Glycaemic Index: is it a joke?

Jennifer / / Nutrition

The wonderful Barry Groves was trying not to laugh when talking about the glycaemic index: “Another oddity is that slicing bread appears to increase its GI. Gluten-free white bread, unsliced…. has a GI of 71 and exactly the same bread made with the same ingredients, sliced, is 80.
“You couldn’t make it up, could you?”, he says with amusement.

I have often wondered why it took me so long to realise that the Glycaemic Index is rubbish and how I could ever have believed the GI peoples’ nonsense that they are measuring a property of foods that influences blood glucose levels INDEPENDENT of the person eating it. 

Last year I made a submission to the WA parliamentary committee looking into the role of diet in type 2 diabetes prevention and management and followed up with a letter about the GI recently.

Here’s an edited version.

Dear Minister

I have read the transcript of Jennie Brand-Miller’s evidence to the WA inquiry in regards to the role of diet in the prevention and management of type 2 diabetes and would appreciate the opportunity to comment on her evidence.

Brand-Miller’s contribution to the inquiry largely concerns the role of the Glycaemic Index (GI) in diabetes management and in the transcript she talks about “common sense” in relation to the GI. 

I would like to follow her “common sense” line of thinking by asking you and the committee members to consider how the GI of a food is calculated and applied and to decide for yourselves if there is ANY sense to it at all.

I would like to explain why I consider the GI ranking of foods to be one of the most inane concepts in the world of nutrition, despite reasonable competition. Being ludicrous does not equate with being harmless. The harm caused to people with diabetes in putting their faith in the GI as a way to make food choices that will help manage their condition, instead of a method with a sound physiological basis and proven benefits eg reducing carbohydrate intake, is potentially immense. 

What is GI? 

According to the GI people:“The glycemic index (or GI) is a ranking of carbohydrates on a scale from 0 to 100 according to the extent to which they raise blood sugar (glucose) levels after eating. Foods with a high GI are those which are rapidly digested, absorbed and metabolised and result in marked fluctuations in blood sugar (glucose) levels. Low GI carbohydrates – the ones that produce smaller fluctuations in your blood glucose and insulin levels – is one of the secrets to long-term health, reducing your risk of type 2 diabetes and heart disease. It is also one of the keys to maintaining weight loss.”

Example of a low GI meal plan

The following is a meal plan based on low GI foods, and according to Brand-Miller “Low GI foods, by virtue of their slow digestion, absorption and/or metabolism, produce a less pronounced rise in blood glucose and insulin levels, and have proven benefits for health.”

Breakfast: Sanitarium UP&GO™ Choc Ice Flavour GI 38

MT: Chocolate cake made from packet mix with chocolate frosting (Betty Crocker) GI 38

Lunch: Instant two-minute noodles, Maggi (Nestlé, Australia) GI 46

AT: Apple muffin, made with sugar GI 44

Evening meal: Pizza, Super Supreme, pan (Pizza Hut, Sydney, Australia) 

GI 36

Supper: Corn chips GI 42

If you have a niggling doubt that eating these low GI foods would achieve the benefits claimed by advocates of GI, I hope I can convince you that your intuition is right.

Brand-Miller and colleagues claim that the GI is ” ….a property of a food…” and that “People have glycemic responses; foods have GI values.“ In other words, the GI people appear to have somehow concluded that their method for determining the GI of foods is able to eliminate individual variables of the test subjects such as health status, physiology, digestion, age, genetics, fitness level etc., leaving a “property of a food” that determines the extent to which blood glucose levels will be raised after eating. Ummm …….. really?

In addition, they appear to believe that the resulting GI ranking for every food that they have tested, on …… wait for it ……. approximately TEN people, can be a guide to making what they consider “healthier” food choices for everyone? Around 7,000,000,000 of us?  

Not only have many scientists rightly questioned this lunacy but also plain common sense can be a good guide in assessing the validity of the concept. Just think for a moment how likely it is that a healthy, lean 20 year old athlete and a 70 year old sedentary person with insulin resistance and type 2 diabetes would both have a similar “smaller” fluctuation in blood glucose and insulin levels after eating a ‘low GI’ Snickers Bar containing 36 gm carbohydrate, equivalent to approximately 9 teaspoons of sugar?

Or that having a teaspoon of low GI sugar in a cup of tea will result “…in a slower release of energy, which can help curb hunger cravings.” ? (More on that later)

Putting common sense aside: what about the science?

If the GI of a food was really a property of a food, it would follow that individual GIs for a food would be the same, or at the very least fairly consistent, between people.

However, as Maryanne Demasi reports, one group of researchers testing the GI of bread using the established testing protocol, found a huge span of individual GI values from 63 people, ranging from 35 to 103. The “official” GI of a food is determined by averaging the individual results from approximately 8-10 people.  Based on the results above, the GI of this particular bread could be low, medium or high depending entirely on which 10 peoples’ results were used.

These results contradict the assertion that the GI is ” a property of a food”. And averaging the results from 10, 100 or 1000 people will still not give a figure that will be meaningful to one individual, let alone 7.5 billion.

Brand-Miller and colleagues saw a comparable degree of variation for themselves in their 2003 study testing the reproducibility of GI values for foods.  

According to Dr Richard Feinman,  Professor of Cell Biology (Biochemistry) at the State University of New York Downstate Medical Center, Brooklyn NY, “The GI values reported in the Brand-Miller paper are so widely distributed that the conclusion must be that there is nothing at all to the glycemic index.”

“We all thought the GI values that are in published literature must reflect a high degree of consistency between individuals for there to be anything of value to the GI.

It turns out from this paper by supporters of glycemic index that this is not true at all. This seems a scandal — really beyond self-delusion.”

“If my lab had made the measurements reported by Brand-Miller in 2003 we would have concluded that they provided strong evidence against the concept of glycemic index. We would never publish something like this claiming it was of scientific value.”

 “The problem with glycemic index is that it is completely meaningless — not measurement error here, limited accuracy there — but completely wrong.”

An excellent critique of GI and Brand-Miller’s et al’s 2003 paper by Dr Jon W. DeVries concludes: “The inability of the GI method to differentiate between foods on eating occasions leads to the conclusion that the food itself is a minor contributor to a given GI measurement, and therefore the GI method does not measure a meaningful property of a food.“

Jennie Brand Miller on GI controversies

On page 1, the Chair stated that Diabetes Australia recommends that people with diabetes follow the “Australian Dietary Guidelines” and that the guidelines do not mention GI at all.  Brand-Miller answered that other countries mention the GI of foods and that it provides a benefit beyond looking at carbohydrate alone. She was then asked to explain why this controversy exists.

As reported by Maryanne Demasi, “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.”

GI controversies part 2.

Further to the “GI controversy” question, Brand-Miller answered that there are a lot of opinions, often polarised, in nutrition. 

This is definitely true in regards to the GI concept and here are just a few examples from scientists not involved in the GI industry.


1. “Long-term weight changes were not significantly different between the HGI and LGI diet groups; therefore, this study does not support a benefit of an LGI diet for weight control.”

2.“Thus, the new information in the present study is that composing a DASH-type diet with low–glycemic index foods compared with high–glycemic index foods does not improve CVD risk factors and may in fact reduce insulin sensitivity and increase LDL cholesterol.”

3. “. Lowering the glycemic index of high carbohydrate, low fat diets …….. in subjects with type 2 diabetes with low glucose tolerance …….has little effect on glycemic control.”

4.“In conclusion, dietary GI and GL were not associated with diabetes risk and substitutions of lower GI carbohydrates for higher GI carbohydrates were not consistently associated with lower diabetes risk.”

5. “In summary, our data indicate substantial variability in G.I. value determinations …….. thus invalidating the practical applicability of the GI value.” and that GI “is unlikely to be a good approach to guiding food choices.” 

Controversy or consensus?

You would never know there was controversy about GI if you relied on the conclusions of a recently published paper: 

Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC) published in 2015

The outcome of the summit was a “scientific consensus statement” which recognized “the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity.” 

Furthermore, members of the Summit recommended that:

“Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.”

“Consensus Summit” participants

The affiliations of some of the participants at the “consensus summit” are as follows:

1. Alan Barclay 
Former CEO and consultant to the Glycemic Index Foundation, an organization whose stated aims are to promote public awareness of both the Glycaemic Index and the GI Symbol. The Foundation receives payment via licence fees from food companies to display the GI symbol on packaging. In the 2017 financial year the GI Foundation received $576,686 (tax free) in licence fees.
Barclay is also a co-author of books about the glycaemic index of foods.

2. Jennie Brand-Miller, also known as GI Jennie

President of the Glycemic Index Foundation. She leads the International Glycemic Index (GI) Database and website at the University of Sydney, where she also manages a glycemic index testing service. She is the author or co-author of over 30 books about the glycaemic index (her books have sold over 3.5 million copies since 1996) for which she receives royalties.

3. Furio Brighenti 
Affiliated to a department of the University of Parma that does Glycemic Index analysis as a service to third parties.

4. David Jenkins 
One of the pioneers of the GI and married to the president of the Glycemic Index Laboratories, Toronto.

5. Alexandra Jenkins
 David Jenkins’ wife and president of the Glycemic Index Laboratories, Toronto, Ontario, Canada, a private testing lab for GI value of foods.

