The world is changing fast and to keep up you need local knowledge with global context.
When Canadian physician Dr Jay Wortman realised he was diabetic 12 years ago, he cut carbs (sugars and starches) from his diet to ‘buy time’ before deciding what medication to take. He was amazed, and hugely relieved, to find that all his symptoms disappeared within a few days, never to return. He doesn’t say he is ‘cured’ in the conventional sense. He does say that he is without any symptoms of the condition, which he says is as close to being cured as it’s possible to come. He knows if he goes back to his old eating habits, the symptoms will return, and he will once again be diagnosed as having type 2 diabetes.
Wortman was a speaker at the recent low-carb, high-fat summit in Cape Town in February. He is a public health specialist, and clinical assistant professor at the University of British Columbia’s faculty of medicine, where he studied the effectiveness of a traditional-style diet for obesity, metabolic syndrome and type 2 diabetes in the Namgis First Nation. His research became the subject of the hit CBC documentary, My Big Fat Diet (to view it on YouTube, scroll down below). Here is a summary I compiled of his presentation to the summit: Ketogenic diet for obesity, metabolic syndrome and diabetes. It includes his personal story. – MS
From Jay Wortman
We have a healthcare system that doesn’t care about nutrition and a food system that doesn’t care about health.
Recent research is showing us that everything we thought we knew about nutrition is wrong.
Major food corporations produce foods comprised of three ingredients –refined grain, sugar and seed oils. Together, this toxic mix is driving the chronic disease epidemics the world is experiencing.
I’m going to talk about my personal journey into the traditional diets of indigenous people. I have become fond of traditional food gathering.
I grew up in the far north of Canada, where the sun doesn’t shine much in winter, and shines all day in summer. I was born in one of the first fur trading setllements in Western Canada. As a young child, I remember a trapper who was visiting my grandmother’s home pulling out a piece of smoked dried moose meat that kept me busy chewing it for an hour. I remember how good it tasted.
Traditional diets have changed, and with it people’s health. Both my grandparents developed type 2 diabetes. They had nine children. All developed diabetes or heart disease or both. My mother has type 2 diabetes as well as breast cancer. Of her four children, three of us have developed type 2 diabetes.
I remember the day I discovered I had type 2 diabetes. I was fatigued, had gained weight, was urinating more frequently and had blurry vision. I thought these were the natural effects of ageing even though I had a family history and genetic predisposition.
Although I should have seen it coming, it was a profound shock when I realised I had type 2 diabetes. As a doctor, I knew too much. I had a young child, and it struck me that my life expectancy could be much shorter.
I knew nothing about nutrition, but I knew that carbs raised blood sugar. I wanted to buy some time to decide which medication I should take so I surreptitiously stopped eating carbs, and tried to hide it from my wife, so as not to worry her. When she noticed I had stopped eating carbs, she said: “You’re on the Atkins Diet, dummy.”
My recovery was miraculous. Over the ensuing days, all my signs and symptoms disappeared and my blood sugars normalized. I started losing weight at a rate of about ½ kilo per day.
I was working with the Canadian aboriginal population at that time. They had very high rates of diabetes and had very recently made major changes in their diets. I started researching traditional diets. I discovered that the traditional diets were low in carbohydrates and virtually every traditional diet had a centrally important fat:
- Coast Salish – they ate oolichan grease, from a small fish, staple highly valued food used as a condiment and medicinal; it accounts for more than 25% of calories in the diet of current users.
- Northern First National – bear moose fat
- Inuit whale fat
- Plains First Nations – pemmican
- Innu – caribou fat
- Australian aborigine – emu fat
Their diets have shifted from low-carb high fat and moderate protein to a majority of carbs and the worst possible kind. It isn’t any wonder that they are now leading the epidemics of diabetes, obesity and metabolic syndrome. This change has occurred over a very short time frame.
We designed a study, trying to do something different, because clearly what we were currently doing to manage these problems wasn’t working. We approached a small Aboriginal community and suggested they try on a low-carb, ketogenic diet based on their traditional diet. People lost weight and improved their metabolic syndrome and type 2 diabetes.
The project was the subject of the Canadian Broadcasting Corporation documentary film, My Big Fat Diet.
I began to realise that there was a continuum of health problems linked together:
We make artificial boundaries, but underpinning them all is insulin resistance. It’s not my original idea. A report in the Journal of Internal Medicine in 2000, said: “The Metabolic Syndrome is synonymous to an iceberg with glucose intolerance above the surface but a group of other key cardiovascular disease risk factors lurking below.”
These are: insulin resistance, hyperinsulinaemia, central obesity, dyslipdaemia, hypertension. This is known as metabolic syndrome and it means increased risk of type 2 diabetes and heart disease. I would add that a bigger part of the iceberg is obesity.
There are other conditions associated with metabolic syndrome and type 2 diabetes:
- NAFLD (non-alcoholic fatty liver disease)
- sdLDL (small dense LDL cholesterol)
- Oxidative stress
- Polycystic ovary syndrome
- GERD (gastroesophageal reflux disease)
- Sleep apnea
Dr Gerald Reaven, endocrinologist and professor emeritus in medicine at the Stanford University School of Medicine, showed in 1997 that the basic defect in Syndrome X, as it was called the, is insulin resistance. Furthermore, he noted that eating carbohydrates with this condition, led to increased production of insulin and hyperinsulinemia.
