Thursday, January 23, 2020

Retrospective #341: “Obesity is Protective,” says Jason Fung, MD

“Obesity is not widely considered a protective mechanism,” Jason Fung began a 2016 blog post. “Quite the opposite,” he says. “It’s usually considered one of the causal factors of the metabolic syndrome and insulin resistance.” Lamentably, most physicians think this way. In large part it is what government research, insurance reimbursement and medical association Clinical Guidelines are predicated upon. And so it is the Standard of Care of most physicians. Who can blame them for believing it?
Jason Fung, however, is a thinker (and a Canadian nephrologist), and he boldly has freed himself from those constraints – like south African Tim Noakes, and Australian Gary Fettke both of whom fought and won in court, and John Ludkin (UK) and Robert Atkins (U.S.), who were cast out by their profession. The list of heretics is long, including Vilhjalmur Stefansson from the 1920s.
Science writer Gary Taubes started it all again in 2002 with his “What If It’s All Been a Big Fat Lie,” and later his seminal tome and magnum opus, “Good Calories, Bad Calories” (2007), whose audience was medical professionals. But Jason Fung also deserves singling out because he is a trailblazer. And unlike Gary Taubes’s GC-BC, Jason Fung’s “The Obesity Code” (2016), is accessible.
“I think obesity is a marker of disease,” Dr. Fung continues, “but ultimately it serves to protect the body from the effects of hyperinsulinemia. Let me explain.” Fung then references a 2016 New York Times article by Gina Kolata about a rare case of a genetic disorder called lipodystrophy (a lack of fat cells). Fung calls this case “very interesting” and goes on to explain how it relates in a causal way to metabolic syndrome and insulin resistance. It’s a fascinating hypothesis. In an earlier blog post he calls it the new paradigm of insulin resistance.
“We need to understand the new paradigm of insulin resistance to understand how insulin resistance, obesity, fatty liver, and fatty pancreas are actually all the different forms of protection our body uses. But what is the underlying disease? Hyperinsulinemia,” Dr. Fung says.
Fung then elaborates further upon the physiological mechanisms of action that the body uses to protect itself from these manifestations. His writing style is easy to follow – just ignore the charts and figures and follow the prose. You’ll get it, I promise. And, if you seek this knowledge and understanding, it’s a worthwhile read.
However, if you want to cut to the chase – the bottom line – these excerpts from Fung will spell it all out for you:
“There are many possible causes of too-much-insulin, but one of the major ones is excessive dietary intake of refined carbohydrates and particularly sugar.
“Insulin has several roles. One is to allow glucose into cells. Another is to stop glucose production and fat burning in the liver (gluconeogenesis). After this stops, then it stores glycogen in the liver and turns excessive carbohydrates and protein into fat via de novo lipogenesis. Insulin is basically a hormone to signal the body to store some of the incoming food energy, either as glycogen or fat.”
“There are two main problems with metabolic syndrome: Glucotoxicity and insulin toxicity. It does no good to trade the increased insulin toxicity to reduce glucotoxicity. That’s what we do when we treat people with insulin or sulfonylureas. Instead, it only makes sense to reduce BOTH glucotoxicity and insulin toxicity. Drugs such as SGLT2 Inhibitors do this, but diet is obviously the best way. Low Carb diets. Intermittent Fasting.
In the end, obesity, fatty liver, and type 2 diabetes and all the manifestations of the metabolic syndrome are caused by the same underlying problem. NOT insulin resistance. The problem is hyperinsulinemia. It’s the insulin, stupid.
“The power of framing the problem in this way is that it unveils the solution immediately. The problem is too much insulin and too much glucose. The solution is to lower insulin and lower glucose. How? Nothing simpler. Low Carb, High Fat diets. Intermittent Fasting.”
Dr. Jason Fung has really nailed it here. I wonder how long it will be before he is tarred and feathered and held in infamy by his chosen profession. As Richard Feinman says in “The World Turned Upside Down” (2016), being heretical is the price to be paid for being right. Or, has the profession begun to turn the corner…and seen the light? Naaaw…

Wednesday, January 22, 2020

Retrospective #340: “Obesity is a hormonal imbalance…”