6. Thomas Wolever

He reports to be part owner and receives payment as the President and Medical Director of Glycemic Index Laboratories, Inc. (GI Labs, a contract research organization) and Glycaemic Index Testing, Inc. (GI Testing, which supplies services to GI Labs) Toronto, Canada. He has authored or co-authored several books on the glycemic index for which has received royalties from Philippa Sandall Publishing Services and CABI Publishers. 

7. John L Sievenpiper

He reports to have received travel funding, speaker fees, and/or honoraria from International Life Sciences Institute (ILSI) North America, International Life Sciences Institute (ILSI) Brazil, and The Coca-Cola Company. He is an unpaid scientific advisor for the International Life Sciences Institute (ILSI) North America, Food, Nutrition, and Safety Program (FNSP).


The following acknowledgment is near the end of the paper: “The Glycemic Index, Glycemic Load and Glycemic Response: an International Scientific Consensus Summit” was supported by: ………. Glycemic Index Foundation, Glycemic Index Laboratories, Kellogg Europe, SUGiRS (Sydney University Glycemic Index Research Service), Enervit, Meal Garden.


There are many scientists who have questioned the utility of the GI who didn’t attend the “International Scientific Consensus Summit“. I wonder how many, or even if any, were invited? On the plus side, it may have been quicker to reach consensuses on so many topics supporting the GI without them there.

The Australian Paradox

No examination of the GI business would be complete without mention of the “Australian Paradox”, a name coined by Brand-Miller and Barclay in 2011:

The Australian paradox: a substantial decline in sugars intake over the same timeframe that overweight and obesity have increased.Nutrients. 2011 Apr;3(4):491-504. Barclay AW1, Brand-Miller J.

In this paper Brand-Miller and Alan Barclay assert that there was a “consistent and substantial decline” in the per-capita consumption of added sugar and sugary soft drinks by Australians between 1980 and 2010, in the timeframe that obesity ballooned. Their claim was that there exists “an inverse relationship” between added sugar consumption and obesity and went so far as to propose that a literal interpretation of this association suggests that reductions in sugar intake may have contributed to the rise in obesity.

As far as I know, they haven’t elaborated on this as yet.

Economist Rory Robertson has pointed out some flaws in this study, one being that the authors appear to have misread their own graphs.

As Robertson reports, the authors’ “finding” of a decline in sugar consumption by Australians over 30 years is contradicted by their own charts ie “…four of the authors’ own published charts – each showing a valid if imperfect indicator of per-capita sugar consumption – trend up not down in the 1980-2010 timeframe.”

Referring to the Brand-Miller and Barclay paper, Robertson says:

“The bottom line is that there is no “Australian Paradox”, just an idiosyncratic and unreasonable assessment – and avoidance – of the available sugar data by those who coined the term. Dr Barclay and Professor Brand Miller’s conclusion obviously was a big winner for the low-GI industry while others took it seriously, yet it stands contradicted by the underlying facts of the matter.”

The food industry and GI: Low-GI sugar

The following is an example of the development, testing and marketing of a low GI sugar ie CSR® LoGiCane™ Sugar, developed by spraying a molasses extract onto raw sugar.

The Sydney University Glycemic Index Research Service (called SUGiRS on their website), for which Brand-Miller is the principal researcher, tested* it. The GI Foundation certified the product, allowing the GI symbol to be displayed on the packaging.

*Note: the number of test subjects is not reported as is usually the case but they are encouragingly described as “normal”.

CSR advertises its product in this way: “By having a low GI, CSR LoGiCane® takes longer to be digested, resulting in a slower release of energy, which can help curb hunger cravings.”

The PR company in charge of launching this product was aware of certain challenges they faced. They stated, “in a media environment focused on highlighting the nation’s increasing rate of obesity“, various experts were “unlikely to support a ‘healthier alternative’ sugar”. As they said, “…the launch required a strategic PR campaign for its success“.

The campaign included Brand-Miller’s support of the launch and collaboration with the Dietitians Association of Australia, for which Barclay has been a spokesperson since 2004, to develop and distribute material to over 3,000 members. End result was that the PR company surpassed targets and won an award.

It may be obvious that I’m not a fan of GI but it goes much further. I’m furious that people who are looking for help to prevent the ravages of diabetes may trust what advocates of the GI advise and choose to use the GI as the basis for their diet choices. And when it doesn’t work, they may give up looking for a diet approach that could be of real benefit.

Substantial evidence supports reducing carbohydrate intake as the first choice in diabetes management.

But from this GI Foundation Position Statement written by Brand-Miller, it seems that she may not agree:

“Low carbohydrate diets have little to offer – they may actually increase the risk of chronic disease.”

And so her advice is to choose low GI options instead.

Fruity Quinoa Porridge, with 54 g carbohydrate per serve (equivalent to approximately 13 teaspoons of sugar) as a breakfast choice to help manage blood sugar levels anyone?

GI is unfortunately not a joke. Laughable maybe but certainly not funny.

For information on managing type 2 diabetes with a low carb approach visit:

http://www.babyboomersandbellies.com

https://www.eattobeatdiabetes.com.au

Hope on the Horizon?

Jennifer / / Dietary Guidelines, Nutrition

WOW!!! The Western Australian Government is holding an inquiry into the role of diet in type 2 diabetes prevention and management, to be completed in early 2019.

I experienced some unexpected hope and optimism when I heard this news. In spite of my natural skepticism, I don’t feel that this inquiry is being held to give the appearance of doing something about the rising incidence of diabetes but rather that the motivation may actually be to find out if diet has a role in preventing or managing the condition.

Imagine the consequences if the members of this government committee come to understand that low carb diets have the potential to not only prevent, but also reverse, type 2 diabetes.

The news will spread worldwide and millions of people will be saved from the ravages of this preventable and treatable metabolic disorder. I’ve allowed myself to be swept away by my optimism to the extent of thinking this inquiry could be a game changer.

So, I put in a submission. It was supposed to be short, but once I started I couldn’t shut myself up.

Here it is with added pictures and some tweaks. (It’s an annoying fact that ideas for improvements only come after the closing date.)

“Dear Committee Members

RE: SUBMISSION FOR THE INQUIRY INTO THE ROLE OF DIET IN TYPE 2 DIABETES PREVENTION AND MANAGEMENT

I have been a dietitian for nearly 40 years, with a particular interest in the management of type 2 diabetes, Metabolic Syndrome and insulin resistance.

Even though I have been recommending carbohydrate restriction to clients with these conditions for many years, this was not my practice in the early days.

When I graduated in 1979 the Australian Dietary Guidelines had just been released. We were taught that these guidelines were the basis of a healthy diet for everyone and for many years I believed this.

My practice changed because of the experience of having a child with a weight problem, despite a very healthy diet and lifestyle. She gained weight around the tummy at an early age, seemed to have less energy than her siblings, was a mouth-breather, suffered with reflux and could be moody at times. All signs I now recognise as relating to insulin resistance.

At around 12 years of age she gained a lot of weight quite quickly and by age 14 was borderline obese. And I was at loss to explain why.

I luckily met a GP whose family situation was remarkably similar to mine; 3 slim, high energy, eat-what-they-like children and one with a weight problem. After hearing about the presence of insulin resistance in young, seemingly healthy children, and not just in people with diabetes as she had been taught, this GP had her daughter tested and suggested the same for my daughter.

A two-hour Glucose Tolerance Test with the addition of 5 insulin measures showed normal blood glucose levels but a high insulin response, fitting the diagnostic criteria for insulin resistance.

I have been researching everything I can about insulin resistance and its relationship to diabetes, obesity and numerous other conditions ever since.

Noting the terms of reference of your inquiry, I would like to focus primarily on the adequacy of prevention and intervention programs.

In Australia, nutrition programs designed to prevent many health related disorders or to manage such disorders once they have developed, are almost exclusively based on the Australian Dietary Guidelines, a set of principles for healthy eating that have been with us for over 40 years.

I believe that the ADGs as a guiding set of principles for good health are a failure and have contributed to the obesity and diabetes epidemics that we are currently facing.

The ADGs are not, and have never been, based on good science. If they were, it would not be possible for the 2003-2013 edition have come up with the advice for Australian adults to eat the equivalent of 6-24 slices of bread per day.

The ADGs have failed to keep the population healthy, and programs based on them have largely failed to treat/manage obesity and diabetes once developed.

To understand why this is the case, I’d like to present some background to the development of the ADGs and propose reasons not only for their failure to keep Australians healthy, but how they may actually contribute to people becoming overweight and diabetic.

History of the ADGs

The ADGs started as a compilation of “ideas” about healthy eating that were accepted and became policy without ever being tested. The first edition in the 70s recommended reducing fat intake and eating plenty of carbohydrates such as breads and cereals and this advice has continued with all subsequent revisions.

A history of the ADGs can be found at http://blog.babyboomersandbellies.com/?p=17

The advice to reduce fat intake to help maintain a healthy weight or for weight loss is based primarily on the fact that fat contains more energy than other macronutrients eg fat has twice the energy content of carbohydrate. (1tsp fat/oil = 36 cals; 1 tsp sugar = 16 cals). Coupled with the common, but erroneous, belief that weight gain is simply a case of eating too much and exercising too little, cutting calories by reducing fat intake seemed like a good idea.

Similar guidelines were being considered for implementation in the U.S. but with more opposition than we saw in Australia. A respected lipid researcher urged caution in the low fat recommendation, saying that if such advice were given to the American population, it would be equivalent to conducting a large-scale experiment, the consequences of which were unknown.

The consequences of demonising fat and recommending “plenty of carbs” for the last 40 years are no longer unknown.

