professional myself, I do worry about the effects that the influence of such a badly put together programme has on the general public. There are those who will have watched it and believed it……just because it said so on the telly. So much irresponsible damage delivered in the space of an hour. I too feel angry and frustrated. What a waste of television viewing time.

    Keep up the fantastic work John. Perhaps the BBC will see sense and invite you to do your own programme. That is long overdue, and the health of the nation would flourish as a result.

    Cat.

  101. Mark John 1 February 2014 at 11:19 am #

    I’m surprised (or maybe not) that the BBC didn’t stretch to a DEXA scan rather than a BodPod. They may as well have used bioelectric impedance or skin calipers:

    The Bod Pod: The Verdict

    The Bod Pod does OK when looking at group averages, with some studies showing error rates of around 2%; however, other studies have indicated average error rates of over 5%. The individual error rate for the Bod Pod can be unacceptably high in some individuals, and the Bod Pod is horrible for tracking change over time. For these reasons I would recommend against using the Bod Pod as a body composition assessment tool. Hydrostatic weighing, despite some of its problems, is much more reliable.

    http://weightology.net/weightologyweekly/?page_id=175

    I’m not sure that I’d agree with recent posts that carb restriction is for those who are “metabolically challenged”. Most people will end up that way after a few years / decades anyway to a degree, so surely prevention is better than cure… And not only that, but the accompanying inflammatory response to a SAD (not just in America!) diet doesn’t help the body either.

  102. Pingo 1 February 2014 at 11:27 am #

    Dr Mackenzie

    We all know that it takes 3-4 months for the body to be completly adapted to a high fat diet and doing a test after just one month indicates that this TV show had stacked the cards in advance.

    In februari last year I got a stroke and at hospital it was discovered that my fasting glucose was 8.7 and you know probably what that implies. I was sent to a diabetes nurse that gave me a blood glucose meter with instructions. She told me to cut carbohydrates as much as I could and monitor the glucose level. I did as she told me and soon found the LC community. After a week the glucose level was 7.2 not yet good and after another week I had 6.4 then it stayed around 6.2 for a long period. After 5 months back to the nurse with new blood tests, she smiled and gave me all my blood tests. I now had fasting glucose 5.3 and HB1ac like a young well trained person. My blood lipids was also great and no statins required.Next week I got a nice letter from my doctor giving me a clean bill of health and congratulating me for doing so well.

    A few months later I discovered that my brown AGE spots on my hands had disappeard completly. Not a single trace of them.

  103. Megan 1 February 2014 at 1:13 pm #

    I didn’t watch because Horizon has turned into dumbed down rubbish. The government is pushing cheap grains and demonising the expensive proteins fewer and fewer people can afford. The notion that fruits were healthy may have had some credence before they were modified to be uniformly high in fructose. As for the silly twins, one hopes they never get another gig on telly.

  104. Miss Stranoital 1 February 2014 at 3:45 pm #

    I fell asleep watching it – obviously too many carbs – so didn’t find out if the very important question was asked about diets high in both fat and sugar.

    This combination – ice cream/cake/custard etc – seems to be responsible for overweighterie in the UK and the US, and of course we are emotionally primed to gorge on this combination, as it is first encountered in breast milk, and at higher levels of sugar in breast replacement milk. Is there any evidence of a higher proportion of bottle-fed babies becoming obese as adults?

  105. greg 1 February 2014 at 6:08 pm #

    I watched it. Cue much shouting at the TV. Really bad ‘science’ journalism. The only thing I took away from it was anti fat bias and just because youre a doctor of infectious dieseases (one of the twins) it doesnt mean your actually bothered by any kind of scientific approach to experimentation. Poor.

  106. David 1 February 2014 at 6:57 pm #

    Dr Mackenzie is on twitter: @mackenzie_dr

  107. Chris 1 February 2014 at 7:06 pm #

    Dear God, I’m really sorry that the unexperienced TV viewer is falling for this. I mean, I know that a lot of people will find validating to avoid high fat foods because it will cause obesity. But what can we do to better advocate for true science to reach to people instead of this mumbo-jumbo?

    I’m gonna do my best into showing the people that are near my area of influence what high sugar causes to our health.

    You’re doing an excellent job Dr. Briffa. Keep it on!

    • Agatha 1 February 2014 at 9:37 pm #

      Thanks for this review Dr Briffa. My mum called me to tell me that my high fat paleo diet had been proved dangerous by this programme. I’m so annoyed with the BBC but sadly, not surprised. Whenever there are TV science programmes about areas I am familiar with the information is usually ridiculously biased and dumbed down.

  108. Helen 2 February 2014 at 12:27 pm #

    It’s all very well some of the comments suggesting we shouldn’t take programmes like this seriously as it’s only TV but sadly, there are many people whose health is suffering as a consequence of the high carb diet and many of them will assume it to be accurate. Therefore, I believe it’s very important we speak out against this misinformation and do our utmost to inform and educate as much as we possibly can.

    I have benefitted greatly from a low-carb diet as I was (at best) pre-diabetic. No doctor would diagnose me and I had to find out for myself through home-testing with my glucose monitor and much research. Not everybody has it about them to do this and are reliant on general medical guidelines and mainstream media and so the BBC have been extremely irresponsible in airing this rubbish in the name of science.

    I would be very interested in finding out the cortisol levels of the high fat twin. Your thoughts on that would be appreciated Dr. Briffa

  109. Kate 2 February 2014 at 4:04 pm #

    Helen may have a point. But to me this is what the debate is really about – the media. I don’t know if the programme was designated “documentary” or not. If so, perhaps we should be seeking to limit the use of such terminology by broadcasting corporations, particularly if publicly funded – in much the same way as the Trades Description Act ensures that a retail product is “as described”. If purporting to be a health “documentary” then its conclusions should be fully backed up by up-to-date, balanced published research trials as required by any scientific public source of information.

    But as a TV programme it’s not, and therefore there’s no requirement. You don’t go the cinema expecting the film “Braveheart” to be referenced for historical accuracy. No matter how ill judged and irresponsible the programme was in the light of the present epidemic of diabesity, the most you can do is remind people that the “telly” is entertainment; it’s terribly patronising to assume the public cannot judge for themselves.

  110. michael 2 February 2014 at 4:05 pm #

    Dr. Mackenzie, Dr. Mackenzie…are you there? Where are you, Dr. Mackenzie? Please show yourself.

  111. Bodil Mjoelkalid 2 February 2014 at 4:11 pm #

    I think MacKenzie is here; doing research on diabetes? LOL!

    http://www.westminster.ac.uk/about-us/our-people/directory/mackenzie-Richard

  112. Robert Park 2 February 2014 at 4:40 pm #

    From the field of commerce may lie the answer to our health and longevity; see:

    http://media.nmfn.com/tnetwork/lifespan

  113. Wilson 2 February 2014 at 5:44 pm #

    I think critical comments should be directed to the producers of the BBC not Dr MacKenzie – verging on a rather uncivilised witch hunt. It is unlikely he would have been involved in the programme’s conception and planning

  114. Wayne Bowman 2 February 2014 at 8:54 pm #

    As usual another programme which highlights that we dont really see foods any more we just see nutrients. I think many people would do very well reading Michael Pollan’s book ‘In the Defence of Food’. Lets stop looking at food as just nutrients and get back to making fresh home cooked meals with natural foods.

    My 10.00 am snack – a chopped apple with a handful of nuts and cinnamon has served me well for years, perhaps next time when I am asked what I am having I should respond today I am having ‘a mixture of glucose/fructose and fat with some spice’

  115. Dave Gale 2 February 2014 at 10:30 pm #

    Having been involved in multiple sports for forty years, that includes 20+ yrs of professional sport, I was interested to see little or no reference in the programme to athletes switching to higher fat diets. I grew up on the high carb diet ‘needed’ to sustain long hours of endurance training.

    As someone who is now in his mid-fifties, I’ve been surprised at the recent upsurge in my athletic performance, much of which appears to be diet related. As I’ve dropped out much of the carbs in my diet, with a significant increase in lean protein, I’ve experienced an explosion of energy in both 60 minute, high intensity dance workouts and HIIT weight training sessions.

    However, I would be the last person to assume that the dietary switch in itself was the sole cause of my recent improvement. ‘Dropping out the carbs’ does not provide a direct causal link. A correlated link maybe, but causal link, no. I am beginning to understand that at least part of my improvement has stemmed from a reduction in wheat-based foods, having lived most of my life without realising or understanding the negative impact.

    My own experience with wheat is just one example that indicates that there are too many other factors at play to point the finger directly at ‘fat or sugar’, unless much more detailed testing has been carried out on the individual. My own performance has demonstrated that I didn’t need the level of carbs that I had been consuming in order to perform at a consistently high level. My gut feel (sic) is that, as I have aged, my ability to metabolise fat has improved.

    For reference, I have an intensive but not particularly long training regime that is touched upon in this article: http://ramtec.wordpress.com/12-week-fitness-challenge/

    Go figure…

  116. Charlie 3 February 2014 at 10:21 am #

    I would like to add my voice in support of Dr Briffa and his efforts to tell people that our diet, the one supported by various national agencies over the last 30 years, is wrong and is doing damage to our health and national coffers. It is no coincidence that the rates of obesity and type 2 diabetes have risen from precisely the time our dietary advice changed.

    You would have thought that that fact alone would force a rethink concerning this advice – but alas it does not – perhaps for the reasons outlined by Tom Naughton in his speech entitled “Diet, Health and The Wisdom of Crowd” http://www.fathead-movie.com/index.php/2013/12/17/speech-diet-health-and-the-wisdom-of-crowds/.

    Even some first year biochemistry textbooks offer an explanation of why the current advice is bound to fail. Put simply (sorry if granny and sucking eggs comes to mind), glucose is released very quickly from carbohydrates and the spike in blood sugar leads to the release of the storage hormone, insulin. Insulin sets about its task of directing the liver to convert excess glucose into fat and cholesterol that is then packaged and deposited into the blood stream in the form of vLDL particles. Insulin also directs the adipose tissue to take up the fat from these particles (and from chylomicrons formed from ingested fat in the gut) and retain it until the level of the hormone falls. None of these events are actually triggered by fat itself and in the absence of insulin the chylomicrons are rapidly cleared from the blood stream and the fat used to provide cellular energy.

    Obviously, the continual consumption of carbohydrate throughout the day will lead to weight gain and hunger since the adipose tissue will resist the release the fatty acids that provide the energy needed to keep us going until the next meal.

    I suppose my question is – since this information is neither new nor complex, how can someone like Mackenzie, and a host of medics and dieticians, not know this elementary biochemistry that is so pertinent to the advice they should be giving?

  117. David 3 February 2014 at 12:32 pm #

    The point was there was no time for correct athletic adaption to a high fat diet. If you refer to Steve phinneys cyclist research from the 1980s you will see very little performance difference between fully adapted fat burning athletes and carb burners.

  118. lala 3 February 2014 at 2:28 pm #

    It was a TV programme. They were not advocating individuals live this way, or saying that either were following an acceptable diet, i.e. the twins were not saying the high fat diet followed on the show replicated the generally accepted healthy high fat diet many of the commentators here seem to support. They were doing a very extreme version of high fat/high sugar, in order to get extreme results, for TV and to increase public awareness and understanding. There was probably little resemblance between his high fat diet, and the high fat diet you are all advocating. And I am sure they know that, as do many of the viewers. Anything that gets people curious/talking about/questioning eating habits in western society is a good thing. We do not have the answers yet.

    If you are on a high fat diet and get checked regularly (as anyone on any kind of diet should do), then that is fine, they were not talking to you, as perhaps you already know a certain amount about this stuff, or at least are curious. I doubt anyone on a high fat diet is eating the way the twin did – they were deliberately random, eating anything and everything from their list of options, for the sake of the experiment.