Obesity is a hormonal imbalance, not a calorie one,” is probably a quote from an online post by Jason Fung, MD. I scribbled it down on a Post It©. I’ve written about this imbalance – specifically the way that an elevated blood insulin level blocks fat breakdown (lipolysis) and results in fat build-up (de novo lipogenesis) – many times, most recently in Retrospective #339 and #328. To my constant readers, it must seem like a tired refrain, but to everyone else – basically the entire rest of the world – it’s new information, so it bears repeating.
How is this relevant to those of us who are overweight or obese? We became that way not because we were gluttons, but because we were hungry. We might even have overeaten (with all its attendant guilt), or eaten over frequently, because our bodies told us to – that we needed food to maintain energy balance (homeostasis). We took that “energy in” by mouth (from “food”) because our hormone insulin level was elevated and prevented our bodies from gaining access to our internal source of stored energy: the food stores (fat) that it put away for that purpose.
An elevated insulin level blocks body fat breakdown because our brain gets the message (via other hormones) that we don’t need to use stored energy; we have energy (glucose from carbs) flowing in our blood (with the transporter hormone insulin) from food by mouth, digested and circulating in our blood but not yet taken up by your cells. This other role of insulin is especially relevant for people beginning to get insulin resistance, the hallmark of a pre-diabetic. It is even more relevant for a diagnosed Type 2, who is by definition Insulin Resistant. Insulin resistance is where the pancreas makes more insulin to help push glucose into cells…and the insulin level stays high a long time.
So, what are the implications of this for someone who is maybe heavier than he or she wants to be? To draw from Jason Fung again, “Fasting is about reducing insulin.” With a reduced level of insulin circulating in your blood, your body can now switch naturally to burning body fat for energy. Your body now has access to your energy stores, and since it is being fed by them, you will not be hungry. Your body will be in energy balance. And it will remain in balance so long as you refrain from eating, (fast), or eat Very Low Carb, and you have body fat to burn. As Jason Fung says, “If you don’t eat, you’ll lose weight, guaranteed!” Pithy, huh? Jason Fung has a way with words. I’m not sure where I found these other scribbles, but it was probably also in his blog, “Intensive Dietary Management,” or in Jason Fung’s very good book, “The Obesity Code” (2016).
Then, there’s another important ramification of running on body fat, via fat-burning mode made possible by a lowered blood insulin level: Your metabolism doesn’t slow down. Why is this important? Because if your body (at the cellular level) senses that you have restricted “energy in”, either by eating less (by mouth) while blocking access to stored energy, it will adapt to this calorie restriction by reducing your energy expenditures. Your metabolism will slow down. I’m not sure where I first read about this important point, but I think it preceded Jason Fung! He does makes the analogy, though, of a household budget. If you have less to spend, the rational thing to do is to spend less. The body is a rational mechanism.
The scientific insight into this physiological phenomenon has been around for a while and is widely accepted by medical researchers. It is also widely understood by dieters. People who restrict their food intake by mouth, and eat a balanced diet, by so doing restrict their access to body fat stores. As a result, they are always hungry because there IS an energy deficit. They ARE literally starving themselves. And the body slows down to compensate. Then, when given the opportunity, it engorges itself and restores its natural metabolic rate, and you regain the weight.
Conversely, when you are fasting, or you eat Very Low Carb, your blood insulin level lowers and your body has full access to and feeds on its fat stores. Thus, the body’s energy level remains high. Your metabolic rate is constant and you have full energy. You’re not hungry, because your body is being fed. It’s a nice place to be.