Carbohydrate metabolism and insulin resistance.

 There is increasing scientific evidence that the idea of overweight simply being the result of too much food and not enough exercise, best managed by a low fat diet/energy reduced diet, is inadequate. It has been demonstrated that there are differences in the way people metabolise foods, particularly carbohydrates, and while many people are able to metabolise carbohydrates well and thrive on a reduced fat diet, this is not the case for all.

Carbohydrate foods such as bread, potato, rice, pasta, cereals, fruit, milk, sugar etc are broken down to simple sugars, predominantly glucose.

Source: Baby Boomers, Bellies and Blood Sugars : the key to successfully managing type 2 diabetes, pre-diabetes and metabolic syndrome

Glucose is absorbed into the blood and the subsequent rise in the blood glucose level triggers the pancreas to release insulin. Insulin aids in the transport of glucose into cells where it is either stored as glycogen or used to provide energy.Many people are able to metabolise carbohydrate foods in this way. They are likely to release the right amount of insulin in response to a rise in their BGL, glucose is quickly cleared from the blood into cells, BGLs remain in the ideal range, our person has lots of energy and doesn’t gain weight easily.

However insulin resistant people have a different metabolic response after eating carbohydrates. If their muscles are resistant to the action of insulin, glucose does not enter muscles quickly and an enhanced insulin response may be precipitated in an attempt by the body to maintain glycaemic control.

High insulin levels may maintain ideal glucose levels for many years but at a cost.

In the scientific literature, there is documentation that high insulin levels are associated with high triglycerides, low HDL, fatty liver, sleep apnoea, excessive hunger, weight gain, central adiposity, difficulty losing weight, tiredness, reflux/ indigestion, type 2 diabetes, gout, hypertension, anxiety, depression, loss of muscle mass, micro albuminuria, inflammation, CHD, poorer breast cancer prognosis and memory impairment. (I can provide references for all these associations if asked)

To put this into real-life context, a person who has an excessive insulin response after eating carbs is likely to have hormonal responses triggered that make them excessively hungry, crave more carbs, experience mood changes associated with comfort eating and/or binge eating, tiredness/lethargy that make them less inclined to exercise and reduced satiation after meals so that they eat more without feeling full.

In addition to these effects on hunger and appetite, high insulin levels promote weight gain by increasing the conversion of glucose to fat in the liver and stimulating visceral fat receptors to take up this fat, resulting in central obesity. And weight loss is made difficult by the effect of high insulin levels on inhibiting lipolysis (fat breakdown).

These are more likely to be the issues that explain the lack of success of the usual practice of focusing on energy and fat restriction, without regard to carbohydrate intake. For insulin resistant people, this advice sentences them to a struggle of cravings, excessive hunger, low energy, reduced satiation and difficulties maintaining a healthy weight.

Development of type 2 diabetes.

Type 2 diabetes and pre-diabetes are often diagnosed at the end of a process that has been developing over many years. The high insulin response at the start of the process may keep the blood glucose level at an appropriate level for a while but over time, insulin levels can change as the disorder progresses. The stage may be reached where there is a decline in β-cell function and the pancreas is unable to maintain adequate insulin production. Blood glucose levels rise as a consequence and the diagnosis of type 2 diabetes is made at this stage.

When a person is first diagnosed with type 2 diabetes they are often advised that it can be managed with diet and exercise. If diet and exercise are not successful in lowering blood glucose levels then medication is given. Often insulin injections are introduced at a later stage if blood glucose levels remain high. The sequence of events from treatment with diet and exercise only, to the addition of oral medications and finally of insulin, is commonly observed.

With the current management approach, blood glucose levels appear to become harder to control over time and increasing doses of medication and insulin are prescribed.

I believe that the reasons optimum blood glucose levels are not achieved is due to poor understanding of the underlying cause, resulting in incorrect dietary advice being given at the very beginning.

The adequacy of prevention and intervention programs 

Generally the diet advice provided by diabetes organisations for people with type 2 diabetes follows similar guidelines. It’s appropriate in this submission to look at those from Diabetes W.A. in more detail.

As detailed on their website, Diabetes W.A. makes the recommendation to follow the ADGs as a preventive measure https://diabeteswa.com.au/prevention/reduce-your-risk/eating-for-good-health/

I do not believe that this advice is correct. If an insulin resistant person followed the ADGs ie reduced their fat intake and ate plenty of carbohydrate foods, they have a greater chance of their insulin resistance worsening over time and eventually developing diabetes.

In addition, for those who have developed diabetes, Diabetes W.A. says that healthy eating for people with diabetes is no different from what is recommended for everyone else.

The website also provides meal suggestions.

Breakfast: 2 slices wholegrain raisin toast with a thin spread of poly or monounsaturated margarine

Carb content: 30 gm carb = approx. 7 tsp sugar

Lunch: 2 slices wholegrain bread spread with 1⁄4 avocado, 2 slices low-fat cheese, lettuce, cucumber and sliced tomato

Carb content: 30 gm carb = approx. 7 tsp sugar

Dinner: 100g lean stir-fried lamb strips served in 1⁄2 wholemeal Lebanese flat bread with sliced tomato, cucumber, onion, 1 cup tabouleh and 2 tablespoons hummus

Carb content: 40 gm = apprx. 10 tsp sugar

Snacks include fruit, crackers and bread, all of which contain around 15 gm carbohydrate each, which will be broken down to 3-4 teaspoons glucose.

Essentially the advice from the Diabetes W.A. is encouraging people who have high blood glucose levels as a result of a problem with carbohydrate metabolism, to eat the very foods that lie at the heart of the problem.

When such diet advice is followed, blood glucose and insulin levels are likely to be raised over the entire day. Over the longer term, these higher levels may lead to weight gain, high blood fats, poor sleep and possibly to the development of other diseases such as gout, kidney and heart disease. The resulting lack of success in reducing blood glucose levels with such diet advice is often interpreted as “the diet not working”. The truth is that high blood glucose levels and weight gain are exactly what should be expected from following advice to eat carbohydrates at each meal and for snacks. Quite simply, such advice is illogical and counter productive.

A marked difference can be seen when contrasted with a lower carbohydrate meal plan.

Such an example could be:

Breakfast: 3-egg omelette with tomato, onion and cheese; pan-fried mushrooms

Lunch: Chicken, avocado and macadamia salad with whole egg mayonnaise

Dinner: Beef in creamy mushroom sauce, cauliflower rice and grilled asparagus.

Small serve berries and cream or full fat yoghurt

Snacks: celery, capsicum, cucumber, cheese, low carb dips

Low carbohydrate meal plans such as this have been shown in clinical trials to result in lower blood glucose levels, improved diabetes markers, improved lipid levels, reduced need for medication and to be well accepted by patients.

A recently published joint position paper from the American Diabetes Association and the European Association for the Study of Diabetes includes approval of Low Carbohydrate diets for use in the management of Type 2 diabetes and recognised that they are both safe and effective. They added that no benefit of moderate carbohydrate restriction (26–45%) was observed.

I would also like to comment on effective diabetes self-management with reference to Aboriginal communities. I note that on the Diabetes W.A. website that diet advice for Aboriginal people with diabetes is to have approximately 50% of the diet as carbohydrate foods. These are suggested to be mainly grains and cereals such as bread, flour, damper, breakfast cereals, rice, pasta and couscous. Also advised are low fat dairy, lean meats, tofu, margarine, vegetable oil and soy milk.

With regard to Australian Aborigines and type 2 diabetes, it is clear that a pre-European diet was a very low carbohydrate diet; however as talked about in this blog (by a West Australian) we have simply tweaked the Australian Dietary Guidelines to apply to all.

http://macrofour.com/prof-andrikopoulos-paleo-pringle-australian-diabetes

This is despite the fact that a traditional diet (which could be regarded by dietitians today as restrictive) was shown in the 1980s to reverse diabetes in people in the Kimberley region however it was not fashionable to continue with that solution because low-fat dietary guidelines were being introduced as a public health initiative. This is described in this blog post by the same author who also takes a look at the diet of Southwest aborigines.

http://macrofour.com/nyungar-diabetes-australian-dietary-genocide

As a dietitian, I find it unfathomable that a guide to healthy eating for indigenous Australians would ignore the body of work by Prof. O’Dea. Should your committee perhaps think about WA producing its own guidelines for healthy eating based upon traditional eating, ignoring dietetic diets based on inappropriate evidence which are inconsistent with the macronutrient composition of a traditional diet?

Finally, noting that other traditional people have the same issue and are using a grass-roots approach to solve it themselves, are we empowering Australians with good information to be able to take their health in their own hands? See this post by the same author about a Tongan in New Zealand using a restrictive low carbohydrate diet and keeping it’s cost low and the food culturally appropriate.

http://macrofour.com/kiwi-tongan-joseph-finau-daphnis

I believe that it is time to reassess the advice currently given to people with diabetes, and to critically evaluate the role of the Australian Dietary Guidelines in contributing to the current high rates of obesity and diabetes.

I hope that Western Australia can lead the way and the rest of Australia follows.

Yours sincerely

Jennifer Elliott

Submission attachment

 A Reduced Carbohydrate Diet Results in Weight Loss and Improved Glycaemic Control in a Patient with Poorly Controlled Type 2 Diabetes.

Jennifer Elliott

Quashing dissent around the world.

Jennifer / / Uncategorized

 I’ve pinched the title of this post from a chapter heading in Professor Richard Feinman’s soon to be released 2nd edition of his fabulous book, retitled “Nutrition in Crisis”.