    Also, chill out! :)

    • Jennie McGinlay 5 February 2014 at 7:44 pm #

      I’m not sure about the “only” a TV programme comment. Some TV programmes are very influential and it makes me sad that Horizon, which used to do informative and interesting science, seems to now just seek to sensationalize and entertain. I think the programme gave the impression that eating lots of sugar is not that harmful really, which is a dangerous implication, which lots of people might be delighted to embrace.
      I eat a high fat/low carb diet, but don’t see myself as “on” any kind of diet – I just eat in way I am convinced is the healthiest. Like many people who have commented here, I have gained huge health benefits from eating this way. About two years ago, I was suffering from really nasty persistent toe infections (worthy of anything on Embarrassing Bodies!), exacerbated by badly swollen feet and ankles all the time. My GP was sympathetic, but baffled when several courses of antibiotics didn’t help at all. I was overweight and eating a low fat diet but not losing any weight. I know that correlation does not necessarily mean causation, but I can say that within weeks of starting to follow the advice in Dr Briffa’s book, my feet went back to their normal size and my infections cleared up. Since then I have lost about 2 stone and have never felt so well. As you can imagine, your exhortation to “chill out” bemuses me – I feel great, I’m pretty chilled out all the time these days :)

    • johnfused 7 February 2014 at 7:18 pm #

      “There was probably little resemblance between his high fat diet, and the high fat diet you are all advocating.” Agreed. And so it was a rather pointless comparison – a straw man argument, so to say.
      ” We do not have the answers yet.” Disagree. The answers to obesity has been in print in English for 150 years – look up William Banting. Experts poo-pooed his experience – the failure of calorie-counting, cutting down on fatty foods (in favour of spuds, “heart-healthy” grains, bread, etc.), and exercise and his consequent permanent, no-starving successful FAT loss. And the expert conscenus is still poo-pooing. Ö “Chill out”?? No way. Thirty years following the expert ‘food pyramid’/ ‘eatwell plate’ beloved of governments and the BHF, I was having to buy 38″ trousers. Gary Taubes’ critique of the conventional wisdom put me on the path. I devoured 100+ books and uncounted calories over a year and a half, switching from low-fat everything to full-fat (and raw, but that’s another issue). The other day I got a shock when I noticed the label on my trousers: 38 — I thought I’d got rid of them over a year ago; then I realised I’d bought them here in France: it was centimetres, not inches.

  119. Snazgul 3 February 2014 at 3:40 pm #

    A slick, glitzy show, and fun to have identical twins (actually genetically identical but very likely environmentally discordant dating from their companionship in-utero).
    Full of dubious opinionation and with generalisations selected, it appeared to me, to support a preconceived premise. For example, what did the sports cycling advisor add other than… to win a race, gel sugar formulations supply fuel quickly. What has that got to do with long term health which was what we all wanted to know. Regrave the oarsman did this and he got T2Diabetes. It was a floating observation, and the carb’ twin got his glucose almost into the diabetic range AFTER a gruelling ride up hill.
    Biggest grouse for me was the inclusion of Dr Lustig but without his being able to significantly contribute. I bet he is spitting feathers! I agree with him when he says ‘It’s the Insulin, stupid!’
    So… I agree with the drbriffa blog comment unreservedly.

  120. jj 3 February 2014 at 4:24 pm #

    Well, as a member of the general-TV-watching population the thing I got out of this was not ‘high-fat diets are bad’, or ‘high-carb dets are bad’, but ‘faddy diets of ANY kind are a waste of time and could actively damage you – discuss them with your doctor before embarking on such foolishness’. Doubtless this marks me down as a gullible fool who will believe anything he sees on TV, but who amongst you would like to argue that the above statement isn’t true? [steps aside to dodge hail of abuse from those on faddy diets...]

    • Thomas Murphy 4 February 2014 at 9:50 am #

      jj:

      I would be most surprised if you received a hail of abuse from anyone on this forum.

      In the first place, most of the comments here are intelligently and thoughtfully made.

      In the second place, most of the people here are commenting on their own experiences of what Dr. Briffa advocates. For many of them, he has provided a coherent and cohesive strategy which is working where everything else has failed.

      In the third place, what he advocates and what the rest of us are trying to follow is not ‘faddy’, so no-one will feel the need to rain a hail of abuse on you.

      Someone else commented here that it is difficult for ‘neutrals’ to appreciate the magic that is the low carb / high fat diet. Perhaps that really is the answer: that some people can “get away with” a high carbohydrate diet in the same way that smoke people can smoke tobacco all their lives with no ill effects. I think most of us would agree, however, that smoking is not good for the majority – and we wouldn’t want to suffer the hideous consequencves of not being “one of those who can get away with it”.

      It is much the same here: those of us who – like me – have never smoked, who drink only rarely, who are not vastly overweight as the sterotype would portray us but who NEVERTHELESS have diabetes, need better answers than medical orthodoxy has yet provided.

    • Laura 4 February 2014 at 9:40 pm #

      Yes, I agree. The agenda of the programme from the outset seemed to be there are some wacky faddy diets out there but a bit of common sense will set you straight. However the presentation of the programme led to a wholly different viewing impression, in my opinion. I’ve read quite a lot about the subject over the last 2 years and yet Sugar V Fat still left me panicked and anxious. What it did to people who have very little information or knowledge, I hate to think. Unfortunately, in the final analysis, I am reminded that nearly all factual TV is actually just entertainment and largely inaccurate and agenda led. And yet I’m sure, the next time I watch something I know little about, I’ll forget and accept it all on face value again. Hopefully however it won’t be about something so important.

      • jj 5 February 2014 at 9:10 pm #

        Thanks, Thomas, for a resoned response – most refreshing! Oddly enough, I’m a type-1 diabetic with a moderately-hard marathon-training target (3h15, 53yrs old), so this blog is of some interest to me.

  121. Wilson 3 February 2014 at 5:22 pm #

    I think Steve Redgrave has Type 1 diabetes

    • Snazgul 4 February 2014 at 8:14 am #

      He is on insulin but… the old classification on the need for insulin injections or not (Insulin dependent, IDDM, and non-Insulin dependent diabetes, NIDDM) has been superseded by looking at how you end up with diabetes requiring insulin treatment; i.e. pancreatic insulin producing cell failure from the start (Type 1), or as sometimes happens insulin cell failure that develops over time as a consequence of prolonged excessive glucose driven insulin demand (Type 2). Just to muddy the water, I gather there is overlap between these as well.
      Anyway, my source was an NHS site. Best wishes

      http://www.nhs.uk/Conditions/Diabetes-type2/Pages/SteveRedgrave.aspx

      • Wilson 4 February 2014 at 12:23 pm #

        Yes darn confusing when you consider the recent T1.5 diabetes categories which is what you mean I guess. I was looking at diabetes.co.uk website

  122. Mark John 3 February 2014 at 8:19 pm #

    They were not advocating individuals live this way, or saying that either were following an acceptable diet

    Maybe not, but they were implying that NOT eating carbs (ie LCHF) was dangerous. Actually not just implying, it was stated at the end.

    There was probably little resemblance between his high fat diet, and the high fat diet you are all advocating. And I am sure they know that, as do many of the viewers.

    Again, probably not. Many consume carbs =< 50g per day and that's what advocated by people like Volek & Phinney. And I would suggest that many (most) of the viewers at home will have come away after watching the programme with the view that LCHF is dangerous.

    We do not have the answers yet.

    We generally do, at least when it comes to insulin’s role in obesity, T2D, fat storage etc.

    If you are on a high fat diet and get checked regularly (as anyone on any kind of diet should do), then that is fine

    Why should you, “get checked” by anyone if you are eating as you were designed to eat?

    Also, chill out!

    The reason why people have got as worked up as they have is precisely because this issue is so important. People becoming ill with various metabolic diseases the world over all because of the “advice” promulgated by health authorities the world over

    • Dr John Briffa 4 February 2014 at 6:56 am #

      All good and pertinent responses, I think, Mark.

      Thanks for providing them!

  123. Frederica Huxley 3 February 2014 at 8:50 pm #

    How interesting; Dr Mackenzie does not deign to converse with anyone who hasn’t published – https://www.facebook.com/photo.php?fbid=10153734903675063&set=o.200675563422703&type=1&theater.

  124. Power Unseen 3 February 2014 at 11:39 pm #

    Mainstream TV has an agenda and can lead you astray if you can’t see through it.

  125. Francesca 4 February 2014 at 8:01 am #

    Found your analysis of this dire piece of TV, and responses from readers, extremely interesting. To me Dr Mackenzie looked uncomfortable and was unconvincing, and I remain unconvinced by his response to your challenge. I am going to send a link to your article and this discussion to the BBC because, as others have said, braodcasting this kind of garbage is – at best – a breach its remit and -at worst – dangerous.

  126. Geoff Cruickshank 4 February 2014 at 8:16 am #

    I think some of the comments go to show that it is hard for someone who hasn’t tried restricting carbs for themself, having a good reason to do so, how miraculous the effects seem to those of us who need to.
    My potted history- I ate as ‘science’ instructed me to. Plenty of ‘healthy whole grains’, very little fat, small quantities of meat, plenty of vegetables, salads and some fruit. I didn’t eat donuts and fast food and mountains of pizza. I wound up with a liver stuffed full of fat and ALT like an alcoholic although I rarely drink. I was lethargic, depressed, desperate and had a minor stroke.My one vice, according to the ‘healthy pyramid’, was chocolate.
    I first found ‘wheat belly’ and cut out wheat. A little more browsing and I cut out other grains. Then I read Dr Briffa’s book and stopped cutting the fat off my meat. I’ve lost 15 kilograms in a very steady way, don’t feel any effort is required to eat this way, liver readings are normal, I have energy again.
    Neutral= what works for you obviously suits you. Some of us don’t tolerate carbohydrate/grains well and when you get in the state I was in, no amount of recommendations on exercise will do anything- you just can’t do it in that depressed state of health. Yet cutting out the carbs sheds the weight almost magically and then gives you back the desire to be active. Perfect example of a virtuous circle.

    • Geoff Cruickshank 4 February 2014 at 8:29 am #

      I should add, that my wife decided to eat the same way as me although she has no problem with weight while eating exactly as I did before.Her idea was that it was just more practical for us to both do it, for which I am very grateful. Now she has not shed much weight at all, about 1 kg- but she has changed shape in a very provoking way:)

      • Jennifer 4 February 2014 at 9:28 am #

        In response to Geoff.
        Your history is mine, and your recovery is mine too. Well done!
        As to your wife’s situation, I was so pleased to see an example of what has been puzzling me over the last 4 months.
        My 30 lb weight loss has stabilised, except for an unwanted 5lb blip upwards over the festive season. I can only put it down to some carbs I had consumed, and quickly got rid of them in a week of very low carb intake, in the 1st week of the New Year. Great! Off they came straight away. At this rate I will be sylph-like in no time!?!
        So I have been very low carb (5-10%) now for 5 weeks. No more weight loss (not a problem with a BMI of 22.5), but my shape is vastly improved, beyond dreams. So….I may still get to be a sylph, albeit slightly heavier than my original goal, but so much healthier than I was year ago.
        It is not all to do with weight. We need to look at shape too, to illustrate health status.

        • Geoff Cruickshank 4 February 2014 at 9:59 am #

          Yes, as illustrated by Dr Briffa’s recommendation to use the tape measure.I didnt really have to though as my belt came in notch by notch.I shouln’t think you would need to go much lower than a BMI of 22.5 though?

