Tim Noakes: Nutrition Network Courses for Health Professionals

Homepage | Nutrition Network (nutrition-network.org)

Tim Noakes shot to fame in the low carb community by being accused of malpractice by two South African dieticians for giving dietary advice when he was not a registered dietician. After five long miserable years and the support of international colleagues he won the case. Anna Dahlquist, a Swedish GP had gone through the same thing a few years before this, and not only won her case, but managed to get the Swedish food guidelines for people with diabetes changed.

Professor Noakes has established online training for health professionals covering a variety of useful topics. Participants can be from all over the world and will receive accreditation. The full list of topics can be found by clicking on the homepage in BOLD above.

Public health collaboration online conference 2021

Sam Feltham has done it again. This year’s conference is now available on you tube right now.

Last weekend there were many contributors from diverse fields including members of the public, doctors, academics, and the scientific journalist Gary Taubes who gave the opening talk about ketogenic diets.

The courses that particularly interested me were about the experiences of type one diabetics who had adopted the low carb approach, how to achieve change, and how to increase your happiness.

There are talks about eating addiction and eating disorders, statins, and vegetable oil consumption.

Much of the material will be familiar to readers of this blog. There are some new speakers and topics which do indicate that a grassroots movement in changing our dietary guidelines is gaining ground.

Dietary gluten in pregnancy is related to an increased risk of type one diabetes in the child

Adapted from Antvorskov JC et al. Association between maternal gluten intake and type one diabetes in offspring. BMJ 22 September 2018

This research was based on a study of Danish women’s food frequency questionnaires completed 25 weeks after their first pregnancies ended. The incidence of diabetes in the children was then noted from January 1996 till May 2016 from the Danish Registry of Childhood and Adolescent Diabetes. After certain exclusions had been made over 63,500 were analysed.

The mean gluten intake per day was 13g ranging from 7g to more than 20g per day.

The incidence of diabetes in the child increased proportionately according to gluten intake. The women who had  20g or more intake had double the type one diabetes in their offspring compared to those who ate 7g or less.

As type one diabetes has risen seemingly inexplicably over the last few decades, there has been a lot of consideration into possible environmental triggers. Gluten is a storage protein found in wheat, rye and barley.  In animal studies, a wheat free diet in the mother has been found to dramatically reduce the incidence of diabetes in the child.

It has been suggested that gluten can affect gut permeability, gut microbiotica and cause low grade inflammation.

Although there is this association between gluten and type one diabetes it could be that other factors, for example the advanced glycation products from the baking process, that are to blame.  Unwanted additives to grain  could also be a factor eg mycotoxins, heavy metals, pesticides and fertilisers.

Mothers who eat a lot of gluten may similarly feed their children a lot of gluten. They also may pass gliadin from wheat into the breast milk.

Although this research suggests that high amounts of gluten may be problematic in pregnancy, further research will need to be done before dietary recommendations are likely to be changed.

Should you get tested for coeliac?

From Allergy and Autoimmune Disease for Healthcare Professionals October 9 2019

Apparently 70% of people who have coeliac have yet to be tested for it.

Who may have it?

4.7% of those with irritable bowel syndrome.

20% of those with mouth ulcers.

8% of infertile couples.

16% of type one diabetics.

7.5% of first degree relatives of people with coeliac.

About 50% of people who are diagnosed have iron deficiency diagnosis  at the time of coeliac diagnosis.

Other people who need to be tested may have:

Pancreatic insufficiency

Early onset osteoporosis or osteopenia

vitamin and mineral deficiencies

gall bladder malfunction

secondary lactose intolerance

peripheral and central nervous system disorders

Turner’s syndrome

Down’s syndrome

Dental enamel defects

persistent raised liver enzymes of unknown cause

peripheral neuropathy or ataxia

metabolic bone disorders

autoimmune thyroid disease

unexplained iron, vitamin D or folate deficiency

unexpected weight loss

prolonged fatigue

faltering growth

second degree relative with coeliac disease

My comment: I had years of  the mouth ulcers, iron deficiency anaemia and irritable bowel symptoms which all resolved completely on a wheat free diet. The problem is that if I did want tested I would need to go back on wheat for a minimum of six weeks to give my antibodies a chance to build up sufficiently to test positive.  Thus, best to get a test BEFORE you go on a wheat free diet.

 

 

Diet doctor: free online course with credit for medical professionals

This is a message from dietician Adele Hite:

I am thrilled to announce that Diet Doctor is now offering a free CME activity to all interested clinicians, patients and carers: Treating metabolic syndrome, type 2 diabetes, and obesity with therapeutic carbohydrate restriction.