 In this chapter he discusses the cases of five low carb advocates who were reported by dietitians to authorities. The ready-for-printing manuscript I read a few weeks ago reported positive outcomes for three of the cases but this has changed for the better since then. Hopefully a last minute adjustment can be made before going to print to include the wonderful news that the original decision in Gary Fettke’s case has been repealed. The Australian National Health Ombudsman independently reviewed the original ruling by AHPRA and found three issues with the AHPRA process. The case was referred back to the AHPRA Medical Board for an independent review, which resulted in the repeal of the previous decision in its entirety. Gary was cleared of any breach of good medical practice and the Board apologised to him.

This takes the number of positive outcomes to four out of five. The decision taken by the DAA to deregister me after its investigation of whether my recommendation of low carb diets for diabetes management was evidence based remains the only negative finding.

Unfortunately I have no avenue of independent review of the DAA’s decision, as it is a self-regulated organisation and has no reporting body to which it is accountable. Neither the Federal Health Minister, Ombudsman or COAG have jurisdiction over the DAA. Even a request to the DAA board members to correct what I consider are very clear factual errors on the DAA website about my case was responded to negatively.

That will be covered in another blog but for now, the good news decisions from around the world. I hope mine can be added to them soon.

Excerpts from chapter 19 in “Nutrition in Crisis” by Richard Feinman.

Quashing Dissent Around the World

“Coincidentally, it was in Sweden that the medical establishment revealed its resistance to criticism and to new ideas. Dr. Annika Dahlqvist lives in Njurunda, Sundsvall. She described, on her blog, how she discovered that a low-carbohydrate diet would help in her own battle with obesity and various health problems that included enteritis (irritable bowel syndrome or IBS), gastritis, fibromyalgia, chronic fatigue syndrome, insomnia and snoring. Recommending low‑carbohydrate diets for her patients and publicly advertising her ideas drew a certain amount of media attention, leading to a run-in with the authorities. In November 2006 she lost her job at Njurunda Medical Center. Ultimately exonerated in January 2008, the National Board of medicine found that a low‑carbohydrate diet was “consistent with good clinical practice.” This was the likely prelude to the announcement in 2013 that the Swedish Council on Health Technology Assessment, which is charged with assessing national health care treatment, endorsed low‑carbohydrate diets for weight loss. While their statements were far from enthusiastic, it was one of a number of events that indicated the fall of the low‑fat paradigm and the no-holds-barred backlash of nutritional medicine.

Stateside, a North Carolina blogger named Steve Cooksey was enjoined from recommending a low-carbohydrate diet for diabetes by the North Carolina Board of Dietetics/Nutrition. After a near-death experience from his own diabetes, and after experiencing the benefits of carbohydrate restriction, he felt it might be good to share the information with others, with due disclaimers about not offering medical advice. That was too much for the professional nutritionists who somehow have gotten the state legislature to designate them as sole purveyors of nutritional advice. Enlisting the aid of the Institute for Justice, Cooksey won a First Amendment lawsuit and the North Carolina Board realized that it could not tell American citizens what they could and could not say. The Board changed their guidelines, but the fury of a nutritionist spurned is great—and even worse down under.

Former DAA CEO, Claire Hewat
Former DAA CEO, Claire Hewat

The Dietitians Association of Australia (DAA) registers dietitians and essentially controls whether they can do their jobs in hospitals, universities or private practice. In 2015, the DAA expelled Jennifer Elliott, a dietitian with thirty years’ experience and a highly-regarded book for patients. She had also published a peer-reviewed critique of the diet-heart hypothesis, which likely contributed to the DAA action. The complaint from a DAA-registered dietitian was that Elliott’s recommendation of LCDs for her patients with type 2 diabetes was not “evidence-based.” The DAA upheld the complaint. In my personal communication with Claire Hewat, head of the DAA, however, she claimed that the cause of dismissal had not been the recommendations of LCD but something else that could not be revealed because it was confidential. The power of LCD diets to provoke hostile behavior remains fascinating if incomprehensible. In a blog post on the subject, I made an analogy to the Protestant Reformation, although unlike Luther, Jennifer Elliott was not particularly rebellious and was not trying to reform anything except her patients’ dietary habits. The DAA functions, after all, as a professional dietitians’ organization and should, as in Macbeth, against the murder shut the door, not bear the knife itself. There was some press coverage but little public awareness or professional outcry over the lack of natural justice and common decency.

 

The Tim Noakes Case. 

“… it is troublesome to hear that Tim is being attacked so strongly for what seems to be a trivial matter, when there are plenty of real problems in health care and our world more broadly.,,,       —– Walter Willett (personal communication)        

Most bizarre for its virulence remains the determination with which the Health Professionals Council of South Africa (HPSCA) tried to keep control by attacking Tim Noakes. A retired physician and widely-admired sports expert, and only a relatively recent spokesman for carbohydrate restriction , Noakes answered a comment on Twitter that suggested a newborn could be weaned to a low-carbohydrate diet, not particularly different from the recommendations of Australian authorities. Yes, this is about a single Tweet, which wasn’t even taken into account by the individual who’d asked the question in first place. A nutritionist was insulted by the affair and brought the case to the HPSCA. The question become whether Noakes’ tweet constituted medical advice—the primary affirmative argument being that because he was a medical doctor, anything Noakes said could be considered advice. This is just as ridiculous as the folk myth that a black belt in karate has to register his hands at local police stations as lethal weapons.

The HPSCA came down hard on Noakes but, after two years of trial, he was exonerated. The HPCSA’s own committee found that no harm derived from the tweet, and that his advice was “evidence-based” and within normal standards. HPSCA was able to establish a warning for other medical professionals, since as Noakes explained: “It’s been very, very demanding on us and on our lives and financially it’s been huge. Noakes asked, further, “Did they ever consider the consequences for my wife and myself and our family?” Indicating that it did not, (or perhaps, that it did — motives are unknown) —the HPSCA immediately appealed the decision of their own committee. While the decision of the new body was supposed to be produced with all deliberate speed, presumably innate pettiness caused them to drag it out for months. Noakes was finally exonerated. Besides a person of stature in Sports Medicine he is a charming, friendly person — I met him at a landmark conference at Ohio State University just as the final edits on this book were being prepared.

 

The most bizarre case, also in Australia, fell upon Dr. Gary Fettke, an orthopedic surgeon. A letter dated November 1, 2016 from AHPRA (Australian Health Practitioner Regulation Agency) stated:

“There is nothing associated with your medical training or education that makes you an expert or authority in the field of nutrition, diabetes or cancer.”

The training of any physician in nutrition is, in my view, problematic, but it has been pointed out that Fettke received the same training as other doctors. The letter continued:

“Even if, in the future, your views on the benefits of the LCHF lifestyle become the accepted best medical practice, this does not change the fundamental fact that you are not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic as a medical practitioner.”

In short, even if they recognize the truth, they will not defend his right to say it. Many have pointed out that Dr. Fettke is in fact trained to remove the limbs of those whose diabetes has reached a critical point, despite the AHPRA’s attempts to diminish his credentials. This lack of due process and common decency speaks to the need for some kind of regulation. The lack of publicity in traditional media has kept the issue relatively invisible, but beyond that, it is clear why your health provider might not want to buck the system. It would be ugly if such a serious ethical problem came to light. Again, you may have to be your own health provider.”

Update on Gary’s case by Marika Sboros

http://foodmed.net/2018/09/fettke-ahpra-drops-charges-apologises

Possible next blog: A glimmer of hope?

 

Dietitians Association of Australia: Judge, Jury and Executioner?

Jennifer / / Deregistration, Dietary Guidelines, Dietitians Association of Australia

This post focuses on a complaint that was made against me for my recommendation of low carb diets in diabetes management. It was made by another dietitian, lodged with my workplace and later forwarded to the DAA.

In particular, I’d like to highlight how the DAA complaints process worked in my case. It’s important to note that the DAA is a self regulated organisation that is not under the jurisdiction of any independent agency, including the Federal  Government (Federal Health Ministry, COAG, Ombudsman, AHPRA etc) that I could find. It sets it’s own rules, make decisions which may result in personal and financial loss to individuals, all with apparent impunity.

So here’s a chance for the DAA to shine as I take a look at our time together during the investigation into my practice.

The Beginning

A letter from DAA dated 10 September 2014, was sent to me giving notice that the DAA was “in receipt” of a complaint made by another dietitian.

The issues of the complaint were:

A. That my recommendation of a very low carbohydrate diet for type 2 diabetes management is inconsistent with Evidence Based Practice.

B. That a letter from a patient indicates that I dismissed previous evidence based advice* given to this patient and provided contradictory advice, resulting in a confused and disgruntled consumer.

*which happened to be from the dietitian making the complaint

C. The use of patient testimonials on my website for my book. (I promptly removed these and the matter was not brought up again by DAA as an issue of concern.)

In this letter I was also informed that the “complaint” had been referred to the Vice President who had “….. determined that there is a need for investigation under the Complaints and Disciplinary process.”

It was a really unnerving letter to receive because it seemed to imply more than the issues the complainant had raised. For example, the DAA mentioned “….breaches of the Code of Professional Conduct and Statement of Ethical Practice….”. I was unsettled by the tone but nevertheless happy to answer what the DAA saw as “areas of concern”.

Response sent

I thought I did a pretty good job with my response, particularly in providing evidence for the use of low carb diets in diabetes management as asked. I was surprised, however, that I had to point out to the DAA that they themselves, by deferring to American guidelines by the ADA, must also support low carb diets as one  of the options in diabetes management.