          • Jennifer 4 February 2014 at 9:22 pm #

            I agree, and that is why I am not worried about further weight loss in the least. But I do like the change in curvature. Drop in clothes size is no problem, as I am handy with the sewing machine,…but all my rings are too large now, as even my fingers have slimmed down nicely. It is like turning the clock back 40 years on the outside….lets hope I have reversed , or at least, delayed, the aging process on the inside too.

        • Lisa 16 February 2014 at 2:19 pm #

          Interesting re shape rather than solely weight. My shape is altering on low carb especially around waist.

  127. paulc 4 February 2014 at 9:49 pm #

    I’ve been low-carb high-fat ever since I discovered Dr. Briffa’s “Escape The Diet Trap” after being diagnosed as T2 diabetic and finding that the official NHS diet prescribed to me was not working at all and I was still putting on weight and suffering from high sugars. The only reason I knew that the NHS diabetic diet wasn’t working was because I’d discovered advice on diabetes forums that I needed to buy my own meter and strips.

    Since switching diet, I’ve dropped in the last two years from 17 1/2 stone (245 lbs) to 13 1/2 stone (189 lbs) (still 1 stone overweight according to the stupid charts) and have also gone down from a 42 inch waist to a 34 inch waist. I have so much energy now in my late 50′s, it’s as if I’m back to my late twenties.

    My blood sugars are under complete control without medication, but I am not cured. I will fail an OGTT spectacularly as I refuse to carb load beforehand with the reccomended 130grams carbs per day.

    • SueG 5 February 2014 at 3:29 pm #

      Jennifer: “It is like turning the clock back 40 years on the outside….lets hope I have reversed , or at least, delayed, the aging process on the inside too.”

      I think you have hit on a very valid point. The issue of weight control becomes more important as you grow older. Whatever we could or couldn’t do in our youth is, in my opinion, slowly eroded as you age if you continue to neglect your “diet”. Fixing a broken body becomes more difficult, though not impossible, because you really can’t see what’s happening on the inside and by the time it is reflected on the outside you’re usually in trouble. That’s the message that the health gurus should be sending, you need to take control of your diet now, just like smoking and drinking.

      I am almost certain (depending on the age you started) that if you smoke past your mid 30′s then even if you give up you are almost certainly going to suffer with smoking related illness at some point in later life because you’ve damaged veins, arteries and tissue beyond repair. Alas, because it’s not visible on the outside, no one really cares.

      Losing excess weight after years of being fat or obese isn’t easy for everyone. There is still plenty to be found out about the process and why this should be so. A lot more research is needed or someone needs to start tying it together. Jack Kruse believes it’s connected to Leptin resistance and a brain/gut connection. He makes a lot of sense to me but even his suggestions aren’t working for me, I simply am still struggling to lose any significant amount of weight. I don’t smoke, I rarely drink alcohol, I eat very few carbs, have increased my fat intake and haven’t had anything sugary or artificially sweetened for weights. I walk the dog twice a day and have been doing squats, increasing a few at a time every day. My weight has not gone down and I’ve been doing most of this for months! There has to be an answer. The TV programme wasn’t it though.

      • Jennifer 5 February 2014 at 6:18 pm #

        SueG. I certainly agree with your statement that health and weight are such complex subjects.
        The variables of age, lifestyle, economic status, and education are infinite, and I would like to see more considered research being done to get to grips with the time bomb we see looming over society.
        Horizon did us a great disservice by trivialising a subject worrying so many individuals.
        I wish you well in your endeavours, and from my own point of view, you seem to be following a lifestyle to at least limit potential problems. I know we don’t come with a book of instructions attached to the umbilical chord, but surely, the academics must have a way of working out a decent diet and exercise programme suitable for the majority at various times of life.
        Horizon was a wasted opportunity if ever there was one. Over to you, Dr Briffa…please continue the fight.

  128. Lisa 5 February 2014 at 10:10 pm #

    I have been eating low carb since Aug 13. I am a hypothyroid and my weight loss is slow, and plateaued. However I feel well, have energy and my skin and hair are looking good. So, I know I am working with my body, not against it.

    I have a question (for low-carbers, not Larry):
    What is the best ratio of fat to protein to carbs? Is it 40:40:20, for example?

    I would love Dr Briffa to answer this!

    • David Gale 6 February 2014 at 7:32 am #

      Lisa – There is no ‘best ratio’. See my previous post on this thread for details of my own experiment. The link ( http://ramtec.wordpress.com/12-week-fitness-challenge/ ) includes a training diary that outlines ‘carb cycling’ that deliberately varies carb intake.

      • Dr John Briffa 6 February 2014 at 7:37 am #

        David – I agree with the idea that there is no ‘best ratio’, as such. The ideal balance of macronutrients probably varies between individuals, and may even vary from time-to-time in the same individual.

        As a lot of people commenting here have discovered, though, for many the ‘ideal ratio’ contains more fat and less carbohydrate than we are traditionally encouraged to eat.

  129. James 6 February 2014 at 1:01 pm #

    I’m no medical professional, but from what I have read the following seems to be a fairly consistent message:

    There is no best ratio as such. However, protein needs are often presented as being largely proportional to your fat-free/water-free weight.

    Weight loss generally seems to be reported if you consume less than 100g of carbs per day (this can be more if you are active), and preferably less than 50g.

    Weight balance seems to be around the 100g to 150g range (again, more if you are active).

    Much more than this and insulin will supress fat burning and weight gain is likely.

    Your daily calorific balance can therefore be met by fat.

    I would be pleased to be directed to any papers that show greater than 150g of carbs per day is necessary. Please Dr. MacKenzie! I’d love an excuse to eat a bag of chips again!

  130. Lisa Rossetti 6 February 2014 at 2:37 pm #

    Thank you David and Dr B. I am happy that I am on the right track at last after 54 years of low fat dieting which started when I was 10; the doctor told my mother to stop giving me fatty foods. I am still not brilliant on a lot of dairy and prefer using oils, olive etc. on my food, although I love butter.
    Although I lost a lot of weight on a low-fat high-carb diet (and kept it off for 5 years), I think I undermined my body and I suspect that I accelerated my thyroid collapse during menopause.
    I find “Escape the Diet Trap” a really useful guide for me, and I like the 80% 20% approach which takes the stress out of weight loss and makes eating socially much more flexible, less punitive.
    I love to read all your research, Dr B. Fantastic work you are doing, thank you!

    • Dave Gale 6 February 2014 at 4:45 pm #

      My own experience and observation of others suggests that many of the middle-aged (Ouch! Is that really me?) substantially underestimate their protein requirement.

      Maintaining muscle mass is not difficult for us over-50s but I seem to benefit from an intake at the very top end of the RDA and maybe even above it. For the record, as well as having been involved in professional sport as a competitor for 20 years, I’ve coached athletics, football, and aerobics.

      “Fitness is a lifestyle”

      http://ramtec.wordpress.com/12-week-fitness-challenge/

    • SueG 7 February 2014 at 12:27 pm #

      Lisa, do take a look at http://www.jackkruse.com he is really into how the various aspects of what you eat affect your ability to lose weight and keep it off and also the connection the quality of what you eat has on what he terms neolithic diseases. It’s quite complicated and there’s a lot of it but basically he believes (and has tried all his suggestions on himself first) that fat should predominate over protein in some cases. His preferred fat is coconut oil, followed by clarified butter (ghee) for those who may not digest lactose well and of course any good fats found in meat, shellfish etc.

      The forum there is packed with a wealth of information, contributed by a range of people, some like me mere amateurs, and others who are very in to the detail. I have learnt a lot just by reading various bits and pieces.

      • Lisa 16 February 2014 at 2:27 pm #

        Thanks SueG, the Kruse site is interesting. Like you, I’m following a low carb way of eating but currently “stalled”. I suspect this is related to my hypothyroid condition. I get accused on low carb diet forums of cheating, tweaking, lying etc. but not true. I’ve been low carbing for 6 months & lost half stone. But now my stomach appears to be increasing again. Actually I don’t weigh myself; I go on fit of clothes. Nothing shifted for at least 2 months. Any ideas? Or must I accept that I’m doing the right thing health-wise, but am not going to lose weight.

        • Liz 17 February 2014 at 9:12 am #

          Hi Lisa, as another fellow staller, I implore you to keep with this way of eating for life. In the end it’s not just about weight, it is about health. Went out for a slap up meal on Friday (Valentines LOL) and ate a delicious meal loaded with carbs, then have spent the rest of the weekend feeling lousy, as was immediately and obviously kicked out of ketosis. Clearly my mouth is going yes yes to carbs and body is going Noooooo! I’ve been low carbing for over 10 years now, in the majority – falling off for special occasions, and never had any trouble shifting any weight gained, until the last 18 months!! Not sure why, but it’ s probably hormonal, due to a mirena coil I had put in about 18 months ago. Do you think that could be you? How old are you?

          • Lisa Rossetti 17 February 2014 at 12:06 pm #

            Hi Liz

            Unfortunately the cards are a bit stacked against me as a post-menopausal 64 year old hypothyroid! I will keep on going with low carb, as this way of eating makes me feel better as I’ve said before. I started low-carbing in August and lost half a stone (again as I’ve said before), but after about 6 weeks the weight loss stopped and if anything I have a bigger stomach now, not smaller! It is very frustrating in one sense. There again, if I just accept it, then I simply appreciate feeling healthier and don’t stress about weight. I believe it is hormonal; and I believe my metabolism is compromised. I am doing my best to choose wisely and really appreciate the science and research behind Dr.Briffa’s work. Just a bit sad about the weight loss though!

        • Thomas Murphy 17 February 2014 at 10:37 am #

          LIsa:

          I was interested to see you mention hypothyroidism. My partner presented with many of the symptoms of hypothyroidism but a battery of tests revealed that her function was normal, albeit low.

          My partner also suffers from very low iron levels. Even with supplements, he bumps along at the bottom of the ‘normal’ range and she found she was continually putting on weight and had no energy.

          A few things helped her. The first was the change of diet to the Paleo diet – which you are also doing. The second – and most important – was changing her iron tablets. She was taking ferrous sulphate. A friend of ours suggested she switch to iron glycinate because the iron take-up is better and there are other heath benefits associated with it. My pther half no longer displays any of the symptoms of hypothyroidism that she used to have and she feels so much better in herself.

          I am not a doctor but, as you are a woman, it might be worth looking at your iron levels, what iron supplements you may be taking and whether changing the type of iron supplement might help. As with all these things, it takes a few weeks for the benefits to manifest themselves but it may be worth a punt.

          • Lisa Rossetti 17 February 2014 at 12:08 pm #

            Hi Thomas, very kind of you to send me a message. I don’t take any iron supplements, just thyroid and occasional adrenal support, occasional antioxidants and daily liothyronine (T3). As am post-menopausal, probably don’t need to take iron; I eat plenty of dark green leafy vegetables on a weekly basis.

  131. Alex 6 February 2014 at 5:34 pm #

    Watching this programme I have to agree that in general it’s approach appeared to support the high carb over high fat – and actually did not seem to be well constructed. I fully expected the programme to come out with the same net result/advice or eat less, move more and avoid fat – that’s a given – don’t agree with it as the matter is much more complicated but hey ho – I’m no scientist so no point banging on about my ideas.

    Two things I did want to raise were firstly from my understanding the body will utilise fat as an immediate energy source and as a means of transporting nutrients into muscles, whilst excess glucose in the bloodstream not immediately required will be stored in the body via insulin to enable usage during starvation times. The show incorrectly states that fat cannot be used to create glucose, however this is wrong – fats contain glycerol which can be converted into glucose via glucagon (the opposite of insulin) – something that to me was massively misleading – and to state that the HFLC twin would be in a catabolic state after 1 hour of moderate training and then a sprint seemed quite scaremongery – really you’d need to do more than just a blood glucose check to be able to state that – plus unless he had a very low body fat %, surely it would take much longer to reach catabolic exercise. Or am I misunderstanding something?