Tuesday, January 21, 2020

Retrospective #339: Low Carb? “It’s not a diet,” I blurted

Those in the know – the cognoscenti – know that eating Low Carb, or Very Low Carb, is not a diet; it’s a Way of Eating (WOE). And in the parlance of the medical establishment (skewed to my purpose), it’s a lifestyle change.
It’s also true that if you make this lifestyle change – that is, follow this WOE – you will lose weight – lots of it – but that’s only a secondary or “side” effect. Of course, you might, as happened when my doctor suggested I try Very Low Carb, make this change for the purpose of losing weight, but, even if that was your primary motivation, the effect on your general health, in many respects beyond weight loss, will be much broader than just the lost weight: e.g., lipids (cholesterol), blood pressure (hypertension), and chronic systemic inflammation markers like hsCRP.
It’s worth noting, however, that in “prescribing” Very Low Carb (VLC) my doctor didn’t know this. The idea may have crossed his mind, though, because as he walked me down the hall to schedule my next appointment, he put his hand on my shoulder and said, “Dan, this might even help your diabetes!” I was then, in 2002, morbidly obese and had been a diagnosed Type 2 diabetic for 16 years. That was 18 years and 150+ pounds ago. But within a day of starting VLC, I had a hypo. Doc immediately took me off the 3rd class of oral meds that he had just started. The next day, after another hypo, he cut the other two “maxed out” orals in half, and a few days later he had to cut them in half again!
So, I guess it’s fair to say the Very Low Carb WOE did help my diabetes, as my doctor thought it might – even though that was NOT the reason either he put me on VLC or I agreed to try to do it. We both wanted me to lose weight – he because he thought (wrongly) that obesity was a “risk factor” and possibly a “cause” of Type 2 diabetes. In fact, as doctors “in the know” now understand, it is Insulin Resistance that causes both Type 2 diabetes and obesity.
If it makes sense that eating low carb is a safe and effective way to lose weight, as is now accepted by most medical researchers, clinicians, food writers and even, lately, the American Diabetes Association (ADA), doesn’t it make sense that eating a high carb diet is how we got fat in the first place? That’s how beef is “finished” (fattened) on the “feed lot.” Surely, you’ve heard that. They are fed corn from a trough for weeks on end! So, why does government still push a high carb diet on everyone – one size fits all – even the Insulin Resistant, Prediabetic and Type 2s among us?!!
If you’re genetically predisposed, a diet very high in carbohydrates –  say 60%, the exact percentage on which the % Daily Value recommendation is based on the USDA’s Nutrition Facts panel – especially carbs that are processed and refined – it will overload the liver and the insulin receptors on the surface of cells that take up glucose. The overload results in backup which results in Insulin Resistance in destination cells, and conversion of carbs to FAT in the liver.
How? The pancreas responds by secreting more insulin to help the destination cells take up the glucose, producing thus an elevated level of insulin circulating in the blood. In the liver, when it’s full glycogen (glucose in the storage form), it makes fat. And when the brain gets the signal that there’s an elevated level of insulin circulating (to help the resistant cells take up the glucose it is transporting), it sends the message that the liver doesn’t need to break down body fat for fuel. It can continue to run on all that glucose “going around.” Instead of burning fat, we add (store) fat.
Then, eventually with all that insulin circulating, the glucose gets taken up and your blood sugar crashes. Your body now needs, indeed it craves more fuel to maintain a steady energy state (homeostasis). But with your insulin still elevated, and access to body fat blocked, your hunger can only be satisfied by eating. Your chance to burn body fat to maintain equilibrium is lost. When you then eat or drink to satisfy your hunger, with your liver already full of stored glycogen, everything that is not burned for energy is converted to fat. The process is called de novo lipogenesis.
If you’re lucky, you’ll just get fatter. If you’re not, you’ll start to develop Non-alcoholic Fatty Liver Disease (NAFLD).

Sunday, January 19, 2020

Retrospective #338: Moí? Grumpy or Grouchy?