Thanks to the support of our members, we can offer this CME at no cost to clinicians.

This fully referenced, evidence-based CME activity is certified for three AMA PRA Category 1 Credit(s)™. It is jointly provided by Postgraduate Institute for Medicine (PIM) and Diet Doctor and is intended for physicians, physician assistants, registered nurses, and dietitians engaged in the care of patients with metabolic syndrome, type 2 diabetes, and obesity.

The course was designed by clinicians for clinicians. As this course outline shows, it covers all clinicians need to know about dietary carbohydrate restriction and how to implement it safely and effectively with patients for whom it is appropriate. In keeping with Diet Doctor’s mission to “make low carb simple,” the course also comes with supplemental materials for clinicians and their patients to make it easy to translate evidence into practice.

We hope that this course will help reaffirm the scientific and clinical support for this approach and — along with other efforts by LowCarbUSA and expert clinicians — act as another step in solidifying a standard of care around low-carb nutrition. We would love it if you would share the news about this course with colleagues. You can forward this email to them or use this flyer to share or post.

Diet Doctor also has some new resources to help make low carb simple for patients and clinicians alike. For patients, we have:
‒ a sample menu
‒ shopping list
‒ a meal planning guide
‒ a substitutes for favorite foods handout
‒ simple meals and planned leftovers, and
‒ information about target protein ranges

For clinicians, we have handy one-pagers on:
‒ monitoring ketones
‒ fasting insulin and HOMA-IR ranges
‒ lab tests and follow-up schedule
‒ type 2 diabetes medication reduction, and
‒ a 5-day food diary for patients who need to monitor their intake

Of course, for those on the list who are not clinicians, anyone can register for and view the course. You just won’t be eligible for CME credits.

For clinicians, please let us know if we can help you help your patients in other ways. And if you are interested in supporting us as we continue to develop materials to make low carb easy for clinicians and patients, please think about becoming a Diet Doctor member yourself.

Finally, we are happy to hear suggestions for improvements moving forward. If you take the time to view the course, we’d love to hear what you think.

Best regards,
Adele

Nina’s plea: Would you write to Congress and change USA food guidelines?

This is a message from Nina Teicholz, writer and low carb activist:

My highest concern about the existing USA Food Guidelines is for the people who have no choice but to eat the food that they are given, which is based on what is thought of as “a healthy diet”. There are many essentially ‘captive’ populations in schools, hospitals, and prisons. Many of these people are the most disadvantaged among us. Native Americans on reservations have no choice about the food assistance they receive.

I’ve spoken with the Native American woman who for years has been trying to change the USDA food they get, and she cannot get even the tiniest change. They desperately need the food, yet it’s more than 50% carbs, and something like 40% of the kids on these reservations have diabetes.

The same is true for poor people, education programs, and feeding programs for the elderly. These people have no choice.  No other food  is given to them. Many doctors also say they have no choice, because  they are required to teach the guidelines to patients. It is the same thing in most federally funded institutions.

Thus, my hope is, if we have to have Guidelines for the time being, that they do as little harm as possible. The Guideline is coming up for review, but the committee have already decided not to review the evidence on low carb diet studies.  We are seeking to change this, and there is already some support for our position, that these studies should be included in the evaluation. Could we get in a low-carb option? Could we force them to consider all the science on saturated fats? This next set of Guidelines will come out by the end of this year, and I think there is still time to try to force change. Our actions now would build awareness around the issue that there is something wrong with the Guidelines. There is so little awareness of the problems. And actually I’m hopeful,  because in the last few months, we’ve worked with a number of groups to raise awareness to a level it’s never been before.

Here’s what I would suggest for now.
Both my group, The Nutrition Coalition and the group Low-carb Action Network,  have webpages that make it very easy for you (if American) to write/call your Members of Congress. This is super important and I urge everyone to do this. USDA is not budging. Congress is really the only body of power interested in change, and they need to hear from people. So I would urge everyone to contact their members of Congress. It can take just a few min.

Thank you,

Nina

My comment: If the USDA food guidelines are changed, it would make it so much easier for the UK to follow. The photograph shows the breakfast given to a diabetic patient in a US hospital who had just had a heart attack. The UK also dishes out abysmal food to its patients. Wouldn’t it be great if they had a low carb option?

Public Health Collaboration conference online a great success

The Public Health collaboration online conference 2020  was very successful.  The videos are available on You Tube for free making the conference even more accessible for everyone who needs advice on what to eat to stay healthy.