    Secondly, what they have completely missed is that it is the proliferation of added sugar in our diets which is the real cause of our worldwide weight increase. Quite simply, increased sugar will lead to increased appetite (as it suppresses leptin and increases ghrelin) which in turn leads to increase intaken – add to that the fact your body will strive to store as much excess glucose in the bloodstream as possible (as what little fat is there in these foods becomes your bodys base energy source)

    The food industry, in my opinion, is too focused on ‘low fat’ for their own very good reasons – removing fat from a diet does not decrease appetite, infact because they had added sugar it has increased appetite, which is consumption and therefore increased profits. Arguments are always made in respect to it’s what people want, it’s the consumer, it’s this, it’s that – but quite frankly the industry is responsible for what they ship out – and it is quite clear there are reasons to over-dose consumers on sugar.

    • Charlie 7 February 2014 at 10:01 am #

      Alex, since I’m a pedantic biochemist, I would just like to make a few points. Firstly, a triglyceride (triacylglycerol) molecule is made up of 4 components, glycerol which is hydrophilic (water loving) and 3 fatty acids which are hydrophobic (water hating). Overall the larger hydrophobic fatty acids win and the triglyceride molecule is water hating and does not dissolve in water and is therefore – a fat. Once the triglyceride is hydrolysed in the body and the glycerol is released, it is soluble in water and, by definition, can no longer be classified as a fat.

      Secondly, glycerol is made up of 3 carbons and the fatty acids made up of say 48 carbons (3*16) so the proportion of a triglyceride molecule that can be converted into glucose is only around 6%.

      Thirdly, wheat starch is a polyglucan and possesses the linkages holding the glucose components together in pretty much the same way as those linkages in our own storage polyglucan – glycogen. Thus wheat flour can be broken down faster than table sugar (sucrose) to yield glucose. So although sugar is a problem – we tend to eat far larger quantities of bread, pasta, pastries etc and thus the blood glucose load could be predominantly from starches rather than sucrose – or at the very least, the blood glucose concentration will reflect our diet.

  132. Colin 8 February 2014 at 10:56 pm #

    The fact that they demonized fat is not a surprise. The vegan/vegetarian crowd is deeply embedded in Western media.

  133. Simon Shorrock 9 February 2014 at 6:42 pm #

    Gary Taubes has written an excellent piece in today’s New York Times. Says it all really..

    http://mobile.nytimes.com/2014/02/09/opinion/sunday/why-nutrition-is-so-confusing.html?referrer=

  134. Jennifer 17 February 2014 at 11:29 am #

    By now the excellent contributions to this site have more than convinced me that low carb intake is the way to continue for the rest of my days. My own experience over the last year has exhibited the ups and downs now being mentioned by other people…but when occuring in isolation to myself, I wondered where I was perhaps going wrong. But, I have stayed on the regime, and continue to benefit health wise, and that is the important thing.
    Yes, I gave in to temptation at high days and holidays….and certainly I noticed detrimental effects!!!
    Yes, I managed to get back on track, fortunately very quickly.
    Yes, my weight is leveling out, but I am now slim and shapely anyway, after good weight loss.
    Yes, the temptations for high card, whether ‘good’ or ‘bad’ choices, has left me completely since experiencing the carb boost over Christmas….I have learned my lesson…..never to be repeated.
    Yes, I still read all the negativity regarding this choice of dietary lifestyle, but now out of pity for those who are unable to accept that this is the way back to good health, once and for all.
    Yes, those of us lucky enough to have taken the steps to implement the lifestyle have found flaws, but I suspect, like myself, we have erred from the straight and narrow, in an attempt to ‘test’ the theory. My silly experiments are behind me now forever.
    Yes, very low carb, high mixed fats, and moderate mixed proteins, are the only way….so call me blinkered, but I am as happy as an ostrich with its head in the sand….just as some of the non-believers profess to be. We will just have to agree to differ.

  135. clm 1 March 2014 at 5:39 pm #

    What was not clear from the article was what kind of fats the “high fat” twin was eating. If they were animal fats, how were the animals raised, and which animals were they? If they were, vegetable fats, from which which vegetables? Coconut oil is quite diffrerent from refined oils. or worse margarine. I think this fact alone could also, at least partially, determine the results of
    the high fat twin

  136. Sean Raymond 8 March 2014 at 9:04 am #

    Please correct me if I missed it – but what seems to have been surprisingly overlooked by Dr Biffa’s critique is that whilst he is correct in saying that fat cannot raise blood glucose directly fat may work indirectly to raise blood sugar levels via increased adiposity of adipocytes & lipotoxicty of organs, such as the pancreas.This is the basic theory of insulin resistance & the role of fat in type 2 diabetes pathogenesis. Yes – his overall fat mass declined however I gather this was subcutaneous fat they measured and therefore wouldn’t take into account possible visceral fat accumulation or potetntial lipotoxicty which is where insulin resistance is most likely implicated.
    On a side note – Dr Biffa gives us a fantastic website, one I recently found, and I wish to say a big thankyou for the wealth of knowledge he imparts to the reader – much can be learned here.

    • ivor 8 March 2014 at 2:52 pm #

      Hi Sean

      Interesting post but I believe there is much confounding and conflating of factors in this area. My understanding is that Fat is a clean burning fuel that absolutely won’t cause the effects you mention UNLESS:
      1. the individual is chronically taking carbohydrates beyond their tolerance level, thus provoking insulin, down-regulating Glucagon, inhibiting lipolysis, encouraging hypertriglycedemia, and thus generally promoting the visceral adipose buildup that you mention
      or 2. The individual has a significant genetic issue (very small % of population)
      or 3. the individual is an utter glutton who, in the absence of excessive carbs, is force-feeding themselves fat obsessively (and I’m not even sure about this one!)

      In short I propose that the path to insulin resistance is driven exclusively by excessive carb intake (excessive varies greatly depending on individual genetic makeup), and when one reaches significant IR via this route, then the dietary fat, with the continued excessive carb, becomes an issue in itself as the body’s ability to process free fatty acids has become dysfunctional. The latter confounding is what confuses the issue for many I believe.

      So, to GROSSLY simplify (using “>” for direction of cause-effect chain):
      Excessive Carb > Insulin Resistance > loss of available energy into fat storage > Appetite Dysfunction > increased perceived energy need > excessive carb and/or fat intake > dysfunctional nutrient metabolism > so Carb AND Fat are now a problem.

      But the current academic orthodoxy seems to just want to focus on the end of the Cause-effect chain, because they seem to love fat being the bad guy – I wonder why? Maybe because they are not engineers, and aren’t really skilled in comparative and mechanistic problem solving, and the absolute paramount importance of causal directionality in the face of confounding factors? Or maybe they just LOVE the Emperor’s stunning suit, and are invested heavily in its luxurious fabric over the past few decades?

      Anyway, last question is the $1M one – sorry for the diatribe! Agree with your side note too!

      Ivor

      • Sean Raymond 11 March 2014 at 10:29 am #

        Ivor

        Thank you for your response, I have to say you make some very valid and interesting points indeed, however whilst I can see where you are coming I gather you are basing this on the insulin-obesity hypothesis and the metabolic advantage gained from low CHO?

        I have many gaps in my knowledge however I do have a few simple queries regarding low CHO diets & the proposed mechanisms by which it exerts it effects – this is from a weight management perspective rather than one which concerns diabetes (I certainly see low CHO as being a very useful tool in managing blood sugars). I am not a sceptic as such about low CHO, in-fact I am intrigued by it, but there are some things I am struggling with which I will try and explain.

        You see, low CHO diets are based largely on the premise that removing CHO from the diet will mean the insulin response is minimised with the idea that this will maintain a state of lipolysis – hence greater fat burning will ensue.

        I struggle with this idea because protein, which will be present in the Low CHO diet, in at least a moderate amount, also instigates a pronounced insulin response – indeed some protein foods will cause as much insulin release as some breads & pasta’s for example. I need to further research this on a gram for gram basis but nonetheless the point is that protein, consumed with every low CHO meal will switch off lipolysis and cause lipogenesis to some extent – if this didn’t happen protein isn’t getting into the muscle.

        So, the Low CHO diets appears to me to be built on a false premise because lipolysis is always going to be shut down to some degree regardless of whether CHO is present or not – we do not eat meals of fat! (I am sure you are aware of the insulin index for reference to the insulinaemic effect of protein).

        I also question the idea that even if lipolysis has not been shut down that we will lose more fat anyway. This is because even if we were to eat a meal of 100% fat, which will not initiate the insulin response, the body will still promote utilisation of that recently ingested meal as its source of energy meaning that even if lipolysis is occurring concurrently, the freed fatty acids will simply not be oxidised and so I assume will simply go back to the adipocytes. This will mean we will have not utilised our fat stores – just as we wouldn’t have if we ate a 100% CHO/protein meal.

        My basic point here alludes of course to the calorie in calorie out theory. To illustrate my point, assume we can exist on pure fat and say that I require 2000 kcals of energy each day to maintain weight and so each day I consume those 2000 kcals from fat, well, if I did this the insulin obesity theory dictates that I will lose weight – but how? I will not have dipped into any fat stores to meet my calorific needs because I have used the calories coming in to meet those demands. Taking this further, if I then consume 2500kcals from fat yet still burn up only 2000kcals am I really not going to gain weight? I have heard about a metabolic advantage of up to 200 kcals a day with low CHO but need to research this.

        Finally – in Obese people we tend to see insulin resistance – this will mean insulin isn’t working as well and so surely this means that obese people are likely to be in a prolonged state of lipolysis because of this – so why do we not see the fat melting away? This is based on the premise that the body cannot use insulin – we know it can’t because blood sugars rise in an insulin in-sensitive state. So surely this follows that because we can’t respond to insulin lipogenesis doesn’t occur at least as much as lipolysis right?? This is a theory – I need to revise the direct mechanism by which insulin works on hormone sensitive lipase and Lipoprotein lipase for the answer here. I’d love to hear your thoughts – or Dr Briffa himself regarding this.

        Cheers.

        • Dawn Waldron 15 March 2014 at 8:37 am #

          Hi Sean

          I can completely see your confusion and your questions are similar to ones I have struggled to answer.

          I may be able to shed some more light on a couple of points. I note your concerns over the insulin response to carbs and proteins being similar. I believe it’s generally agreed that, overall, protein elicits a lesser response but it can sometimes approach some carb levels. The problem is always when you deal with average responses in the average body. My work with obese clients and my own weight loss journey would suggest that for some people, particularly those with severe weight problems, the insulin response to carbs is highly exaggerated leading to insulin resistance. This overreaction to carbs makes protein a better food choice. There is, of course, always a certain amount of insulin in circulation, but starches seem to create an unnaturally high surge in some people.

          The other point is your analysis of the calorie balance in a lipolytic diet. I completely see where you’re coming from there. I would, however, refer you to Gary Taubes work. In his book, Why We Get Fat, he suggests that obesity is a problem of fat storage, not overeating. A fine distinction but particularly relevant here. In a high insulin environment free fatty acids enter the adipose cells, reform as triglycerides and are locked in by insulin. In the relative absence of insulin they remain in their free state, free to cross the membrane in or out of the cell. Taubes posits that the constant presence of insulin in insulin resistance disrupts homeostasis, leading to over storing. Further that when insulin is low the body ‘becomes aware’ of its excess stores and sets to work to normalise body weight. This adjustment would be independent of the calorie argument as the fats are not being burned for energy, they are simply being dumped, in a similar way to the way we might over breathe if the oxygen balance in our blood was disrupted. Homeostasis is the driver, not energy balance. He cites some interestings at studies to support his point. I found it persuasive. It goes some way to explaining the mysterious Atkins metabolic advantage and helps also explain why some people can only lose weight when they cut carbs. It certainly flicked the switch for me and allowed me to lose three stone.