But apparently the DAA was not satisfied.

I am not sure why my response was considered inadequate but I received a letter from CEO Claire Hewat on 19.11.2014 saying that, “…you will still be required to provide a response regarding the two areas of concern highlighted already by the Vice President.”

I wanted to reply: “I’ve already provided responses. Haven’t you read them?” but dutifully sent off two further replies: One, Two with more details.

I did however have to ignore what I considered an unnecessarily menacing tone in the DAA letter. In view of the fact I had responded promptly to every request, I think it was unnecessary for the DAA to write, “A general response is not sufficient. If no satisfactory response is received, DAA will progress this case as allowed by our By-laws. You will have deemed to have disengaged from the process and

the material will be sent to a Hearing and Assessment Panel for consideration with or without your input.”

WHOA!!! Where did that come from? A friendly bit of advice to assist a member or barely veiled intimidation?

Oh, but on a more positive note, CEO Claire Hewat finished her letter with the lovely offer that if I required support, “please do not hesitate to contact me”.

Possibly one of the greatest comedic lines in the DAA joke book.

Did I receive a fair hearing?

It has been suggested to me recently that the DAA may have contravened it’s own By-Laws in the handling of my case.

The By-Law for Complaints and Disciplinary Procedures clearly sets out the steps to be followed after a complaint is made.

Firstly, the Chief Executive Office completes an initial assessment of the material gathered concerning the Complaint.

According to the relevant By-law, the INITIAL ASSESSMENT OF THE EVIDENCE states that:

“5.1  The Chief Executive Officer must assess all the information and material provided by the Complainant, the Respondent, itself and any other third party in relation to the Complaint.”

After gathering this information, the CEO is then supposed to discusses the issues with the Vice President, who then determines whether the complaint should be dismissed or proceed.

“All the evidence” referred to is stated to include both the complaint and the response, otherwise it would only be one side of the story. Obviously. And how could the Vice President be expected to make a decision about what is to happen next if she doesn’t have all the information?

Well………..

In my case, CEO Claire Hewat appears to have had a discussion with the Vice Pres after receiving the complaint but BEFORE I’d even been informed that there was a “complaint” against me. Not only that, the Vice President made her decision that there was a need for an investigation rather than any other course of action BEFORE having received, and therefore read, my response.

Anyone smell a rat?

How does that constitute giving due consideration to the complaint and the evidence if I hadn’t yet been given the chance to provide a response to the accusations? Is it possible that I wasn’t being treated fairly?

Anyway, this farce of what could be likened to a Kangaroo Court continued for a while and by the end of the ordeal, DAA’s decision was no surprise.

The Verdict

A letter from DAA dated 21.4.15 informed me of the Board’s decision.

The Board resolved that the complaint from the dietitian had been upheld; they deemed me guilty of professional misconduct (the DAA has refused to specify of what) and I was to be expelled from membership of the DAA.

Also, the Board supported the recommendation to alert relevant authorities such as Medicare, health funds and relevant government departments and  I was informed that my “status” would be noted on the public section of the DAA website. The DAA wrote to the SNSWLHD to inform them of the Board’s finding and I consequently lost the job I had held for over 20 years.

Thanks DAA.

Possible next post:

SNSWLHD directive that “Nutritional advice to clients must not include a low carbohydrate diet”

 

 

Evidence based Nutrition Therapy: who decides?

Jennifer / / Nutrition

Did low carb (or I) stand a chance?

In July 2014 a complaint was made by a dietitian concerning my recommendation of low carbohydrate diets in diabetes management.

This complaint was lodged with my workplaces and forwarded to the DAA office. Specifically it was in regards to what the dietitian considered “..the use of non-evidence based Medical Nutrition Therapy”, in particular the recommendation of “…….very low carbohydrate diets for the treatment of metabolic syndrome, pre-diabetes and obesity.”

Before I get to the nitty gritty of the complaint process and outcome in my next blog, I’d like to explore the question of who actually decides the evidence for Evidence Based Medical Nutrition Therapy, at least in Australia.

Setting the scene

Presently, and for some years, the DAA has had control of the dietetic curriculum at universities, which may help explain why the Australian Dietary Guidelines are still taught even though they do not reflect current science; step out of line and the DAA can suspend accreditation. Which apparently it has done.

A strong evidence base in the teaching of nutrition and dietetics will be a welcome change if and when it happens. A good start may be putting the curriculum in the hands of universities rather than with an organisation that hasn’t moved on much from the ideas expressed in its little pamphlet, “Stop and Think before you Eat and Drink” from the 1970s. Back then the DAA recommended to “Increase your intake of …..breads and cereals” and for 40 years the organisation continued to stick to their “carbs are good” position.

Evidence for this comes from the DAA’s website over the last few years, including the years 2014-2015 when the DAA was investigating the complaint against me that my recommendation of low carb diets for diabetes was not evidence based. Here are some examples of the DAA’s recent views on a variety of topics, downloaded from the DAA website around 2015.

DAA’s views on carbohydrate:

“Carbohydrate is an important nutrient found in many foods.

Carbohydrate is an important source of energy for the body. Try to eat carbohydrate-containing foods in every meal to provide the body with energy throughout the day.”

 

 

DAA’s Smart eating ideas for brekkie:

“A bowl of whole grain cereal with reduced-fat milk and sliced fresh fruit

English muffins or crumpets with some reduced-fat cheese, baked beans or avocado

Untoasted muesli or rolled oats”

DAA’s opinion: Are carbohydrates fattening?

“Foods rich in carbohydrate are an important part of a healthy diet – they’re a source of energy for our body, and fuel for our brain. Many people fear that eating carbohydrate-rich foods will make them gain weight, but if you’re choosing smart*, high quality carbohydrate foods in the right amounts, there’s no need to worry about weight gain.”

*I wonder what the DAA considers a “smart” carbohydrate food?

DAA’s Healthy eating tips for insulin resistance:

“Eat wholegrain foods everyday such as high fibre breakfast cereals, multigrain bread, oats, barley and cracked wheat.”

DAA’s views on carbohydrate and diabetes:

“Foods containing carbohydrate include bread, rice, pasta, noodles, breakfast cereal, potato, corn, legumes, fruit, milk and yoghurt. It is important to include some of these foods with each meal.”

DAA’s views on low carb/ high fat diets for diabetes:

“An argument for the use of the diet can potentially be supported by ‘established principles in biochemistry and physiology’3, however long-term randomised controlled trials with consistent dietary methodology are lacking.

Therefore, this diet type remains controversial – and DAA believes more research is required on the safety and efficacy of such as diet, in people with diabetes and the general population.”

I sought Professor Feinman’s* response to the DAA’s comments on his paper (3) quoted above.

* Richard David Feinman is Professor of Cell Biology (Biochemistry) at the State University of New York (SUNY) Downstate Medical Center  in Brooklyn

Professor Feinman: “It appears that the DAA has superficially read my article and flippantly chosen to dismiss it. As the article pointed out, “the benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication.”

As far as I know there are more studies, including RCT’s, of low-carb diets than any other, and they did well. The constant harping of health organizations that there are insufficient trials is what was called in one of the countries in Gulliver’s Travels “that which is not” because their language did not have a word for lying.

And the continued emphasis on method rather than content is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available.

And seriously, what qualifies the DAA, a member organisation for dietitians in Australia, to say that “this diet type remains controversial”.  Former DAA CEO Claire Hewat declined my offer to discuss the science of carbohydrate restriction when in the process of deregistering Jennifer Elliott for using such an approach with her diabetic clients.”

Not only did the DAA support the regular eating of carbohydrate foods generally, it also displayed an unfathomable opposition to the hosting of a conference on low carb nutrition at the University of Sydney in 2014.

The DAA’s CEO Claire Hewat was involved in this infamous episode when she wrote to the University of Sydney voicing the DAA’s opposition to a low carb conference being held in the university grounds.

The response was that Sydney University supported academic freedom, the conference went ahead and researchers and academics working in the area of carbohydrate restriction were able to present their research despite the DAA’s efforts.

Who knows why the DAA would oppose the hosting of a scientific conference on the benefits of carbohydrate restriction with world renowned experts sharing their knowledge?

And why the DAA, which over the years has received thousands of dollars from it’s partnerships with companies such as Nestle, Arnotts and the Australian Breakfast Cereal Forum, has supported the regular eating of carbohydrate foods for all sorts of conditions, including those of carbohydrate intolerance?

There have been suggestions that the DAA is in bed with Big Food and critics who say that the DAA is little more than a front for the food industry. Journalist Marika Sboros explores these accusations in her excellent article IS DOWN UNDER’S DAA REALLY IN BED WITH BIG FOOD? and encourages people to make up their own minds.

 

Pick the odd one out

A possible example of the DAA’s seeming ambivalence to low carb diets in diabetes management can be found in the DAA’s submission to the Royal Australian College of General Practitioners for their publication “General Practice Management of Type 2 Diabetes”, in April 2016.

 

In the Dietary section of the RACGP document the DAA made 5 recommendations, referencing the 2014 American Diabetes Association publication “Nutrition Therapy Recommendations for the Management of Adults With Diabetes” as the source.

There is an obvious exception. See if you can pick it.

Here is a comparison of the recommendations between the two organisations.

1 (a) ADA: The recommendation for the general public to eat fish (particularly fatty fish) at least two times (two servings) per week is also appropriate for people with diabetes.