If you are able to contribute to the PHC fund to keep up our good work please do so. Sam Feltham has suggested £2.00.  This is via the PHC site.

This year there were contributions from mainly the UK but also the USA.

Visitors to this site will be very pleased to know that keeping your weight in the normal range, keeping your blood sugars tightly controlled, keeping your vitamin D levels up, and keeping fit from activity and exercise, are all important factors in having a good result if you are unfortunate enough to be affected by Covid-19. We have been promoting these factors in our book and website for several years now, mainly with the view to making life more enjoyable, especially for people with diabetes, now and in the future. The reduction in the severity  to the effects of   coronavirus is a side effect of these healthy living practices.

Several talks went into the factors and reasons for this, but in a nutshell, if you are in a pro-inflammatory state already, you will have a much more pronounced cytokine inflammatory response to the virus than is useful for clearing the virus, and you end up with inflammed lung tissue which leaks fluid thereby impairing your blood oxygen levels.

A talk that I found particularly apt was the talk from a GP who had had a heart attack at the age of 44 despite a lack of risk factors except for massive stress. He gives a list of self care practices that helped him. I would also include playing with your animals. Emma and I are cat lovers and can vouch for this!

My talk is about VR Fitness, which was the only talk this year which was specifically exercise related. The Oculus Quest has only been out a year and has been sold out since shortly after New Year. I was fortunate enough to buy one in anticipation of my imminent retirement, and it has been great as an exercise tool over the long, cold, dark winter and more useful than I had ever anticipated over the lockdown as a social tool.

There were several very professional cooking and baking demonstrations on the conference this year, and indeed, this could not have otherwise happened on a traditional stage format.  We had low carb “rice”, bread, pancakes and pizza demonstrations which may well help you if you prefer to see how it is done step by step or if you want to broaden your repertoire.

I was particularly taken with the pizza base idea from Emma Porter and I will follow up with this in a later post.  The whole video is available from the PHC  site which takes you to all the videos on You Tube.

 

 

 

Belinda Fettke: The origins of the food companies behind the grain based diet

This is part one of a three part series on how we have ended up with a cardiovascular disease epidemic, what treatments we are using which don’t work, and what treatments do work.

The in first episode Belinda Fettke discusses the history behind the 7th Day Adventists who genuinely believed that they were bringing health to the USA population by promoting a grain based diet.

This is a long video but entertaining as well as informative.

 

Dr Maryanne Demasi: What does “low GI” really mean?

The Low GI Label: sound science or a ploy for product promotion?
Mar 5, 2019 | Business, Comment Analysis

Is it ethical to promote the health benefits of “low GI” labelling? How about multinational food companies paying to have their products certified? At best, it provides little value to the consumer, writes science journalist Dr Maryanne Demasi, At worst, the low GI symbol is misleading and should pass the way of the Heart Foundation tick.
FOR DECADES, “low GI” foods have received the backing of high profile scientists and nutritionists, promoting them as the “healthier choice”.
A lucrative industry has evolved whereby food companies pay to showcase the low GI symbol on the front of product packaging, much like the now defunct Heart Foundation tick.
Recipe books, weight loss programs and nutrition health messages are often bound to the notion that low GI foods are “better for you”. But a closer examination of the science exposes fundamental flaws that threaten the credibility of the low GI industry. What is low GI and are consumers being misled?
What is Low GI?
According to the Glycaemic Index (GI) Foundation, the “GI” of food is simply a ranking of how quickly various foods cause a spike in your blood sugar levels.
The entire concept was based on the results of only 10 healthy subjects who ingested carbohydrate-laden foods and the effect on their blood sugar levels was assessed.
The GI scale ranges from zero to 100. A GI of ≤55 is classified as “low GI” because it causes a slower rise in blood glucose compared to “high GI” (see graph)