          Hope that gives you some more avenues to explore.

          • Lisa 15 March 2014 at 9:25 am #

            Gary Taubes work sounds interesting. I have long known that my overweight is not to do with overheating, yet 90% of diet advice is based on this assumption. And for women, a special category called “comfort eating” (which I don’t do).

            I am writing this at a low point in my attempt to shed the weight gain from severe hypothyroidism in 2008. Low point mentally, not in terms of weight loss unfortunately! I have been low-carbing for 7 months, have lost hmm maybe 4lbs (off my waistline). But that is it. And the lost weight is now coming back (no alteration in diet).

            I don’t know what to do now.
            I don’t know what to do now.

        • Sean Raymond 15 March 2014 at 9:19 am #

          Just thinking about the question marks hanging over low CHO a bit more…….

          My idea (and I imagine other peoples) that insulin resistance causes a down regulation of HSL due to insufficient cell sensitivity to the hormone insulin actually seems to tie in with the fact that in the obese state we DO see greater fatty acid efflux from adipose tissue.

          This makes sense because in the obese state adipocytes literally become filled with lipid and begin to resist the action of insulin because they literally cannot store more fat and or because these lipid filled cells signal that we are in a state of energy abundance and so it would make biological sense that the body will resist taking up more energy into the cells if it is not needed.

          Therefore the question now begs answering – why do we not see the fat disappearing off the obese when they are in an increased lipolytic state as the insulin-obesity theory would dictate.

          This is a crucial point to be answered because if people do not hold to the calories in calories out theory (not all low CHO people agree with this I accept) then obese people who may be still eating in excess should be seeing some of the advantages due to a lack of insulin response i.e. fat loss/weight loss due to prolonged fat break down.

          I think the reason we do not see this fat loss/weight loss in the obese as a result of greater NEFA turn over is because as I said, if the person is not in an energy deficit then that NEFA will literally flow back to other adipocytes or to new ones being formed by adipogenesis which will be stimulated by the increased need to store fat as a person gains weight, not to mention it also filling up our organs ala lipotoxicity.

          These simple points which contradict the insulin-obesity hypothesis are not being answered by people like Gary Taubes (if he has I will be hugely interested) and is why, despite being very excited by the idea of low CHO, I am not seeing any proposed mechanisms that are holding up but rather I am simply expected to believe that low CHO causes low insulin release causes increased lipolysis causes increased fat loss. Not good enough I am afraid.

          Finally, I will throw this out there – NAFLD is the one of the fastest growing diseases in the world and because of the ramifications to blood lipid and progression to NASH (20% of NAFLD–>NASH–>Cirrhosis) is quite rightly of some concern to the medical profession. Whilst there is no doubt that high intakes of fructose, refined CHO and sugar in general is a massive contributor, the obese state is also intimately related to it largely via this greater release of fatty acids.

          Therefore I propose that quite possibly, low CHO diets have the potential to plausibly contribute to NAFLD independent of sugar ingestion or adiposity – this is because lipolysis accounts for the greatest proportion of hepatic triacylglyceride and so it follows, as in the obese state, that greater lipolysis will increase the risk of elevated fat storage in the liver.

          This may hold true only if the diet is in excess of the particular calorie requirement of the individual but because we know that NAFLD can occur in non-obese individuals due to over consumption of certain macronutrients (CHO, fructose, maybe even excess fat?) this gives rise to the possibility that it may still occur in a state of energy balance (or even negative balance?) due to a simple re-shift of where the fat is stored i.e. NEFA leaves the adipocytes but isn’t being oxidised due to say, energy balance (or perhaps the degree of lipolysis exceeds the energy requirement at that moment in time) and so finds it way to the liver (as well as back to the adipocytes of course).

          I have never heard any links between low CHO and NAFLD and it was something I began mulling over only yesterday – again, if Dr Briffa is around I’d love to hear his thoughts – even if to completely correct what I have said thus far. I am more than happy to be wrong about any or all of what I have said.

          I just want to know the answers to the obesity crisis.

          • Dawn Waldron 15 March 2014 at 10:54 am #

            “Therefore the question now begs answering – why do we not see the fat disappearing off the obese when they are in an increased lipolytic state as the insulin-obesity theory would dictate.”

            I’m confused by this comment. I may have misunderstood you. Lipolysis becomes the key energy pathway in LCHF diets, and there seem to be many thousands of people losing weight via this method.

            Unfortunately there are no studies – nor probably ever will be due to all sorts of considerations – to back this up.

            It may be true that not all obese people lose weight when lipolysis increases but then not all people who make their energy via glycolysis (and who lose the ability to switch into lipolysis as a result of insulin resistance) get fat.

            In the end, I suspect that the science/medical drive to find an answer that is true for everyone is a major part of the problem. Different bodies develop different pathologies in identical circumstances.

            Apologies if I misunderstood your original point and missed it altogether!

          • Liz 15 March 2014 at 11:48 am #

            “Finally – in Obese people we tend to see insulin resistance – this will mean insulin isn’t working as well and so surely this means that obese people are likely to be in a prolonged state of lipolysis because of this – so why do we not see the fat melting away? ”

            Hi Sean, and also Dawn, who is much better placed to answer this than I am, but my understanding in answer to your question/doubt about why the obese don’t lose weight when they are in lipolysis, is that they aren’t in lipolysis!! The problem is that there is so much insulin in their system, it can only store excess cals from carbs/protein as fat, and that the very presence of constant insulin that the body is now ignoring, locks that energy INSIDE the fat cells, the body can’t then access that reserve of energy, it can only add to it, and the person concerned actually feels hungry, eating again, and thereby starting the whole process of fat storing and weight gain again. Lypolysis can only begin when the levels of insulin are brought down ie by not eating starch/sugary food.Then the weight loss begins. I have may have got it a bit confused as is it highly scientific, but I think that’s the gist of it – Dawn, have I got it right??

            Regarding protein, it does have a much lower effect on insulin levels, but too much will cause insulin spikes in some people,, hence we call it LCHF -low carb, high fat, being the the healthy animal fats and only olive and coconut oils as vegetable oils, fat and oil having no effect on insulin production.

            Sean, take a look at both Dr Peter Attia and Sam Feltham, who have eaten up to 5000 cals a day of a LCHF diet and not gained weight but maintained and lost inches!! Extreme, but it proves a point.

          • Nuaman 15 March 2014 at 12:24 pm #

            Hi Sean,

            You are oversimplifying the issue. Calorie in calorie out is obvious and true. What Gary tries to explain is why calories in calories out and that this is EFFECT not CAUSE of obesity which is true if you realise how a fat tissue grows. I would recommend you to read this:

            http://eatingacademy.com/weight-loss/how-to-make-a-fat-cell-less-not-thin-the-lessons-of-fat-flux

          • Dawn Waldron 15 March 2014 at 6:14 pm #

            Hi Liz. Your explanation is great! In the future, when science (and hindsight) has advanced enough to show us the precise nature of what’s happening to cause such widespread obesity, we may have to revise our opinions. Just now the debate is still polarised. Some of us may indeed be ‘wrong’. What we need more than biochemical explanations is clear information that helps people to lose dangerous weight. If we wait forever for double blind placebo controlled trials (and medical consensus) to tell us what to do, then half of us will be dead. If low carbing works for you (and you remain healthy and energetic) then why wouldn’t you use it to lose weight?

  137. Lisa 15 March 2014 at 10:10 am #

    Sean, I sense you are making important points. But as a lay person, I don’t understand what you write. I do not understand why I am not losing weight on low carb. I am sure it is linked to autoimmune, thyroid damage and insulin problems in our family (diabetes). Perhaps your knowledge can help me.
    Could you write a short lay version of the points you make?

    • Dawn Waldron 15 March 2014 at 11:20 am #

      Lisa

      I have had clients in a similar position who have had cortisol/DHEA imbalances getting in the way. I would echo the suggestion below about fasting, although you must approach it with care. You might want to read my article on fasting here: http://dawnwaldron.wordpress.com/2014/03/04/the-not-so-fast-guide-to-fasting/. Using fasting is helping me to shed my last few pounds to my goal weight.
      Good luck!

    • Sean Raymond 15 March 2014 at 2:46 pm #

      Hi Lisa.

      My apologies if I have been too technical – I think I am so used talking to myself these days I almost write that way now.

      I am in a bit of a rush at the moment but I promise I will respond tomorrow evening, with an easy summary of what I have prattled on about. Trust me – it is very very easy to understand as I will show you.

      Dawn

      Again – I will respond to your points tomorrow, but I will say now that I am familiar with Gary Taubes – I haven’t read his books but I am aware of his interesting ideas about weight gain being a storage issue as opposed to one of energy in and energy out. Needless to say – I think the truth of all this is somewhere inbetween – because as I have tried to say – Gary’s ideas have too many holes in them for me to fully accept although I do accept he is on to something

      Many thanks for your replies.

      Sean.

      • Ivor Cummins 15 March 2014 at 7:03 pm #

        Hi sean

        Travelling and too busy right now to reply to all the stuff (!) – will do sunday- in the meantime peter attia is a good suggestion, but I highly recommend Jeff Volek’s last lecture, search for him and enjoy! Fyi I’m delivering a seminar on cholesterol shortly, and my draft slidepack has some fun stuff on low carb physiological effects towards the end:

        http://www.thefatemperor.com/latest-material/

  138. Snazgul 15 March 2014 at 10:33 am #

    To formerly hypothyroid Lisa who can’t shed weight…
    I found the 2/5 intermittent fasting very helpful indeed
    It seemed (for me) to boost my other diet intervention quite dramatically
    Might be work a try?

  139. Lisa 15 March 2014 at 10:09 pm #

    What do those of you who are nutritionally trained think of Dr Joel Fuhrman’s theories? He advocates high nutrition low calories. I would think a regime based on a lot of fruit would not be good for me (I am probably insulin resistant)?

  140. Sean Raymond 16 March 2014 at 9:51 pm #

    Liz – thank you for the reply although you seem to have misunderstood what it was that I was trying to say

    I am aware of the hyperinsulinaemic state commonly seen in the obese (who are insulin resistant) but I was questioning the automatic assumption that this would mean that such a person will be in constant lipogenesis as you suggest

    In insulin resistance the body cannot respond to Insulin’s action – hence why we see elevated blood glucose. Therefore, if the body cannot use insulin correctly then why do we assume insulin can still shut down hormone sensitive lipase?

    I propose that in an insulin resistant state where insulin can no longer co-ordinate the switch between the fed and fasted states efficiently then this may plausibly also mean that a prolonged lipolysis takes place because the cells cannot react to insulin meaning HSL is not down regulated . (Just to be clear – the presence of glucose in the blood causes insulin release which in turn signals that the body is now in a fed state which is why lipolysis is shut down. This insulin will suppress HSL because HSL is what breaks down fat in adipose tissue (lipolysis) to provide energy substrates when we are in the fasted state.).

    Hence obese/insulin resistant people may be in a more lipolytic situation more often than non-obese/insulin sensitive people. This idea ties in nicely with the fact that the obese appear to have higher rates of NEFA release from adipose tissue. So – the obese do release more fat from their fat stores.

    I hope that made more sense.

    • Liz 18 March 2014 at 2:59 pm #

      Sorry Sean, I don’t think I misunderstood you at all, I was trying to explain, in the best why I could why it doesn’t happen the way you seem to think it does/should. It is very hard to grasp, and I am no scientist, so my explanation to you will be lacking I know.