“Claiming a math ‘block’ just doesn’t cut it with me,” I told a friend whom I’m mentoring…and she shot back, “You might have an empathy block.” Apparently, I had touched a nerve, and I deserved that riposte.
She wasn’t through with me, though. She then raised another issue. She said that I said that exercise “makes me ‘grumpy or grouchy.’” I replied that I had said no such thing. I said exercise makes me sweaty and hungry, to which she replied, ‘Okay, I’ll give it to you. I stand corrected and apologize,’… but then she added this zinger: “Why would I think of you as ‘grouchy and grumpy,’ I wonder?” Hmmm…That got me to thinking.
Years ago, I helped the circulation of a couple of local weekly newspapers by writing a “Letter to the Editor” every week during heated debates over issues like school district capital budgets and land use issues. One issue was a zoning change to permit quarrying in a rural residential district. Apparently, my letters were such a boost to circulation that the editor-in chief of one of the papers and the publisher of anther invited me to write a weekly column. The editor actually suggested a title: “The Country Curmudgeon.”
I declined. I didn’t think of myself that way, but I was dismayed that others thought of me as curmudgeonly. I was just trying to shine a light, I thought, on what was “wrong” for our community. My goal was to educate and thus influence the reader (and voter) on these issues. In the school district’s capital budget, I was a community member of the School Board’s Facilities Committee and faithfully attended weekly meetings to be informed and participate. My letters were pretty edgy though. One critic fairly and accurately called one of them “vitriolic.”
So, I am continually wary of being overly negative about nutrition. I do, however, occasionally rant about a particularly egregious pitch for some so-called “healthy” processed food. And I am angry, most assuredly with good cause, at our government, especially the USDA/HHS and the ADA, the AHA and the AMA. The reason is simple, as Dr. Tim Noakes explains #334, “A Unifying Hypothesis of Chronic Disease, Part 1,” and particularly in his pithy #335, “Gerald Reaven's Unified Hypothesis, Part 2.” Almost nobody read them, but they were among the best I have published. Read them! You won’t regret it, and you’ll thank Dr. Tim Noakes for his courage in writing about Reaven.
So, if I occasionally express a little anger and use a little invective, or even if I’m at times “vitriolic,” and that equates with “grumpy and grouchy,” well, that’s a price I’m gonna have to pay. As Evelyn Stefansson, wife of the famous arctic explorer Vilhjalmur, said, in the preface to Richard Mackarness’s 1958 book, “Eat Fat and Grow Slim,”
“Stef used to love his role of being a thorn in the flesh of nutritionists. But in 1957 an article appeared in the august journal of the American Medical Association confirming what Stef had known for years from his anthropology and his own experience. The author of this book has also popularized Stef's diet in England, with the blessing of staid British medical folk.
“It was with the faintest trace of disappointment in his voice that Stef turned to me, after a strenuous nutrition discussion, and said: "I have always been right. But now I am becoming orthodox! I shall have to find myself a new heresy."
You should really read Evelyn Stefansson’s entire 1-page preface (Retrospective #151). It’s an homage to her husband, the famed explorer-anthropologist Vilhjalmur. I wrote about him in “Stefansson and the Eskimo Diet” (Retrospective #61). If you don’t know his story, that’s another link I encourage you to read. Stef was “right,” and after a year on a special diet of just fatty meat and offal, the medical doctors of Bellevue Hospital had to admit it.
Well, I haven’t gone to those extremes, but as Vilhjalmur did, I have improved my health tremendously, by eating a diet of very low carb, moderate protein, and fat (mostly saturated). I’ve been doing it for 18 years, and I feel great!
N.B.: Stefansson's "Eskimo diet" was 100% protein and fat, including lots of offal (organ meats). 