Our current approach is the shotgun of medication, the polypill. There are about 25 classes of medications used to treat metabolic syndrome and type 2 diabetes:
- Blood sugar control: sulfonylureas, meglitinides, biguanides, TZDs, alpha-glucosidase inhibitors, SGLT2, DPP-4 inhibitors, insulin.
- Blood pressure control: ACE inhibitors, diruetics, beta-blockers, vasodilators, calcium channel blockers.
- Cholesterol control: statins, niacin, bile-acid resins, fibric acid derivatives, cholesterol absorption inhibitors.
- Coagulation control: aspirin
- Inflammation control: (statins)
- Weight control: SNRI, pancreatic lipase inhibitors, appetite suppressants.
Polypharmacy and money are involved in managing these problems.
Prevention methods have involved telling people to eat less and exercise more. But research shows that fat in the diet is not the primary cause of weight gain and associated problems.
A large meta-analysis was conducted by Harvard researchers which found:
- no association between national percentage of energy from fat and median body mass index in (European) men … fat intake varied from 25 – 47% of energy
- in 65 counties in China, no correlation … dietary fat from 8 – 25%
- fat consumption within the range of 18 – 40% of energy appears to have little if any effect on body fatness
- clear inverse relationship was observed in European women
- diets high in fat are not the primary cause of the high prevalence of excess body fat in our society, nor are reductions in dietary fat a solution.
Even the huge Women’s Health Institute study could not show a benefit from reduced total fat and increased intake of veg, fruits and grains. Clearly it is not dietary fat that is driving insulin resistance and diabetes.
An alternative paradigm suggests that an imbalance of hormones is at the root of these problems.
Sugar is toxic out of the normal range in the blood. The body goes to extraordinary lengths to keep it in normal range. When you take in a huge amount, say from a banana, with waffle and syrup, the body suffers a metabolic emergency, trying to dispose of the toxic stuff.
Insulin is secreted in large quantities to deal with a high carbohydrate intake. It pushes fat out of the way, and pushes glucose to the front of the queue to be burned.
The body is not burning glucose because it likes glucose as a fuel. It is burning glucose because it is toxic. In the liver insulin takes excess glucose in the blood and turns it into fat. In the adipose tissue, insulin pushes fat into the fat cells and won’t let it out. All of this is done to keep blood sugar in the normal range by disposing of excess glucose.
Another hormone involved is leptin, the messenger from fat tissue to your brain that tells you can stop eating. In people who are IR, the leptin signal does not get to the brain. Because they have high insulin levels, the insulin acts as a leptin antagonist.
When the brain does not receive a leptin signal, it interprets this to mean you are starving. All animals react the same way, when they are starving, they conserve energy and they seek food. The same thing happens with humans. It’s a primitive survival signal.
Our prescription is to tell people to get their sorry butt off the sofa and go jogging and stay away from the fridge. Some people can overpower these primitive survival signals telling them to do the exact opposite, but most fail.
The conventional medical paradigm to explain obesity and associated conditions has been the energy imbalance, calories in, calories out theory: Increased calories + decreased activity make you fat.
All the experts agree.
The WHO has said: “the fundamental cause of obesity and overweight is an energy imbalance between calories we consumed on one hand and calories expended on the other hand.”
The UK Medical Research Council has said: “Although the rise in obesity cannot be attributed to any single factor, it is the simple imbalance between energy in (through the food choices we make) and energy out (mainly through physical activity) which is the cause.”
But it is not about calories. It’s about which food you eat.
In my paradigm, the target for intervention is not calories, it’s carbs.
Studies that properly administer a carbohydrate-restricted diet demonstrate:
- significant weight loss
- correction of insulin and leptin resistance
- normalization of blood sugar
- normalization of blood pressure
- normalisation of cholesterol
- reduction in inflammation
Scientists have tried to tease out the variables to show how low-carb diets work to achieve weight loss. It hasn’t been easy because there is a reluctance to fund low-carb research. Some researchers invented other names for low carb diets, such as the Lo-BAG diet, to get funding. They conducted a number of studies which showed that diabetic control improved dramatically on a low carb diet, even without weight loss.
This is a case study of a 48 year old First Nations man with type 2 diabetes. He had:
- hypertension, dyslipidemia
- history of stroke
- was on insulin for 17 years
- Humulin N 25u, R 3-5u qid
- Ramipril 10 mg
- fasting glucose 9 – 10 mmol
- weight 291lbs (135 kg)
- begins carbohydrate restriction
Within two weeks he had a weight loss of 17 lbs (8 kg) , normal blood glucose and was able to discontinue insulin. By 18 weeks he had a weight loss of 46 lbs (21 kg), and all his markers were normal: glucose, BP cholesterol and he was off all medication.
The intervention is simple. We advise patients to avoid starch, sugar and vegetable oils. Eat fewer carbs, more natural fats and protein,
There is a growing research interest in low-carb ketogenic diet now. Studies are looking beyond diabetes and metabolic syndrome now. There is promise that LCHF diet may be therapeutic for conditions including
- Brain injury
- Parkinson’s and more.
It is clear that the belief that a low-fat diet is healthy is not based on good science. We began telling people that fat was the primary cause of heart disease, and a food can’t make you fat if it doesn’t have fat in it. That just led us to eat more carbohydrate foods, and sugar. That’s the driver.
We need to go back to the balanced diet of our ancestors.
- Watch My Big Fat Diet here:
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