      For everyone’s interest I found and intersting PDF about foods and the insulin response they invoke. It is very complicated (as always) and I’m trying my best to understand it, but there are some interesting things that leap out.

      http://www.nutrientdataconf.org/PastConf/NDBC35/4-2_Sampson.pdf

      The thing to remember here, which I can’t seem to find mentioned anywhere, but I have only skim read it, is that everyone is different. We all have different insulin responses to different things. Insulin can be produced just by thinking of food, or waiting at the petrol station looking at all the choccies, in some people!! Some people have an insulin response to artificial sweeteners, others don’t. I’m guessing that until we all carry a blood glucose/keto meter around permanently, no one will no for sure.

      I have tried to answer your question previously as to why the obese aren’t in Lipolysis all the time, for me the answer is that insulin is the fat STORAGE hormone. My understanding is that T2/pre diabetes is where the body can only read store, store, store, from the insulin response, the person actually feels hungry because they can’t access their own stores of body fat – ie energy. They then eat again. And the insulin levels keeps rising and rising perpetuating the hunger/fat storage. If you look at Sam Feltham’s blog, and also Dr Peter Attia, they conducted self experiments where they ate around 5000 cals mainly high fat. These “excess” cals will be used biologically by hormones throughout the body, whereas cals from other food groups can’t.

      Also found this article fascinating, j about ust how under-rated meat and fat is in our society today:

      http://www.zoeharcombe.com/2012/03/five-a-day-the-truth/

      Makes fascinating reading!!

      Ivor, love your upcoming website/seminar. Congrats on a great job!! (BTW appears a broken on the home page- under the HCA quote – the “learn more” button)

  141. Sean Raymond 16 March 2014 at 10:56 pm #

    Lisa.

    Ok, here is a simplified overview of why I question the proposed mechanism for how low carbohydrate (CHO) diets work.

    First – I am not saying low CHO doesn’t help lose weight – too many people are having success with it and so clearly something is happening – but what?

    The idea for low CHO is that the lack of glucose in the diet causes people on low CHO diets to have a minimal release of insulin. When our body releases insulin we stop fat breakdown (lipolysis) and switch to fat synthesis (lipogenesis).

    Lipolysis occurs when we are in a fasted state i.e. when we haven’t eaten for a certain amount of time we obviously are not providing the body with energy and so we will start breaking down our fat stores to release fatty acids in order to give us that energy.

    Thus, people say that the lack of insulin response in low CHO means that we do not shut down lipolysis and so we continue breaking down fat even if we have eaten.

    The problem with this idea is that protein, which will be in most meals eaten by low carbers, also causes insulin to be released and therefore they will still shut down fat breakdown even if no CHO has been eaten. Insulin is released when we eat protein because insulin allows the (muscle) cells of our body to take in that protein in the same way insulin allows our cells to take in glucose for energy.

    Some protein foods DO cause as much insulin release as some CHO foods although admittedly we do eat less protein than CHO on a gram for gram basis in the typical Western diet (we eat about 100g protein per day compared to say 250g CHO for example). But whilst overall we may release less insulin from protein than CHO, due to eating more CHO than protein, we still do release insulin and so do stop fat breakdown.

    My other point regarding this is also simple – even if we assume that low CHO causes prolonged fat BREAKDOWN why does this mean we will BURN more fat and LOSE weight?

    Fat breakdown is NOT the same as fat burning.

    If a low CHO person requires 2000 calories a day to maintain their weight and are eating a 2000 calorie low CHO diet then surely even if they are breaking down more fat – that extra fat which has been broken down will not be used (burned) for energy. This is because the person has matched their bodies energy requirements of 2000 calories with their energy intake of 2000 calories!

    Thus, that extra fat which has been broken down due to eating little or no CHO will simply go back into our fat stores because the body simply hasn’t needed to BURN that broken down fat for energy

    Does that make sense?

    Regarding my comments about insulin resistance and fat breakdown – what I tried to say was this:

    A person who is insulin resistant obviously cannot respond to insulin – their cells are insensitive to it (hence why their blood sugar will go up). If a person’s cells cannot respond to insulin then it may be true that the insulin they release, and which they are insensitive to, will not shut down fat breakdown – so such a person will be in a constant state of fat breakdown.

    This is because as mentioned, insulin stops lipolysis and insulin stops fat breakdown by inhibiting an enzyme called hormone sensitive lipase – the enzyme in the body that breaks fat down in our fat stores.

    Because we do not see the fat melting away in obese people due to this prolonged state of fat breakdown due to being insulin resistant may mean therefore that what dictates weight lose is not whether we release insulin or not but rather just a case of the good ole calories in and calories out theory.

    What I have just said is only an idea but it is one which is logical because of the simple fact that if we are insulin resistant we can’t use insulin very well! As I have mentioned – obese individuals do release more fat from their fat stores than the non obese which ties in with this.

    I hope that has all made much more sense in what I am trying to say?

    If you want to understand my idea about non alcoholic fatty liver disease and low CHO diets I can try and explain that easier if you wish.

    Cheers.

  142. Sean Raymond 17 March 2014 at 8:52 am #

    Dawn.

    With regards to your comment about some people having an exaggerated insulin response to carbohydrate foods and so (I assume) imply that this exaggerated/prolonged insulinaemic state causes a concomitant suppression of fat breakdown. Maybe.

    I have not dealt with the blood biochemistry of such people and so I cannot comment on this however this exaggerated response of insulin will only matter if you hold to the idea that it is insulin behind the obesity crisis. As I have mentioned, even if we have a low insulin response leading to increased fat breakdown via an almost constant state of lipolysis why does this mean we will oxidise that fat for energy IF such a person is either meeting their energy needs or are in excess of it? Furthermore, these people who have abnormal insulin spikes are still going to be in the minority and so would not explain the obesity epidemic where being clinically overweight is now the norm.

    I realise you have said that Gary Taubes has postulated that this excess NEFA efflux from our adipocytes caused by an absence of insulin can be simply ‘dumped’ rather than oxidised. I understand but do not understand by what mechanism can that happen? I am more inclined to believe that indeed that fat is dumped – dumped into our organs and back into adipocytes. I would be very interested to read the mechanism by which Gary taubes explains how the body dumps the excess (i.e. eliminates from the body) products of lipolysis in a state of energy balance/excess.

    There may indeed be a metabolic advantage to low CHO as you suggest which could account for this dumping of fat but I have never seen concrete evidence or heard of a convincing mechanism – I’d be interested to hear your ideas for this if you would be kind enough to share them. I believe that the metabolic advantage is small with it being proposed to be about 180 calories

    With regards to my questioning statement about why we do not see fat melting off obese insulin resistant people. What I was trying to question, and which I have explained in other posts, is that MAYBE insulin resistant people are unable to shut down lipolysis as well as insulin sensitive people by virtue of the fact they are insensitive to insulin. Therefore, maybe insulin resistant people have increased fat efflux (which studies have shown) similar to those on a low CHO diet – but we see no weight loss in these insulin resistant people – which is what we would expect if the insulin-obesity theory is correct. I.e. the insulin resistant person cannot use insulin to store fat because insulin isn’t working hence greater fat breakdown!

    I realise that such an individual will not be in ketosis (if not following a low CHO diet) and so will not be using fatty acids as their main energy source but as I have said, breakdown does not mean fat burning if we are in a state of energy balance or excess.

    I am NOT discounting any of what you have said but am trying to build up a picture of how low CHO can work IF they are meeting their energy demand or are in excess of them.

    I hope that made sense and answered your query?

    Nuaman – I will read that post you so kindly gave me the link to.

    Ivor – I will take a look at Peter Attia and this Jeff Volek. Thankyou very much Sir.

    • Dawn Waldron 17 March 2014 at 4:24 pm #

      Sean
      I think I understand what you are trying to clarify but I don’t think I can help you. In my practice I have helped a lot of people lose a lot of weight. My ‘evidence’ that weight is being lost rather than transferred from adipose tissue to organs or back again is a significant loss of body mass, generally associated with a reported increase in vitality. The number of experts advocating ketosis for obesity (and also for diabetes, cancer, Alzheimer’s etc) is growing by the day. I cannot explain the exact mechanism by which the body may be adjusting its stored fat independently of energy requirement but I’m sufficiently disillusioned with the calories in/out argument which has held sway for too long to be open to new possibilities. I don’t share your assumption that people with abnormal insulin response will be in the minority. I’m inclined to believe the opposite. In the end I expect we are both left with many questions at each end of the ideological debate. The ‘old’ calorific argument has clearly failed. Surely no one could question that? New ideas are urgently needed and if they are tried and found to work before the exact mechanisms are understood I don’t see that as a hindrance. The metabolic advantage, since it isn’t properly understood, can surely not be quantified. It may turn out to be 180 calories but if calories prove to be irrelevant (at extremes of obesity) and if, instead, it is the hormonal regulation properties of insulin that dictate fat storage, there may well be a better explanation. I still don’t fully understand your point about fat efflux in insulin resistant people. Do you have any studies to show that insulin resistant people don’t lose weight on a ketogenic diet? I echo Ivor’s suggestion to look at Peter Attia and Jeff Volek. Both fascinating and leading edge thinkers. As is Dr John Briffa.

      • Sean Raymond 18 March 2014 at 9:32 am #

        Dawn

        Thank you again for your comments although again I think you are misinterpreting what I am saying regarding fat efflux and insulin resistance as evidenced by your comment “ do I have any studies to show insulin resistant people do not lose weight on a ketogenic diet”. I do not know how you gleamed that from my responses because I haven’t said or even remotely suggested that. I really apologise if I am not being clear enough and confusing you.

        I am NOT questioning the efficacy of low CHO at all – and nor do I question its ability to work in the insulin resistant. What I am merely saying is a person who, say, is obese and insulin resistant ans so will be in a state of insulinaemia. This is because he cannot respond to his insulin, so his blood sugars rise and so the body releases more insulin etc etc. What I am suggesting is that if he cannot respond to insulin in terms of glucose uptake due to insensitive cells then MAYBE he cannot respond to the lipolysis suppressing effect of insulin by its inhibition of HSL also. So an insulin resistant person may therefore be in a prolonged state of lipolysis.

        I have tried to research the effect of insulin on HSL in the insulin resistant state but I cannot gather enough information to be sure what I said actually happens – we don’t know. Therefore, I extrapolate this point to low CHO by the following hypothesis

        IF an obese and insulin resistant person (not on a low CHO diet) is not able to switch off lipolysis effectively because his HSL cannot be switched off by insulin (because his cells are insensitive to it) and because we know that obese people DO appear to have higher fat efflux then why – if in a prolonged state of fat breakdown do we not see fat loss in these individuals the way a low CHO diet would suggest. This is because low CHO is about causing a state of extended lipolysis to cause fat loss/weight loss and if what I have just said is true about insulin resistance and HSL then the insulin resistant people may also be in prolonged states of lipolysis. But we see no fat loss in obese insulin resistant people who MAY be in this prolonged state of fat breakdown. So now we come back to my main question about low CHO – just because a person breaks down more fat with these diets does not mean that a person burns more fat with these diets.

        I hope that is clear? What I question I suppose to summarise broadly is this – just because a person is in lipolysis may not mean we are more likely to lose weight.

        I think that was my best shot at explaining what it is I am trying to say and so If I have failed to make myself clear this time around I think I will cease commenting in order to not drive me mad and worse, continue confusing people which is not what I wanted to do at all.

        I have had a brief look at the Peter Attia fat cell flux article – indeed he does seem to offer possible explanations for what I have just raised – i.e. if a person is in ketosis will not automatically equate to fat loss. I need to re-read that article and digest it further before I am able to comment more fully.

        I do not doubt what you are seeing with your clients (and well done for achieving that by the way) – I am trying to work out why you are.

        Sean.

        • Dawn Waldron 18 March 2014 at 6:45 pm #

          Ah! I had misunderstood you but now I’m much clearer.