(b) DAA: Consumption of oily fish at least twice a week is recommended for the general public.

2 (a) ADA: Individuals who have diabetes should receive individualized MNT as needed to achieve treatment goals,

(b) DAA: People with diabetes should receive individualised medical nutrition therapy to achieve treatment goals

3 (a) ADA: For overweight or obese adults with type 2 diabetes, reducing energy intake while maintaining a healthful eating pattern is recommended to promote weight loss.

(b) DAA: For overweight or obese adults with Type 2 Diabetes, reducing energy intake while maintaining a healthful eating pattern is recommended to promote weight loss.

4 (a) ADA: The amount of carbohydrates and available insulin may be the most important factor influencing glycemic response after eating …

(b) DAA: The amount of carbohydrate eaten and the available insulin may be the most important factor that influences the glycaemic response after eating.

5 (a) ADA: Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes.

(b) DAA: Evidence does not support a particular macronutrient composition to improve glycaemic control.

So far the DAA is mirroring the ADA, which is no surprise since the DAA made it clear some years ago that they don’t do the work themselves but that the “….recommendations of the DAA Practice Guidelines are based on the US Practice Guidelines due to their rigorous development process and also their transferability to the Australian setting.” ref

But maybe only when it suits them?

6 (a) ADA:

“Multiple …… eating patterns can be effective for achieving metabolic goals.”

Eating patterns for achieving metabolic goals include:

  1. Mediterranean style
  2. Vegetarian or Vegan
  3. DASH (Dietary Approaches to Stop Hypertension)/ Low fat diet
  4. Low carbohydrate

 

(b) DAA: Alternative dietary patterns that improve glycaemic control include:

  1. Mediterranean-style dietary pattern
  2. Vegan or vegetarian dietary pattern
  3. Incorporation of dietary pulses (e.g. beans, peas, chick peas, lentils)
  4. Dietary Approaches to Stop Hypertension (DASH) dietary pattern

 

As can be seen, the DAA’s recommendations to the RACGP are pretty much copied from the ADA guidelines, but there is one very obvious omission.

It appears that the DAA do not want Australian GPs to think that Low Carbohydrate diets are one of the “Alternative dietary patterns that improve glycaemic control” as the ADA recommend.

This is despite the ADA going into some detail about the research supporting low carb diets.
“Some published studies comparing lower levels of carbohydrate intake (ranging from 21 g daily up to 40% of daily energy intake) to higher carbohydrate intake levels indicated improved markers of glycemic control and insulin sensitivity with lower carbohydrate intakes (92,100,107–111).

“Some studies comparing lower levels of carbohydrate intake to higher carbohydrate intake levels revealed improvements in serum lipid/lipoprotein measures, including improved triglycerides, VLDL triglyceride, and VLDL cholesterol, total cholesterol, and HDL cholesterol levels (71,92,100,107,109,111,112,115)”

A surprising detour from the ADA guidelines by the DAA? Or not really?

In their submission to the RACGP, the DAA also showed their support for the inclusion of sugar in diabetic diets, and wanted to pass on this “wisdom” to GPs.

On page 8 of their submission, the DAA says: “All sugars do not need to be eliminated. A small amount of added sugar, as part of a mixed meal or food (e.g. 1 teaspoon of sugar/honey added to breakfast cereal), will not adversely affect blood glucose levels.”

I guess when a person with diabetes eats a breakfast along DAA’s guidelines e.g. a bowl of whole grain cereal with reduced-fat milk and fresh fruit, what’s an extra teaspoon of sugar added to the approximately 10 tsp of sugar that will come from the carbohydrates* in their their cereal bowl?

* During digestion, carbohydrates in foods such as cereal, milk and fruit are broken down to sugars, predominantly glucose, which is then absorbed into the blood. Amounts of sugar in the DAA recommended breakfast are: 1 cup of whole grain/high fibre cereal approx. 4 tsp sugar; 1 cup low-fat milk approx. 2 tsp sugar; a small banana approx. 4 tsp sugar.

More details and examples at Eat to Beat Diabetes

Who decides the evidence?

Back to my case. Two different dietitians were enlisted by my workplaces to investigate whether low carb diets are evidence based . The DAA under the leadership of CEO Claire Hewat ran its own investigation.

The DAA has not disclosed the names nor occupations of the people who were on the panel deciding whether or not low carb diets were evidence based, but the DAA board, made up primarily of DAA registered dietitians, had the final say.

At one workplace, one investigator was a DAA registered dietitan and at the second workplace, the investigator was not only a DAA registered dietitian, but also a DAA Board Member at the time.

During the process, Professor Richard Feinman wrote to the DAA CEO Claire Hewat and suggested “…….a discussion, perhaps an online webinar, in which all sides present their case. I and/or my colleagues would be glad to participate.  I have made the point that, analogous to a court of law, evidence must be subject to evaluation of its admissibility. You can’t simply judge the value of your own evidence. I think a real give-and-take would provide both practitioners and patients a chance to truly evaluate the evidence. In this, Ms. Elliott may have given us an opportunity.”

CEO Claire Hewat replied “DAA is interested in and carefully assesses all relevant evidence nor is DAA afraid of debate but this is not the place for it.”

So in answer to the question, “Evidence based Nutrition Therapy: who decides?”, it looks like in Australia it might be the DAA.

Next post: The complaint. The answer. The Verdict.

When what you’ve been taught is wrong: a dietitian’s path to evidence based practice and deregistration.

Jennifer / / Deregistration

Before my deregistration by the Dietitians Association of Australia (DAA) in April 2015, I had been a dietitian for over 35 years. It was only for the last 10-12 years of practice that restricting carbohydrate became a primary intervention for clients with type 2 diabetes and insulin resistance. In this blog, I will take you through the triggers that shifted my practice to include lower carbohydrate approaches.

 

When I graduated in 1979, much of our dietetic training was based on a set of non-referenced, unsubstantiated and untested guidelines, put out by the Australian Dietitians Association, now known as the DAA, in a little pamphlet called “Stop and Think Before You Eat and Drink”. Link to prev blog We were taught that these guidelines formed the basis of a healthy diet for everyone and as far as I remember they were not questioned openly by the nutrition community in Australia back then. And certainly we were not encouraged to do so as students .

We weren’t taught the origins of “beliefs” such as “atherosclerosis is caused by the deposition of cholesterol in arteries”, “saturated fat increases blood cholesterol levels” and that “weight gain or loss is entirely due to energy balance”. We were taught these as facts. And that is a big disadvantage when you come face to face with different facts or opposition. It’s difficult to discuss, consider and assimilate other ideas if you don’t know the strengths and weaknesses of your own.

Basically we went to work as university trained “experts”, to educate people about nutrition with a set of “beliefs” that we didn’t know the background to and could therefore not defend, nor even discuss, rationally and logically. I’m not sure that much has changed and unfortunately often see challenges to our still unsubstantiated and untested diet guidelines being met with emotion and defensive behaviour, which is the usual resort when support from facts, logic or science isn’t available.

1980: entry into the workforce 

After graduating, my first position was at a large teaching hospital in Melbourne, predominately with the diabetes unit. At that time, diet advice to people with type 2 diabetes included recommending daily ‘portions’ of carbohydrate foods; specifically, 12 portions for weight maintenance and 10 portions for weight loss. At that time, one portion was equivalent to 10 gm carbohydrate, which translated into diets containing 100 to 120 gm carbs a day.

Then, in the early 80s, with the flick of a pen, one portion suddenly became 15 gm of carbs and overnight people with type 2 diabetes were advised to up their carb intake by 50%. The main reason for this change appears to be for continuity between Australian States and Territories. It was also considered easier for Australians to translate one portion of carbohydrate into food serves, as 15 gm was closer to the amount of carbohydrate in a regular slice of bread.

Also at this time, the only way patients could monitor their blood glucose was in a clinical setting. Blood-glucose machines had become available in hospitals but being big, expensive, and taking 2 minutes to get one reading, regular monitoring of blood glucose at home was impractical. This left measuring the amount of glucose that had spilled into the urine as the main monitoring practice, and of course was so imprecise that, unlike now, no connection between diet and BGLs could be accurately made.

Break from dietetics

After 3 years of advising patients on the “recommended dietary advice” of that time, as I’d been taught, I took a break from dietetics to start a family. We moved to the country for what we considered a good lifestyle for children; home grown/ home cooked vegetarian meals, little processed foods, plenty of outside play and TV time limited to what my now adult children refer to as “deprivation levels”.

Two of my children thrived in this environment—healthy, energetic and lean—but my middle daughter, Jeanne, was different. She gained weight around the tummy at an early age, seemed to have less energy than her siblings, was a mouth-breather, suffered with reflux and could be moody at times: all signs I now recognise as relating to insulin resistance.

At around 12 years of age she gained a lot of weight quite quickly and by age 14 was borderline obese. And I was at loss to explain why.

I am forever grateful that I was in the right place at the right time to meet a GP whose family situation was remarkably similar to mine; 3 slim, high energy, eat-what-they-like children and one with a weight problem. After hearing about the presence of insulin resistance in young, seemingly healthy children, and not just in people with diabetes as she had been taught, this GP had her daughter tested and suggested the same for Jeanne, who was 14 years old at this time.

A two-hour Glucose Tolerance Test with the addition of 5 insulin measures showed normal blood glucose levels but a high insulin response, fitting the diagnostic criteria for insulin resistance.