Retrospective #337: Facts and Fallacies about the Nutrition Facts Panel

Probably more than half my readers are women, but I’ll venture that almost all my readers (both men and women) are deceived – I believe intentionally – by the USDA’s design of the Nutrition Facts Panel on manufactured “food” products. Many women especially have been handicapped by their refusal to use their intelligence to do a little simple math. Claiming a math “block” just doesn’t cut it with me.
The most recent example came to light when my pre-diabetic friend (and new LCHF acolyte) thought she was in compliance with her announced plan to eat only 15-30g of carbohydrates per meal. For her convenience, she wants to continue to drink a meal replacement or “snack” beverage called Glucerna Hunger Smart Shakes, which, according to their website, is “specially designed for people with diabetes.” The Nutrition Facts Panel on the product says it contains 180 calories, with 8 grams of fat, 15 grams of protein and 16 grams of carbohydrate.
I told my friend that this beverage was 35% carbohydrates and that that was a higher percentage of carbs than I thought she wanted to eat (on her new LCHF 60/20/20 eating plan). She replied by sending me the percentages on the label that she apparently believed were the percentages of calories in that serving: FAT 12%; CARBS 5%, and PROTEIN 30%. SHE THOUGHT THAT THE PRODUCT SHE DRANK WAS JUST 5% CARBS. In fact, the actual percentages of calories in that serving are 40% FAT, 27% CARBS (see footnote*) and 33% PROTEIN. How do I explain that?!!!
Well, the percentages on the Nutrition Facts panel are the percentages of the USDAs catastrophic recommendations for “% Daily Values (%DV)”: That recommendation is CARBOHYDRATES: 300g a DAY for women and 375g A DAY for men; PROTEIN: 50g; and FAT: 67g. By percentage of calories, that’s a whopping 60% CARBOHYDRATE for both men and women, 10% PROTEIN AND 30% FAT. The USDA doesn’t care if you’re diabetic or pre-diabetic, young, old, active, or sedentary. The USDA’s Nutrition recommendation is ONE-SIZE-FITS-ALL.
So, the % Daily Value then – the % that appears on the label on the Nutrition Facts panel – is a percentage of the government’s horribly flawed DAILY recommendation, which is WHOLLY UNHEALTHY FOR ANYONE, much less someone with INSULIN RESISTANCE who has been told they are PRE-DIABETIC. My friend thought the drink was 5% carb; it was actually 27%. And this trap is easy to fall into, as I believe intentional. The USDA wants you to eat carbs.
But if you disagree with the USDA’s bias in favor of carb, you need to know a little about how to find the truth. The Nutrition Facts panel doesn’t tell you that. You have to do the math.
     Protein contains 4 calories per gram, so to get protein calories, multiply the protein grams by 4 and then divide that by the total calories to get the percentage of protein in the product.
     Carbs also contain 4 calories per gram, so to get the carb calories, multiply the carb grams by 4 and then divide that by the total calories to get the percentage of carbohydrate in the product.
     Fat contains 9 calories per gram, so to get the fat calories, multiply the fat grams by 9 and then divide that by the total calories to get the percentage of fat in the product.
The math is easy. I do these in my head to get a rough number, which is good enough. But if you don’t want to do that, you could just buy and eat real food. Real food doesn’t need a Nutrition Facts panel to tell you it’s good to eat.
The recent changes in the Nutrition Facts panel only reshuffled the numbers in the panel and change the font size. They did not, however, make any substantive changes in the content. They did not change the % Daily Value of the macronutrients. A “mostly plant based” diet that is 60% carbohydrate is still the USDA’s/HHS recommended “eating pattern” – with the same macronutrient distribution that, since 1977, has MADE US FAT AND SICK.
* The micronutrients listed on the label added up to 196 kcals (not 180) so I had an online chat with a Glucerna nutritionist who said “some sugar alcohols in the product contain fewer than 4 kcal/gram and some fiber is not absorbed.” So, I calculated that the number of carb grams contributing to the 180 calories was not 16 but 12.)

Saturday, January 18, 2020

Retrospective #336: Noakes: “It’s the fatty liver disease, stupid.”


Continuing my theft of Dr. Tim Noakes' 2016 post on South African blogger Marika Sboros’s FOODMED.NET, Dr. Noakes relates how “more support for Gerald Reaven’s unifying hypothesis of chronic disease has come from an unexpected source – from those doctors, hepatologists, who specialize in…diseases of the liver.”
Dr. Noakes adds, “It has been known for some time that the added risks associated with obesity depend, in part, on where that extra fat is stored in the body. Thus, fat that accumulates under the skin – subcutaneous fat – is far less unhealthy than is fat that accumulates within and between the organs in the abdomen, so-called visceral obesity.”
“The hepatologists have now gone one step further to show that the real killer in visceral obesity is the fat that accumulates within the liver, causing NAFLD, a disease that is now reaching epidemic proportions” (bold added).
“Their work shows that it is NAFLD and not obesity per se that produces the abnormal metabolic state – the atherogenic dyslipidemia – that causes heart disease in those with insulin resistance and the metabolic syndrome.”
“The metabolic features of atherogenic dyslipidemia present in those with NAFLD and insulin resistance
    Elevated blood glycated hemoglobin (HbA1c) levels
    Elevated fasting blood insulin levels
    Elevated fasting blood glucose levels
    Hyperinsulinemia and hyperglycemia (elevated blood glucose levels) in response to carbohydrate ingestion
    Low blood HDL-cholesterol concentrations
    High blood triglyceride concentrations
    Elevated numbers of small dense LDL-particles
    Elevated blood Apo lipoprotein B concentrations
The absolutely key point is that dietary carbohydrates and not dietary fat cause NAFLD. For when the insulin resistant eat excess carbohydrates including fructose found in sugar and fruits, they must convert into fat any extra carbohydrate they cannot either use as a fuel or store immediately as carbohydrate in liver or muscles.”
“Note that all these options are severely reduced in those with insulin resistance.  Instead under the action of insulin – the fat-building hormone – that fat is stored, initially as fat in the liver.  But as NAFLD develops, insulin resistance worsens, hyperinsulinemia increases, atherogenic dyslipidemia deteriorates and the seeds for the chronic diseases of obesity, diabetes, heart disease, NAFLD and perhaps cancer and dementia are sown.”
“Thus, it is that dietary carbohydrates and not dietary fat are the direct cause of this group of chronic diseases in those with insulin resistance.”
Noakes’s Summary:
    The work of Dr Gerald Reaven is as revolutionary to the understanding of medicine as were the works of Newton, Galileo and Darwin to their disciplines.
    By producing a unifying theory for perhaps six chronic diseases and by presenting the initial evidence that these conditions are initiated by high carbohydrate diets in those with insulin resistance, he has fundamentally changed our understanding of how these conditions develop and how best they should be treated.  And also how they might be prevented.
    Our challenge is to incorporate this new understanding into our teaching and practice of medicine.
If you read this in a hurry, please go back, print it out, and read it again…and again. And give a copy to your doctor. It should inform us all.