          I can’t answer to your question with any certainty. Clearly it’s the old answer ‘more research needed’. But here’s what I think:

          We need to distinguish between triglycerides and free fatty acids. High circulating blood lipids are an unsurprising result of insulinaemia due to insulin’s stimulation of FFA formation and esterification of FFAs into triglycerides.

          However, despite high levels of blood lipids, in the presence of insulin beta-oxidation will be inhibited which means the FFAs cannot be broken down into ketone bodies or used in energy production.

          The low CHO theory (and metabolic advantage) depends on the fact that excess FFAs, in the (relative) absence of insulin, are not stored. Those not needed to meet energy requirements are oxidised and excreted as ketone bodies.

          This suggests that only a diet that causes the lowest possible levels of insulin release would provide the right conditions for lipolysis, ketosis and associated weight loss.

          So I think you’re right. Lipolysis is not the key indicator. Ketosis is.

          Like you, this is my last attempt to see if we understand each other.

          Even if I’ve misunderstood again thanks for the mental stimulation!

          with kind regards,

    • Nuaman 17 March 2014 at 6:59 pm #

      Hi Sean,

      I guess without reading Gary’s work especially GOOD CALORIES BAD CALORIES, it would be mere speculation to comment on what he is trying to teach obesity researchers.

      “With regards to my questioning statement about why we do not see fat melting off obese insulin resistant people. What I was trying to question, and which I have explained in other posts, is that MAYBE insulin resistant people are unable to shut down lipolysis as well as insulin sensitive people by virtue of the fact they are insensitive to insulin. Therefore, maybe insulin resistant people have increased fat efflux (which studies have shown) similar to those on a low CHO diet – but we see no weight loss in these insulin resistant people – which is what we would expect if the insulin-obesity theory is correct. I.e. the insulin resistant person cannot use insulin to store fat because insulin isn’t working hence greater fat breakdown!”

      Most of insulin resistant people are overweight simply because there is too much insulin present in their bodies which causes fat accumulation, they become weight stable when their fat cells also become resistant to insulin. Usually it is liver cells and muscle cells that become insulin resistant before fat cells do. I don’t understand why the fat would be melting off in insulin resistant overweight people when there are high levels of insulin present. Due to high levels of insulin present insulin resistant people really struggle with achieving lipolysis (fat breakdown) as low insulin levels are required for the fat cells to release fat. The reason insulin resistant people cannot lose weight in fact supports insulin-obesity theory. If their fat cells become resistant to insulin, which usually happens after a lot of fat accumulation, it does not mean that now they should be achieving lipolysis or losing weight. The fat is stuck in their cells and it is not going to come out in the presensce of high insulin levels.

      • Sean Raymond 18 March 2014 at 9:45 am #

        Nuaman

        “I don’t understand why the fat would be melting off in insulin resistant overweight people when they there are high levels of insulin present. Due to high levels of insulin present insulin resistant people really struggle with achieving lipolysis as low insulin levels are required for the fat cells to release fat. The reason insulin resistant people cannot lose weight in fact supports insulin-obesity theory”

        Maybe you are correct. BUT my question is simple – what if high insulin levels in the insulin resistant state cannot switch off lipolysis? See, you are assuming that an insulin resistant person in a hyperinsulinaemic state can still respond to insulin to switch off lipolysis – but why do we assume this? It is called insulin resistance – their cells resist the actions of insulin, we know this because we see blood glucose go up so why is it not logical to extend this insulin resistance further to the cells resisting the lipolysis suppressing effects of insulin either? Maybe in these people they are so insensitive to insulin that the copious insulin they release will not inhibit hormone sensitive lipase – the enzyme which breaks down fat from our fat stores?

        I am questioning this – that is all. MAYBE in the insulin resistant state the body can still use insulin to shut off lipolysis so maybe you are right – but I have not seen this proved as yet. I personally would love low CHO to work, because our calorie interventions are not working (although it does for some), we need something else and because low CHO hasn’t been used as a mainstream intervention as yet, and in consideration of all the anecdotal evidence on blogs such as this – maybe low CHO can help tackle it. I am simple trying to understand how it works.

        You are correct in me not speculating about Gary Taubes having not read his work – however I have seen his videos discussing the insulin obesity hypothesis and it is this hypothesis I have discussed. If his theory is more nuanced then fair enough, but I am merely discussing what I have thus far heard him propose on a number of youtube videos. I do take your point though mate.

        Cheers

    • ivor cummins 17 March 2014 at 10:12 pm #

      Hi Sean

      Sorry late reply , and still too busy to do questions justice, but quick version:

      1. To clarify, I am not driving the idea that tons of fat is ok due to the body “dumping the excess” in the relative absence of Insulin. Also, yep Protein elicits an Insulin response (though compare it to bread!), and at least in the case of protein you got something useful from the trade-off, right?
      2. One of the critical phenomena with low carb advantage I believe is the avoidance of appetite dysfunction (latter drives more consumption, which isn’t going anywhere good, right?)
      3. Treating this whole question as an Engineering Problem Solving exercise, the Root Cause Analysis for Obesity/Diabetes/Dyslipidemia would result in a primary solution via the adoption of a Low Carb / High Fat / MODERATE Protein regime, which I believe achieves the following constellation of beneficial and I would suggest synergistic vectors:
      (a) Appetite control / consumption moderation (can explain later, or see my seminar: http://www.thefatemperor.com/latest-material/ – scroll down to get it at the bottom)
      (b) Enabling the natural fat-burning metabolism – an Advantaged Metabolic State as Peter Attia phrased it (that’s the main topic from the replies you got I guess)
      (c) Increase in HDL
      (d) Decrease in small dense LDL
      (e) Decrease in Large, Trig-rich VLDL
      (f) Decrease in Serum Glucose and associated HbA1c
      (g) Decrease in serum Insulin, fasting and challenge (note: watch out for physiological Insulin Resistance though (the “good” IR – super confounder warning – must take around 150g carb for 3 days prior to an OGTT or you’ll be sent down a rathole like the poor doctor in the rubbish Horizon documentary!
      (h) Decrease in Serum Triglycerides
      (i) Reduction in systemic inflammation, especially if you ditch the wheat too
      (j) Marked Reduction in Systolic / Diastolic B.P.
      (k) Almost certain Visceral Adipose and general weight reduction
      (l) Reduction in Serum Gamma Glutamyl Transferase, a potent mortality risk factor that I personally was off the chart on, happily now down to below average for the population
      (l) et cetera et cetera ad infinitum…..

      On the point about magically dumping the excess FFA’s, I don’t have time to get into it here – is the above not enough in and of itself? The controversy about taking in large excess of calories via primarily Fat and not Carbs, while retaining weight control, it’s kinda a side issue for me – in fact, that might constitute genuine gluttony! Basically, achieving (a) to (l) above is a massive prize, and has been a life changing experience for myself and others. My route was through studying the fundamental biochemistry and associated decades of research, though others hopefully will find their way through good advice from Dr Briffa and others on the leading edge.

      Anyway, my rapid two-fingered typing must draw to a close – outta time again! I’ve posted draft slides for my next seminar, need some editing and further material but they not a mile off – down with Insulin, by any reasonable means, that’s what I say!:

      http://www.thefatemperor.com/latest-material/

      I’ll send on the youtube of it when delivered – hopefully I’ll incorporate some impromptu humour, and of course acerbic comments about the state of the current orthodoxy!

      As always, best regards
      Ivor

      p.s.: specific Jeff Volek link is:
      https://www.youtube.com/watch?v=GC1vMBRFiwE
      Gotta love this guy…..a true scientist, and so modest to boot

      • ivor cummins 17 March 2014 at 11:12 pm #

        Quick extra – I just LOVE Prof Robert Lustig’s thought experiment around elevating Insulin and the negative implications pertaining to that scenario (particularly for struggling overweight & obese folks):

        Say you ingested 2000 kCal on a given day and were relatively healthy, feeling good and active.

        Now I sneak up behind you and inject a bolus of Insulin (in fairness an anesthetic spray might be needed to avoid fisticuffs) .

        So a proportion of the calories you consume today will be shunted into fat storage – let’s say for argument’s sake 500 kCal.

        Ooops – now you’re feeling peckish, right? Missing that 500 kCal, a less-than-happy-camper now.

        Ok, so you respond to your contemporaneous calorie deficit, and gobble down another 500 kCal of stuff. But………..the continued elevation of Insulin will take care of a chunk of that mulch – into the adipocytes we go – let’s say 100 kCal.

        Now you’re still a little unhappy – but fear not, a promptly snaffled 100 kCal cereal bar will do the trick.

        Mmmmnnn……..now in fairness we get back to status quo (in terms of your energy perceptions at least) – but there’s an extra 600 kCal snuck it’s way into your growing physiology via yer cakehole; not so good my friend – better start doing some of that “activity” they all go on about – after all, you’re “slowly becoming a sloth” (pardon the pun)

        So, to avoid this Insulin Insanity, always keep an eye over your shoulder…….and stay low-carb!

        Ivor

      • Sean Raymond 18 March 2014 at 9:50 am #

        Ivor Cummings

        I have nothing to add to your post really aside from that it is very exciting to simply read off those proposed benefits of the low CHO diet without touching on the possible metabolic advantage of low CHO which will only be of significance if we hold to the calories in calories out theory.

        I have seen people lose weight with a structured, calorie in calorie out increased exercise programme and they keep it off – it does work but clearly not for all and it clearly isn’t the be all and end all due to the increasing obesity epidemic.

        The decrease in the CVD risk markers is genuinely intriguing and I know enough to understand the plausible nature of CHO raising cholesterol & TAG however what is of more fascination to me is your suggestion that low CHO can affect appetite regulation, I assume by effecting the gut hormones (PYY, leptin, Grehlin etc). I would like to explore that idea further but certainly, fat and protein are far more satiating than CHO and thus, this may be where the answer lies. But it still would then boil down to calories in calories out – although I appreciate things maybe a bit more nuanced than that.

        Many thanks and I will certainly have a look at those seminars.

        Oh – just a point regarding insulin release and protein – the insulin index showed that beef causes as much insulin release as brown rice whilst fish can elicit a response similar to wholemeal bread. I believe these were isocalorific comparisons not gram for gram ones admittedly and I do accept we don’t eat as much protein as CHO gram for gram, but clearly protein is in our diets in sufficient quantity to cause a signifcant insulin response and concomitant lipolysis suppression (I realise this is a minor point of the bigger picture of low CHO benefits that you propose)

        http://ajcn.nutrition.org/content/66/5/1264.full.pdf

        Cheers.

        • ivor cummins 18 March 2014 at 11:56 pm #

          hi sean

          Short term carb issue: Significant carb ingestion with commensurate insulin spike to process the blood sugar inrush, followed by insulin mediated blood sugar drop/overshoot – followed by hunger pangs – followed by carby snack – followed by post-prandial insulin spike and so on and forth

          Long term carb issue: slowly developing insulin resistance by the above merry-go-round; progressively develop neurological resistance to insulin, appetite dysfunction and increasing buildup of adipose tissue mediated by, you guessed it, chronically provoked insulin.

          Long term impact: excessive Adipose tissue, particularly visceral variety, latter promoted specifically by sugary carb (I won’t even start on about Fructose here!): subsequent increased circulating levels of Leptin, Leptin functionality adversely impacted by Insulin Resistant state, ultimately Leptin Resistance effect synergistically acts on poor fattie who is trying to fix it all by pathetically…….reducing his fat intake. Sad.

          In short, this is inherently an engineering control system problem, and I’m brutally summarizing the core elements above. Yes there is plenty more in the detail, but the art of technical problem solving is to identify the thrust of addressable root cause for a given issue – and execute on it.