My knowledge about insulin resistance was limited to “a connection with type 2 diabetes” but my daughter was not diabetic. How insulin resistance fitted as a diagnosis for a 14 year old with normal blood glucose levels was a mystery to me.

Real learning begins (finally)

A Google search for insulin resistance today brings up over 49 million entries. My first search nearly 20 years ago brought up just over 1 million entries, still enough to elicit the question: “Why hadn’t I been taught any of this?” My nutritional biochemistry lectures had focused primarily on kwashiorkor and marasmus; the aetiology of insulin resistance would have been a useful addition.

And it should have been part of the curriculum because insulin resistance is not a recent discovery. Professor Gerald Reaven and others were investigating carbohydrate intolerance and insulin resistance in the 1960s. Reaven established the importance of insulin resistance in human disease, not only in type 2 diabetes but also in nondiabetic individuals, making the connection between the role of insulin resistance/compensatory hyperinsulinemia and a range of symptoms.

Once I’d narrowed down my search a little and started reading, I found answers to all the pieces of the puzzle and explanations for many of Jeanne’s symptoms: her mouth breathing and snoring; why the weight went on predominantly around her tummy; why she seemed not to have an off-switch when it came to eating at times; her mood swings, reflux and lack of energy.

If the aetiology of insulin resistance had been part of the dietetic curriculum instead of teaching the Australian Dietary Guidelines, I would have been able to offer appropriate advice to clients with type 2 diabetes and known how to improve my daughter’s health at least a decade earlier than was the case.

Carbohydrates and insulin insulin resistance 

After researching insulin resistance and Jeanne’s symptoms, it became clear that higher than normal insulin levels were to blame and that a diet designed to reduce these levels is what was needed. It was also clear that a reduced carbohydrate diet was the way to go. We started experimenting with different diet approaches, and with instant feedback available from what I jokingly called my ‘live-in guinea pig’, I learnt more than would ever be possible from just the literature or in a clinical setting. This experience was invaluable.

The diet we settled on was very low carb during the day, but allowing some carbs in the evening meal. For Jeanne, the eating plan was generally eggs, bacon, tomato, avocado for breakfast; protein and salad at lunch; protein and low carb veggies for the evening meal with some carbohydrate in the form of a small amount of fruit, plain yoghurt or dark chocolate.

This worked well; no excessive hunger, good energy levels, even moods, no reflux and easily maintained healthy weight. Jeanne has now been eating this way for many years and has maintained all those positive changes. She doesn’t think of herself as being ‘on a diet’, because as she says, “This is just the way I eat”.

Advising clients on lower carbohydrate diets

Before I started advising clients on a lower carb approach for insulin resistance and type 2 diabetes, I anticipated the ‘fat’ problem. One of the main arguments against low carb diets is that such diets are higher in fat, particularly saturated fat, which is believed to increase cholesterol levels and lead to heart disease.

Although this is not borne out in multiple clinical trials, where an improvement in lipid profiles is generally observed on low carb diets, observations from the Framingham Heart Study, a long-term and influential research project developed to identify risk factors of cardiovascular disease,should have squashed the misconconception that saturated fat and dietary cholesterol raise serum cholesterol levels before it ever took hold.

Study director Dr. William P. Castelli reported, that “……in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol.” Arch Intern Med. 1992;152(7):1371-1372.

Even with this evidence, I recognised that I didn’t yet know enough to support a case for a higher fat lower carb diet if I had to “argue my case in court” (my benchmark).

To be fully confident in recommending my new lower carb diet approach to clients, I started researching what I, and I believe no dietitians who have qualified since, have been taught; the basis for the diet/heart hypothesis.

The end result of my investigation was the publication of my paper: Flaws, Fallacies and Facts: Reviewing the Early History of the Lipid and Diet/Heart Hypotheses, published in 2014 in the journal of Food and Nutrition Science.

http://www.scirp.org/journal/Home.aspx?IssueID=5519#50455

and confidence that the diet/heart hypothesis is so flawed that it should never have been used as the basis of diet recommendations.

I cautiously introduced the idea of my new approach to GPs in my area in around 2005. I explained in writing, personal discussions and presentations my plan to advise carbohydrate restriction to people who fit the diagnostic criteria of Metabolic Syndrome and were therefore likely to be insulin resistant (high triglycerides, elevated BGLs, central weight, low HDL and high BP); asked that recent biochemistry be provided and rechecked after 3 months to assess effects of the diet; that medications, especially blood pressure and blood glucose lowering medications, be monitored and reduced if required. 

Many GPs supported this new approach, some tentatively at first, and then with more enthusiasm as a result of the positive feedback from clients and the excellent results (weight loss, improved BGLs and reduction in medications) that were seen.

A stand out example of the benefits of carb reduction was reported in one of our patients – a male with type 2 diabetes. After 7 weeks on a lower carb diet he had stopped taking insulin, lost 13 kg and reduced his HbA1c from 10.7 to 7.7 mmol/l. My medical colleagues found this remarkable! As did I.

Charged with Using a “Non-Evidence-Based” Dietary Approach

For over 10 years, GPs referred patients to me because of the diet approach I used and the results they saw in their patients.

In July 2014 a dietitian initiated “an inquiry” into my use of low carb diets in the management of diabetes with my workplace and informed the DAA office of this. The complaint was regarding what the dietitian considered “..the use of non-evidence based Medical Nutrition Therapy”, specifically, the recommendation of “…….very low carbohydrate diets for the treatment of metabolic syndrome, pre-diabetes and obesity.”

In September 2014 the DAA wrote that they were “in receipt” of a complaint, with a specific area of concern being that my “recommendation of a very low carbohydrate diet for type 2 diabetes management was inconsistent with Evidence Based Practice”.

I was confident that the verdict from these investigations would be in my favour, not only because of the positive results clients were achieving, the substantial body of evidence from clinical trials supporting low carb approaches but also because I WAS following the latest guidelines from the American Diabetes Association, as was the DAA recommended practice for dietitians in Australia at that time.

How naïve to think that evidence was all that was required!

Next instalment: Evidence based Nutrition Therapy: who decides?

Dietary guidelines: where’s the evidence?

Jennifer / / Dietary Guidelines

Dietary guidelines are at the core of dietetic training and practice in Australia.

Ask a dietitian a question about your diet and you’ll likely receive an answer based on the guidelines.

Take for example answers from four dietitians when asked if cheese is bad for us. Thankfully all said “no”, but every answer had disclaimers that invoked the Dietary guidelines, either in terms of allowable quantities (2-4 serves dairy per day/a matchbox size for one serve), or fat content (“This is because fat is an energy-dense nutrient and lots of us are overweight, and because a lot of the fat in cheese is the ‘bad’ saturated fat.”) ref

These comments are made by dietitians involved in training the next generation of dietitians and represent one of the many ways The Dietary Guidelines have influenced “beliefs” about nutrition, in this case, of “experts” in the field.

But should the Dietary Guidelines be afforded such a position of influence? Is the evidence base for them as strong as what many dietitians, and others, believe?

Here’s an overview of how dietary guidelines in Australia came into being, which hopefully will add some clarity to the question of whether or not they have a solid “evidence base”.

 

               Evolution of Australian Dietary Guidelines: 1960-2015

 

1960s

Not official nor government endorsed but I remember these gems from the 1960s:

 

 

  1. drink milk because it is good for your teeth
  2. don’t eat too many lollies because they’re bad for your teeth
  3. eat your crusts so your hair will grow curly
  4. Peter’s ice cream is the health food of the nation

 

Professor Richard Feinman once commented that in view of what we have now, these don’t look so bad.

Until the late 1950s, before Government dietary guidelines were introduced, advice on food was pretty general. Emphasis was on liberal intakes of the ‘protective’ foods such as milk, eggs, fruits and vegetables www.ecodietitians.com.au

The next decade saw the beginning of the downhill slide.

 

1970s

This is the time when I thought it would be a good idea to become a dietitian. I began a science degree in 1976 and completed my Postgraduate Diploma in Dietetics in 1979.

 

At around this time the first dietary guidelines made an appearance in Australia.

“Stop and Think Before You Eat and Drink”  was the name of a pamphlet issued in the 70’s by The Australian Dietitians Association, now known as the DAA. This little pamphlet encapsulated what could be assumed to be the organisation’s “beliefs” about healthy eating. These guidelines cannot be considered as evidence-based as there are neither references nor any documentation to support the scientific legitimacy of statements such as “limit the fat in your diet”, “reduce salt intake” and “increase your intake of ….. bread and cereals.” Also unexplained is the change from “exercise moderation in the amount of carbohydrates eaten” to “increase your intake”.

At the end of a 1978 seminar organised by the DAA, the organisation resolved to set up a committee to develop a national nutrition policy. Few responses were received to serve on the committee and the DAA members and Professor Truswell decided to go it alone and as he said“…. draft ourselves a set of dietary guidelines for Australians” ref

Within a mere eight months, this small group of people had not only written “Dietary goals for Australia” but had had them accepted and ready for presentation by the Commonwealth Department of Health.

Quoting from Truswell, two things stood out to me from his account of this time.

  1. “There was no background review of the scientific literature at the time”

You’re kidding, right?

No review of the scientific literature for a professional body such as the DAA for their 1970 pamphlet isn’t great, but for the DAA to support having dietary guidelines signed off for an entire population without demonstrable evidence…how can we have ignored this action for so long?

It does however explain how the whole exercise was done so quickly; reviewing the science is time-consuming.

