Wednesday, December 13, 2017

Diet Wars

It's unquestionably a sign of our times...the lack of mature,sensible and calm debate. The world of health is no different- and noticeably evident in recent debates about the relevance of diet. The views are absolute, there is no budging...and even if that be an admirable trait in some eyes, what hasn't been edifying is seeing the unfettered vitriol which comes with it.
The debate about low carbs and its efficacy in helping with diabetes (yes, all types) has been going on for some time...but recently seems to have slipped into a different gear with the publication of the DIRECT study. That study has been more about low calories followed by primary care based support- rather than low carbs- and the data is there for anyone to interpret. What however has been fascinating to see is believers in the science of low carbs use exactly the same tactics that they have, sometimes rightly, accused others of. The tactic of sneering at research which doesn't fit a view, the view that it needs to be discredited, rather than be seen as yet another option for the average Joe on the street.

Now I will be honest- as many advocates of low carbs will know too,I have no issues engaging with anyone- and I have- whether it be with Aseem Malhotra, David Unwin or indeed the folks at  such as Charlotte & Arjun. I share cordial relations with all- as I see its potential and I also see that it may indeed work for some indeed. By the same token, I also have met Roy Taylor and Mike Lean, the brains behind the DIRECT study in an effort to understand what possible application can be brought to bear in real life- and perhaps seen as yet another option. By the very same token, I also met with the British Dietetic Association too...because give or take? They are all allies to me - giving ideas about what may help the population. As I would with anyone who brought another diet to the table which they believe will improve population health.

There is however a need for a reality check too. Albeit perhaps tongue in cheek, David Oliver makes a very relevant point about the #Carbsnatchers of NHS England. In a policy role, there is a need to strike a balance between what can and should be mandated (smoking in public places is a good example) and what interferes with personal choice. Is it about mandating or is it about giving people the information- and then letting them choose? And where does socioeconomic deprivation fit in with amount of carbohydrates in your food?

Either way, a rational debate is needed...simple mudslinging is likely to achieve little. Comments such as "if you don't eat low carbs, you will have your feet amputated" ...well..I am not sure who that actually helps.I have never been a big fan of shroud waving. There needs to be an acceptance that there maybe folks who consciously choose NOT to adapt a low carb or low calorie diet- that could be an individual call or driven by economy. It's not right to judge others when you don't live their lives.And I have had my share of abuse- as sizzlingly racist as they can get- specifically from the low carb lobby. What has fascinated me is the passion that drives such people to send things like that. I tweeted about it...condemnation from the big guns of low carb lobby? Miniscule - I saw it as tacit encouragement to the hordes...the problem is..if that's how you engage with national policymakers, then the chance of impacting on policy...well...minimal is the word I am looking for. What drives individuals to champion something to such an extent that it crosses all threshold of decency, ignores any science, feeds into the ethos that experts either know nothing or just corrupt? What creates this aura of being self appointed vanguards of public health...I mean , if you want to impact change, why do so from the outside? Why not apply to Public Health and join? Engage in a rational manner and make the case?

A personal viewpoint, if I may? I read regularly and would say am a reasonably informed person. So what diet I undertake to reduce my risk of type 2 diabetes should and is down to me. I have always loved my food and desserts but as time has passed, I am more aware and conscious - but that doesn't mean I have given up on things I have always loved. It's also about what I can afford. It's also about what I can sustain and feel well with. It doesn't matter if YOU feel great being on any new diet, what matters is how I feel on it after trying it. It's about perspective.

At a policy level, we are indeed looking at all the evidence and perhaps a change in guidelines will happen- engage with the process in a sensible adult like fashion and there are enough people willing to listen. And as much as it may be surprising, no, there isn't some Bond-villain style conspiracy going on. You can't impact change by simply being reactive and angry- it's more about winning over people, not continuing in a bubble of folks who believe the same.

And genuinely? If you want to improve diet and create a healthy population, we should perhaps concentrate our efforts on access to the right food- which links with socio economic deprivation. When you are sleeping rough, shivering in the cold, it's not the low carbs or low cals which are at the foremost of your thoughts. A tin of baked beans or a packet of crisp feels like a gift from heaven. 
We would do good to bear that in mind - before tweeting our righteous anger from a smartphone, while comfortably tucked up in a nice warm house- enjoying the blessings life has provided us with.


  1. One reason low carb proponents can be vociferous is due to a significant number of health professionals refusing to accept that low carb can work v well for some individuals despite improved health.
    My initial professional health guidance on being diagnosed t1d was 'eat less sugar'and nothing else!

    1. Vociferous is absolutely fine- I myself am a big advocate of many things such as making sure type of diabetes clarified, hospital safety better for those with diabetes etc etc
      However, that should not result in lack of professionalism or abuse

    2. I am yet to see a single person deny the low carb works for weight loss. What people get frustrated at is the claims the low carb can cure things like cancer, that calories dont matter etc or that people follow the guidelines and that is why they are obese.

      The other main issue is quite a few prominent low cabrers associate themselves with know quacks. This lessens their credibility and harms their cause.
      The low cabr ring leaders need to stop isolating themselves like this and re-integrate into mainstream science and solve the problems from within. Rather than write books, run studies etc.

  2. The most evangelistic proponents I have come across seem to be those who had an absolutely terrible time with the standard dietary advice they were given. Some having gained weight, others struggled with disastrous BG levels, others seeing the onset of complications. When they discovered 'low carb' and it transformed their experience their n=1 was absolutely unequivocal, and it is some of these people who feel almost betrayed by their HCPs (and mainstream dietary thinking) and who can then eagerly buy-in to the conspiracy theories, and subsequently rail against any other opinions. The fact that it would not work exactly as effectively, or be as eagerly adopted by absolutely everyone seems impossible to them.

    I know people for whom low carb is an essential stragegy, and had been for a decade or more. I know others for it does not seem to work, or is simply not sustainable.

    Personally I think moderation in general, and flexibility of approach tends to be more successful.

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  5. I agree with the comment about not associating with quacks. It doesn't look good and I for one wouldn't do it. However, some of them (the associators) might reply, correctly, that the quacks who try to be scientific, often have a lot of what they say, correct, in contrast to the powers that be who can be quite wrong in the same stuff. Still better to stay away from them.
    You will hear chaps like Mercola rabbiting on giving detailed opinions about this and that, and no-one asks.. How do you KNOW that? And of course that is essential. Some of what may be quackery has a serious ring of truth about it, but is unproven. What's very striking is the variation from country to country of diseases like colon cancer, or ischaemic heart disease. There are so many variations in potential factors like sunlight, vitamin availability, social interaction, clean water, pollution, exercise, relaxation and sleep that they are a Gordian Knot of a puzzle.
    Dr.Garry Lee.