          Calories In / Calories Out is side-stepping the entire thrust of root cause for Obesity – I see this kind of thing all the time with junior staff, fixating on what intuitively appear to be important mechanistic elements, but ones which actually distract from the core cause-effect chain. A control system problem is exactly that – and is not simply related to the classic conservation of energy equations – the latter are fine for steam engines (energy balance simple style if you will). This basic thermodynamic engineering (although I’ve done a lot of it and love it!) is NOT applicable to biological systems with exquisitely interacting control feedback complexity, that millions of years of evolution have honed for survival in the prevailing environment – an environment that we have hopelessly deranged with the ubiquitous high GI carb.

          When you limit carb, the Insulin/Glucagon/Ghrelin/Leptin and other mediators can actually DO their work as nature intended; the human physiology didn’t get thrown together as a final year college project – and it was superbly adapted until we turned the prevailing macronutrient pool upside down in the past few decades. If you’re lucky and are genetically carb tolerant (post Ice-Age adaptive stuff), or athletically exertive, you can “dodge the bullet” of this Darwinian Debacle, and hold to the calories in / calories out half-truth. But for anyone who struggles with weight (probably 60%+ of modern westerners), the imperative is to understand how this crap works, and it isn’t easy when the government and academics have been screeching bad advice for decades.

          So yes you can control weight by restricting calories – of course you can – but for most it will be pulling on a tireless spring until the spring wears you down – that’s why it’s sadly a fool’s game, and why diets so often fail. Fix the control system by taking away the macronutrient spanners thrown into its delicate machinery, and let the beautiful biochemistry of life manage most of your problem for you. As it happens you’ll greatly improve the machine’s longevity and resistance to degenerative disease also as I pointed out earlier – when you play ball with the force of nature, it rewards you greatly – so super, what’s not to like?

          Sorry for the rant, lucky I love this stuff or I’d be frustrated myself…….!

          Best Regards
          Ivor

          • Dawn Waldron 19 March 2014 at 6:29 am #

            Ivor Cummins, you are an inspiration! What a brilliant explanation. Thank you.

  143. Sean Raymond 21 March 2014 at 1:59 pm #

    For some reason my computer will not let me reply directly so…

    Dawn –
    Thankyou for your reply as ever – I am glad we got there in the end! You make an interesting point regarding why low CHO may work – rather than it be due to lipolysis it may be due to ketosis where by any energy not oxidised is simply excreted out. Interesting. We know this happens in type 2 Diabetes where weight loss occurs by peeing out energy in the form of ketones during Diabetic ketosis. Thankyou.

    Ivor
    Thankyou again for the interesting posts and links to your very iluminating lectures. Where do you give these and do you have audio copies?

    You have certainly given me much to ponder and investigate and I duly will, however I will briefly just add this to some of the things you said reagrding insulin and CHO.

    With regards to the ‘thought experiment post’ you seem to suggest that insulin causes energy storage which causes increases in appetite. I am sure that studies show insulin to exert a satiety effect and can only be implicated in hunger stimulation if excess release were to cause hypoglycaemia. But a dramatic dip in blood sugars is not always a given each time we eat CHO. Furthermore, insulin would only cause energy/fat storage if the energy taken in exceeded that expended over the course of that day so any transient meal to meal effects will be balanced out. That is if we just accept the calories in and out theory granted rather than insulins effects on energy storage granted.

    Also – with low CHO, I must question then why is it that Asian and Oriental populations as well as some Island cultures where diets are largely based on CHO have not shown to be obesegenic (at least traditionally any way – that is until the recent and on going Westernisation of their diet). Indeed, I think the Chinese show (showed?) some of the lowest levels of obesity, diabetes and heart disease despite significant CHO intake. This doesn’t fit with the idea of CHO being so bad as some are suggesting. Although I straight away can counter some of what I have just questoned by the likelihood that these cultures have or had far higher rates of, let’s say a more robust manual type of lifestyle. But then if this was true we come down to good ole calories in and out again rather than the metabolic effects of CHO. This is because surely we’d have seen the harm of CHO that you alluded to in these populations?

    Again – I am not dissmissing anything – just trying to work it all out and you are far more ahead in doing so than me I feel and so maybe you can explain some of that?

    Either way – I am glad you are so enthusiastic about this stuff – me too, Nutrition and health is a truly fascinating field. But a frustrating one for sure.

    • ivor cummins 24 March 2014 at 10:17 pm #

      Hey Sean

      Just saw your post on other thread – didn’t realize you were a recently qualified dietician and rightly questioning the poop in your course material – my God they even referenced that nutjob Keyes in there, super stuff! Jokes aside I sympathize – you’re in a sticky position there on the “what do I advise people” front, and the very best of luck with it.

      Only have time for brief reply because I’m juggling 3 other challenges with my team right now that make this stuff look easy!

      On the Insulin front, don’t worry I’ve lived that crap for >20 years, now totally free through understanding it – it’s almost a cliché now that for many people in order of increasing carb-intolerance they drive their appetite relentlessly by overconsuming the stuff – and as mentioned it’s a feedback control problem – the more you do it, the more you’re driven to do it – yaada yaada yaada – it’s a cliché because…………it’s true. And as you drift into overconsumption, the problem gets worse, again the positive reinforcement driving your visceral adipose tissue with a mind of it’s own. And then increasingly dysfunctional Leptin joins the party – oh boy now you’re in trouble – death by food pyramid son. Don’t get caught up too much with the storage mechanism alone – it’s a synergy between increasing appetite dysfunction AND inherent storage propensity – and I just love synergistic/confounding problems, so much more fun to resolve, and they leave the masses behind you….

      On the Chinese point yes that’s an old chestnut, and I haven’t worried too much about it but I’ll give my 2 cents worth:

      There are always anomalies in complex issues in spite of the root cause thrust being clear overall, and they exist either because of a confluence of as-yet-undefined factors, or because of missing data within the world of the problem solver – this indeed seems like one of these anomalies. So what might the sneaky confluence of factors be, to make us scratch our heads and not feel quite so smart-ars*d about the whole thing? Well I can think of a few:

      1. Genetic heritage – although the Chinese etc have not been eating rice forever, they have a considerable history, so some adaptation is to be expected (note the converse also, for example that the American Indians have very little carb history, perhaps that’s why they explode with obesity and diabetes on the US diet, even when compared to their bloated conquerors!)

      2. The historical economic realities – these guys had to work like hell generally and scrimp a living from the land, but I’m sure their rulers were a tad more bloated – I’m conscious here that this speaks to your activity/calories burned point – and I accept there is an element of that involved, will speak to it again at the end of post.

      3. The historical cultural reality (compare to the selfish individualized indulgent mess we have developed) – and this speaks again to your calorie point in fairness – I would think there was an innate understanding that you ate according to your needs, and I’m sure they prized fish/meat etc as a balance with their rice, and I would guess that constantly grazing/gorging on brown rice was not a custom of the times.

      4. The brown complete rice they would have consumed has quite a bit of fibre compared to the purified stuff we get today – this would help a little on the GI front

      5. They didn’t hit the wheat, or have refined sugar, or all the other staples that we “enjoy” in the west

      6. A few others I’m sure

      Now, here’s the money shot: my definition of Root Cause for a complex problem is double-barreled, and I never tire of teaching younger technical staff this. It is both:

      (1) A proven primary causal driver of the issue at hand
      (2) An eminently addressable factor – that can be executed upon successfully to resolve the issue satisfactorily

      This is critical: if you don’t have (1), then you’re playing in the dirt, like the saturated fat vilifying idiots; if you don’t have (2), then you are an ineffectual engineer, doomed to Band-Aid fixes and eternal mediocrity.

      The Chinese anomaly illustrates a type (2) problem – the path to achieving the Chinese high-carb historical equilibrium IS NOT ADDRESSIBLE for all intents and purposes. In the West, the legions of the obese will NEVER take this on – they will never recreate a miniature 19th/20th century Chinese society amongst themselves, working happily in the paddy fields 14 hours a day, and spending their remaining waking hours with their collective fat ass on an exercise bike. SO IT IS NOT A VIABLE ROOT CAUSE SOLUTION FOR THE POPULACE.
      Luckily, there is a perfectly safe, healthy and practical root cause to pursue, which will also improve all your mortality risk factors to boot – strong moderation of carbohydrate while ingesting an appropriate (and now happily calorifically self-regulating) quantity of satiating and delicious fats. Congratulations my young friend, you’ve now identified your first Root Cause Solution, which will set free the carb-intolerant majority!

      I’ll post the cholesterol seminar when I get time to execute on it – too busy at moment to take ~200 engineers out of the loop to do this one – probably early to mid April – targeting 90 minutes + questions, should be fun (and I have a little more material to stuff in there yet). I don’t have recordings anywhere except on http://www.thefatemperor.com – links along the top bar because it’s my first website and I’m learning that stuff.

      Wow, I just whacked out this post in a few minutes with two fingers – maybe I should try journalism as well!!!

      Best of luck and keep exploring
      Ivor
      http://www.thefatemperor.com

  144. Kate 24 March 2014 at 9:18 pm #

    “Blood sugar spikes and troughs mediated by over-consumption of carbohydrates leading to metabolic syndrome, fat storage, and further hormone dysfunction is not corrected by long term calorie control nor fat avoidance” (31 wds) – the scenario described in recent posts (e.g.Ivor, 18/3) is hardly new.

    I believe that of the big three – insulin, leptin and cortisol – leptin is the dominant force over these as well as having a negative effect on thyroid function. We are familiar with the “dance of the hormones” as applied, say, to oestrogens and progesterone in regulating female fertility: i.e. hormones do not work in isolation from each other. Insulin resistance is probably the key player in all degenerative diseases but leptin resistance has become so in the obesity epidemic.

    How to normalise leptin response? The three T’s (total, type and timing) might go some way towards it:

    1. The total amount consumed at each meal.
    2. The type of calorie ingested.
    3. The timing of meals.

    The total amount consumed is surely relevant to the amount of insulin generated in response to a meal. Overconsumption of any macronutrient will in time lead to insulin and leptin resistance. Protein is hardly the innocent bystander here (ref. Sean, 18/3) since excess amino acids are converted by the liver into carbohydrate via gluconeogenesis. Some suggest 60 – 100g protein/day is sufficient (i.e. 2g per 5 lbs body weight of pure protein – not the total weight of the protein rich food). Fats are clearly necessary for nutrient absorption and transport, cell signalling, steroid hormone synthesis, fertility, in short the continuation of the species and have been for millenia – Ancel Keys and six decades of misinformation notwithstanding.

    The type of calorie is important if you accept the premise of glaecemic load being relevant to insulin response and there are myriads of reasons to give processed/fast foods a wide berth. The quality of fresh foods however is dependent on the method of agriculture and the soil in which they are grown. The effects of these on the human microbiom and its relevance to obesity are beginning to be understood.

    The timing of meals could be the most important as regards leptin resistance. Two or three meals per day separated by 4-5 hours plus overnight fasting will probably normalise it within 2 -3 months. Come to think of it, is this not the way we used to eat before Big Food, Big Ag and TV took over?

    • ivor cummins 24 March 2014 at 10:35 pm #

      yep Kate no arguments there – excessive protein not a great idea, but I wouldn’t overplay the gluconeogenesis factor myself as it happens – if you’re safely low on carb, then I think it only really matters if you’re going protein crazy or you’re an obsessive hydroxybutyrate head – but open to being incorrect (sort of!). Fat is King really, so moderate meat and loads of macadamia nuts etc to boost the relative fat intake is my regime.
      It’s great to see so many knowledgeable people on here, sadly a tiny percentage of the populace though I’m afraid……

      rgds
      Ivor
      http://www.thefatemperor.com

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