2. “The setting was conducive to a positive reaction.”

I get the sense Truswell may have thought getting dietary guidelines accepted by government so easily without opposition was a positive thing. This “positive reaction” may have been more a reflection of the audience, which consisted of food industry reps, consumer organisations, dietitians and bureaucrats, than an indication of the strength or soundness of the guidelines.

There was one dissenting voice to passing these dietary goals. The Nutrition Society of Australia opposed the guidelines because: “Some of its members considered dietary guidelines are politics, not science.”

Politics vs science was exactly the situation that was playing out in the U.S., where a congressional forum in 1977 to discuss the adoption of dietary goals, opposition was immense. Many researchers and scientists claimed that it was indisputable that no adequate trials had been undertaken to assess the effects, either positive or negative, of the diet changes being suggested.

This was eloquently stated by Prof E.H Ahrens, a lipid researcher from Rockefeller University, who addressed the hearing. On the proposal for Americans to reduce their fat intake, Professor Ahrens stated that this advice “…… on the strength of such marginal evidence was equivalent to conducting a nutritional experiment with the American public as subjects”.

However, politics and not science won the day. See ref for an excellent review of how this happened.

In answer to his own question as to why the Australian guidelines were accepted so well here, and weren’t met with “…… the spate of criticisms of the US dietary goals …. … or opposition like the British criticisms…..”, Truswell ref suggested the following:

  1. “The scientific nutrition establishment was small and new.”
  2. “Introduction of the Australian goals was well staged and tactfully presented.”
  3. “Australians are more receptive to new food ideas than people in the longer established countries.”
  4. “Dietary guidelines answered a deep need for the emerging profession of community nutritionists/dietitians”

 

So ……. not because the science had been settled?

 

1980s

In 1980 I started work at Queen Victoria Hospital, a large teaching hospital in Melbourne. Like many dietitians then and now, I went out into the world prepared to spread the message I had been taught: a low-fat diet with plenty of carbs as bread, cereals and fruits, is the way to good health. My apologies to every patient I counselled and the students I mentored.

 

It took me many years to see through this brainwashing. It wasn’t until the personal experience of having a child with a weight problem that I was forced to “think differently”. I fear that if this hadn’t been the case, I might have remained ignorant to the potential harm in recommending lower fat, higher carb diets to people who are carbohydrate intolerant . This turned out to be the majority of my clients.

The DAA pamphlet appeared in a second edition in this period. The message was the same and absence of evidence was maintained.

1990s

The 1992 edition of Dietary Guidelines for Australia link was produced by a committee of five nutritionists, one food industry representative, a psychologist and two bureaucrats. It was the first to include references, seemingly in an attempt to retrofit the 20 years of “what to eat to be healthy” recommendations.

In many sections of the 1992 Dietary Guidelines, references were far from comprehensive and appeared to be cherry picked to support each guideline. Or were mistakenly quoted as supportive when that wasn’t the case. Take for example Guideline 3: “Eat a diet low in fat and, in particular, low in saturated fat”

The basis of the demonisation of saturated fat is the belief that it raises the blood cholesterol level, and that a high cholesterol level causes atherosclerosis and cardiovascular disease. This is referred to as the diet/heart hypothesis, and has remained a theory lacking confirmation for over 50 years.

Even so, the unnamed author (or authors) of Guideline 3 attempted to back up the claim that “Saturated fatty acids elevate plasma total and LDL-cholesterol.” by citing one reference as proof.

The problem is that the referenced article is actually the OPPOSITE of supportive. Rather than it lending support to the idea that saturated fat increases cholesterol, it is CRITICAL of the methods used to incriminate saturated fat as cholesterol raising!

How could that happen? Did the author(s) not read the article or not understand it? Whichever the case, since 1992 the recommendation for Aussies to reduce saturated fat intake has been embedded in our guidelines, based on disputable evidence.


2000s

Is it possible to go from bad to worse?

The 2003 review of the guidelines suggests yes.

This decade was the golden era for industries that had anything to do with cereals and grains. It is the time when the recommendation of the Australian Dietary Guidelines was to eat “plenty of cereals (including breads, rice, pasta and 
noodles)”

And by eat “plenty”, they really did mean PLENTY. The recommendation was for women aged 19-60 to have the equivalent of 8 to 18 slices of bread and 10 to 24 for men.

Per day, no less.

How was this decision to recommend eating up to a loaf of bread per day reached? Who was responsible?

In the absence of finding anything directly answering this question, I looked at information ref about the person who wrote the chapter on breads and cereals, Peter Williams.

Peter Williams was a University of Wollongong Associate Professor of Nutrition and Dietetics 2006-2011. His publications include a paper called Report on the health benefits of whole grains and legumes for Go Grains Health and Nutrition Ltd, a paper on The benefits of breakfast cereal consumption: a systematic review of the evidence base. Adv Nutr 5:636S‐683S and a book chapter, Williams P (2003). Eat plenty of cereals (including breads, rice, pasta and noodles) preferably wholegrain. In: Food for Health: Dietary Guidelines for Australian Adults. pp31‐49. NHMRC: Canberra.

Williams was an invited lecturer at the ILSI Australasia and Grains & Legumes Nutrition council Symposium in 2013, on the topic of “The pros and cons of carbohydrate intake in modern Australia and New Zealand – an overview of health effects.

There were commercial consultancies, which totaled $1,292,349 from 2000‐2016,

Prof Williams has received awards from the DAA for his contributions to the profession and in 2010 received Honorary Life Membership.

Professional activities of Williams include :

2002-2003 President, Dietitians Association of Australia

2000- 2003 Member, NH&MRC Dietary Guidelines Review Working Party

2000-2002 Member, the Go Grains Advisory Committee


I must admit to feeling surprised and a little uneasy when I noticed the overlap of time-frames for some of the professional activities noted above.

According to the blurb from the 2003 guideline review, preliminary work started in 2000 and revisions were finalised in 2002.

From 2000 to 2002 Prof Williams was involved with Go Grains, an advocacy body for the Australian grain industry, at the same time as he was writing the chapter for the guidelines titled “EAT PLENTY OF CEREALS (including breads, rice, pasta and noodles)”, which translated into the National advice for adults to eat the equivalent of 8-24 slices of bread per day.

 

2013 – now

With the foundations of our Dietary Guidelines being shaky, and, uncontested, it was no surprise to me that the 2013 review produced “more of the same”. What was disturbing though, was the number of reviewers, senior advisors, working groups, and consultation rounds, and no one was able to pipe up with even one “hang on a minute….”

There were certainly some missed opportunities for this in the latest review. Take for example the evidence statements in the 2013 guidelines for ‘limit intake of foods high in saturated fat’. Instead of this statement being graded on the strength of evidence, or even having a reference, it was simply described as ‘established’.ref

Table 3.1: Evidence statements for ‘limit intake of foods high in saturated fat’
Established evidence
Saturated fat is the strongest dietary determinant of plasma LDL concentration.

How did the brains behind this go from one reference which they thought supported the guilt of saturated fat, but which didn’t, to deciding a few years later that the matter was done and dusted, no references required?

It should be noted that the antipathy towards saturated fat reflected in the Australian guidelines is not shared by international experts such as Arne Astrup, Head of Department of Nutrition, University of Copenhagen.

In relation to a recent review of the U.S. guidelines he writes:

“The [Dietary Guidelines] committee seems to be completely dissociated from the top level scientific community, and unaware of the most updated evidence. There are now several new meta-analysis of both observational studies and also of randomized controlled trials clearly showing that there is no benefit of reducing saturated fat in the diet. All analyses and research can be criticized, but these meta-analyses have been published in leading scientific journals typically after critical reviews by 3-5 independent scientists (including a statistician), and by expert editors, so they cannot and should not be dismissed so easily….Equally important is that the scientific studies that were the basis for the ‘cut down on saturated fat recommendations have been re-evaluated, and it is quite clear that today we would have concluded that there is no robust evidence to substantiate the advice.”

And James DiNicolantonoi (Saint Luke’s Mid America Heart Institute) wrote:

“Problem three is that there was never any evidence to demonize saturated fat per se back in 1977 in the original Dietary Goals…”

—Quoted in Cardiobrief

                                                                          

Where to next?

I subscribe to the concept “one can criticise without having to offer solutions”, however, I feel it fair I do as a nutritionist, and on behalf of the health of Australians.

 

 

 

My preference is to see the scientific, social, and political communities make an admission the guidelines have been a disaster and to scrap them.

In the event that doesn’t happen and we have a repeat waste of taxpayer’s money for another review in a decade or so, at the very least my hopes are:

  1. The DAA does not win the tender, and has limited involvement in the review.
  2. Any person with ties to the food industry is excluded from participating.
  3. A person who has reviewed a chapter/guideline previously is excluded from future reviews. An exception may be made for those of strong character who are able to admit to stuffing things up in the past and genuinely want to do better.
  4. And most importantly, my wish is for the possibility of harm to be seriously considered for the first time. Not only have these guidelines not met their objective of improving health, there is a good case that they have likely caused harm to hundreds of thousands of people.

Rates of obesity and type 2 diabetes have risen dramatically. Children as young as 10 yrs are being diagnosed with type 2 diabetes. It has to be considered whether the advice to “eat less fat/plenty of carbohydrates” is implicated.

It may be that because the intention behind the guidelines was good ie to improve health, that harm has never been considered. After 40 years and deteriorating health, it’s about time it was.

Coming soon

Undoing the brainwashing: my road to recovery.