Does GI work in practice?
On the surface, the GI concept makes sense.
That is, the low GI symbol should guide consumers to choose products that will not spike their blood sugar levels too high, which is especially important for people with diabetes.
Except, the science doesn’t back it up.
Researchers have put it to the test and determined that the GI of food cannot predict, with any accuracy or precision, the way a person’s blood glucose will respond.
For example, when 63 healthy subjects ingested an identical meal of white bread in order to calculate its GI (based on the protocol), the results were highly variable. The range of individual responses to white bread saw GI calculations as low as 35 whereas others were as high as 103.
With such a large margin of error, the researchers concluded that there was “substantial variability in individual responses to GI, demonstrating that it is unlikely to be a good approach to guiding food choices.”
Registered nutritionist Anthony Power says these results demonstrate the futility of labeling products with the low GI symbol.
“The method for ranking the GI of food might work well in a test-tube but it does not translate to the human body,” says Power. “The variability in people’s response to GI does not make the tool useful”.
Prof Eugene Fine, a physician from at Albert Einstein College of Medicine, NY says “the whole point of the GI, is supposed to be its usefulness in predicting blood sugar levels. But since studies show such a broad scatter plot, it’s clinically useless”.
Prof Mary Gannon, nutrition researcher from the University of Minnesota, agrees.
“In our opinion, the clinical relevance is minimal. The reliability of the GI as a standardized index of food response is questionable,” says Gannon.
Another fundamental flaw in the GI labeling of food is that various situations will alter the GI properties of food once its ingested.
For example, the GI of a slice of bread will change if it is accompanied with butter or avocado, rendering the GI label redundant.
In defence of GI
Professor Jennie Brand-Miller, nutrition researcher and early pioneer of the GI concept, has defended the criticisms, although she does concede that low GI foods have variable results in people.
“It’s been known for a long time that glycaemic responses are highly variable between, and within, individuals,” says Brand-Miller in a written response. “But the Glycaemic Index is a property of the food – not the person – determined by testing 10 people according to a precise protocol of over 300 data points”.
Prof Brand-Miller adds, “The GI ranks foods according to their glycemic potential, gram-for-gram of carbohydrate.”
However, Richard Feinman, professor of biochemistry and medical researcher from SUNY Downstate Medical Center NY, says there’s no point assigning an index to food, if it doesn’t have any relevance in the human body.
“The studies demonstrate that there is no ‘true’ GI for any food that reliably predicts a person’s blood glucose,” says Feinman.
Prof Brand-Miller, who promotes the benefits of low GI foods, did disclose that she receives royalties from co-authoring low GI books along with other high profile nutritionists.
According to the University of Sydney, Prof Brand-Miller’s book sales “have gained her international acclaim, having sold over 3.5 million copies since 1996”.

GI for people with diabetes
Originally, the GI label was intended as a tool for meal planning for people with diabetes. Prof Brand-Miller says low GI diets have been shown to reduce blood glucose levels in people with diabetes.
“A large body of research shows that diets based on healthy low GI choices improve glycemic control in people with diabetes, and reduce the risk of developing diabetes in healthy populations,” says Brand-Miller.
However, Associate Professor Kieron Rooney, exercise and obesity researcher from the University of Sydney suggests that the GI ranking of food is likely to have very different outcomes in people with diabetes.
“It is possible that most products would be high GI for a person with diabetes by nature of the underlying disease,” says Rooney referring to the inability of people with diabetes to naturally control blood sugar levels.
Even if low GI food reduces the spike in blood sugar, the total “load” of glucose entering the blood stream still has to be processed, which requires substantial amounts of the hormone insulin. Symptoms from high insulin levels include food cravings, fatigue and weight gain.
Prof Gannon suggests a more practical alternative to focusing on the low GI diet. “A more clinically relevant approach for dietary treatment of high blood sugar would be to limit dietary glucose,” says Gannon.
Put simply, people should eat less starchy carbohydrates, which get converted into glucose once ingested.
Professor Feinman agrees. His recent study demonstrated that restricting dietary carbohydrates should be the first approach to managing diabetes, over the low GI diet.
In addition, Professor Eric Westman and colleagues at Duke University Medical Centre NC, conducted a study in people with type-2 diabetes and showed that restricting dietary carbs led to greater improvements in blood sugar control and reduction/elimination of medications, compared to the low GI diet.
A marketing ruse?
GI is focused on “glucose” and overlooks other sugars like fructose, which is often added to sweeten foods in the form of refined cane sugar, corn syrup or fruit concentrates.
“The standard methodology for assessing GI is to utilise a glucose drink as the reference food,” says Rooney, “but the most common sugars added to products will contain significant levels of fructose. Therefore, if one is only measuring blood glucose response to a food you are missing out on a lot of the story.”
Fructose has a low GI (doesn’t spike blood glucose levels). Therefore, food manufacturers have been able to exploit this loophole.
Products can be sweetened with concentrates containing fructose and rewarded with a low GI symbol, essentially giving a “healthy halo” to highly processed sugary foods.
For example, low GI foods include Golden North Good ‘n Creamy Vanilla ice cream GI = 31, Sanitarium™ Up & Go™ Chocolate drink GI = 28 or Nestlé® Milo® Energy Dairy Snack GI = 45.

Even pure table sugar is marketed with the low GI symbol, CSR LoGICaneTM, claiming that it’s a “healthier” sugar.
“I am not convinced that by consuming a lower GI form of another refined sugar product, the health of an individual will be improved,” says Rooney.
“We need to shift away from a culture of adding refined sugars and seek enhancing the palatability of our diets by consumption of natural unrefined/minimally processed foods,” says Rooney. “In any policy that hopes to inform people on foods and drinks to maintain or improve glycaemic control, I think fructose has to be considered.”
Chronically high levels of fructose have been associated with fatty liver disease and diabetes.
When asked whether fructose sweetened drinks like Sanitarium™ Up & Go™ Chocolate drink were considered “healthy” because of their low GI symbols, Prof Brand Miller declined to comment.
“Just because a product is low GI, it does not mean it hasn’t got a sting in its tail,” says Power. “As a practitioner who counsels patients to reduce their sugar, sweetener and carbohydrate intake, I find products like Low GI sugar to be unhelpful, misleading and possibly harmful to patients. It should not be allowed.”
Who supports GI?
Despite Prof Brand-Miller’s defence of GI, official guidelines do not endorse low GI diets.
For example, Health Canada has stated that “the inclusion of the GI value on the label of eligible food products would be misleading and would not add value to nutrition labelling and dietary guidelines in assisting consumers to make healthier food choices.”
In response to the question of whether low GI foods are healthier, UK’s National Health Service (NHS) states
“using the glycaemic index to decide whether foods or combinations of foods are healthy can be misleading”.
Closer to home, our National Health and Medical Research Council (NHMRC) dietary guideline’s committee, also does not officially endorse the low GI diet. And despite the GI Foundation lobbying the NHMRC to change its mind, the response was a direct one;
“The Committee agreed that there was insufficient significant evidence to support change. It was noted that this is a physiologically based classification, with large variability and several limitations.”
Meanwhile, the GI Foundation, the University of Sydney and its high profile advocates continue to profit from the marketing of low GI foods.
Will the “Low GI symbol” suffer the same fate as the “Heart Foundation Tick” which was scrapped after consumers complained it was “health washing” highly processed, sugary foods?
What remains now, is a question of ethics.
Is it ethical to promote the health benefits of low GI labelling? At best, it provides little value to the consumer. At worst, it misleads them.
——————–

Dr Maryanne Demasi
Dr Maryanne Demasi is an investigative medical reporter with a PhD in Rheumatology.
You can read more about Dr Demasi’s work on her blog, or follow her on Twitter @MaryanneDemasi.

#LowCarb Vegetarianism and other adventures

meat-free alternatives Maybe it’s the Extinction Rebellion folks gluing their hands to pavements, disrupting flights and parking their uncooperative crusty* posteriors on roads throughout central London.

Or it could be the underlying anxiety about eating meat that has always bothered me since I took it up again after more than 20 years of vegetarianism. But lately I have drastically cut down on the amount of it I’m eating and embraced the substitutes.

Vegetarianism and particularly veganism aren’t natural fits with a low-carb diet, the one I follow because I believe it’s the best one for helping people with type 1 and type 2 diabetes manage their blood sugar levels. Heck, the good Doctor Morrison and I even wrote a book about it!

Quorn slices

But the meat substitutes have come much further than the last time I ate them. Quorn makes decent fake ham slices. Cauldron sausages and marinated tofu work for me too—all of them low carb, though not as low-carb as the real thing. Even the Diet Doctor—the best source of everything you need to know about a low-carb diet in general—recognises that many people do want to follow a low-carb diet that they can square with their conscience and the website offers low carb vegetarian and even vegan plans these days.

While I question some of the health claims people make for a plant-based diet (and I’m picky about the word being used to mean ‘veganism’—I’ve always based the bulk of my diet around vegetables), poor Mama Earth’s resources will run out far too quickly if meat consumption continues at its current levels.

As I have no children, I can tick that big box on the green credentials list but the other two are eating a plant-based diet and not flying anywhere. As someone who’s not that fussed about travel, the latter might be easily achieved too. That just leaves me with what I choose to eat. As I don’t do absolutes any more, opting to be a vegetarian with limited dairy most of the time is what appeals.

Low-carb vegetarian recipes

How about you? Have you changed your diet because of environmental concern s or do you plan to? We do have veggie options on our website if you are looking for low-carb meat-free recipes. They include low-carb curried cauliflower cheese, aubergine and pepper parmigiana, baba ghanoush, Tofu with teriyaki sauce and crustless spinach and feta quiche.

*As Boris Johnson called them. Maybe he was attempting ‘wit’ as a distraction from the chaos he is in midst of creating in the UK.