Friday, January 17, 2020

Retrospective #335: Gerald Reaven’s Unified Hypothesis, Part 2

Yesterday’s column was heavily cribbed, with attribution, from a 2016 post by Dr. Tim Noakes on South African Marika Sboros’s excellent blog FOODMED.NET. Today I’m going to continue with an almost verbatim extract. It is so well written, and so profound in its implications, I don’t want to botch it with “editing”! Props, Dr. Tim!
We left off with Dr. Noakes explaining how endocrinologist and Stanford professor Dr. Gerald Reaven presented at the 1988 ADA annual Banting lecture a “unified hypothesis of chronic disease,” called Syndrome X by Reaven but which thereafter became known as Reaven’s Syndrome. These days it is called “Metabolic Syndrome.”
Noakes continues, To determine whether nutritional factors contribute to the development of the metabolic syndrome, beginning in the 1980s, Reaven completed a number of RCTs of the effects of low-carbohydrate diets in patients with this condition. Without exception his studies showed that removing carbohydrates from the diet uniformly improved all measures of health in those with insulin resistance and metabolic syndrome.”
“So besides establishing the fundamental role of insulin resistance in these chronic diseases, Reaven also discovered the optimum treatment – carbohydrate restriction. By any measures, Reaven should be a shoe-in for the Nobel Prize in Medicine.  But perhaps not.  For he failed subsequently to emphasize the curative effects of low-carbohydrate diets in insulin resistance.”
Why [did Reaven fail to emphasize the curative effects of low-carb diets in insulin resistance],” Noakes asks?
“I suspect that during his daily work at Stanford Medical School, Reaven was in close contact with some of the more important cardiologists in the USA and perhaps in the world. They would not have taken kindly to their colleague’s suggestion that, to prevent heart attacks, cardiologists should be prescribing high fat diets instead of the low fat diet dictated, then as now, by the American Heart Association.” (emphases added by me)
“Had he chosen that route, Reaven’s colleagues would have excommunicated him, his research funding would have dried up, and his career would have been over, exactly as happened to Dr John Yudkin in England for his (correct) suggestion in the 1970s that sugar, not saturated fat, causes heart disease.”
“So, it seems to me that Reaven kept quiet, choosing rather to continue researching insulin resistance without paying much attention to how a low-carbohydrate, high-fat diet might – simply, effectively and at low cost – prevent and reverse all the medical disguises through which insulin resistance reveals itself.”
Thus, Reaven’s unified hypothesis of chronic disease:One disease, one cause, many symptoms:”
“Reaven’s problem is not unlike that faced by Darwin and Galileo whose findings estranged each from religious orthodoxy.  For Reaven’s unifying hypothesis of chronic disease must offend not just his colleagues in cardiology.  For his hypothesis strikes at the very heart (pun intended) of the pharmacological model that we practice in modern medicine.” (Statins, do ya think?)
“For if obesity, diabetes, heart disease, NAFLD and high blood pressure (and perhaps also cancer and dementia) are in fact all symptoms of the same underlying condition, insulin resistance, then our current model of medical management must be wrong, requiring as it does, specific but different pharmacological treatments for each separate condition, overseen by different hierarchies of medical specialists.”
BUT WHAT IF THE CORNERSTONE FOR THE TREATMENT OF ALL THESE CONDITIONS IS A LOW-CARBOHYDRATE DIET – the very diet that has now been vilified by my profession for the past 50 years?  That must be an extremely frightening thought for very, very many.  How does one come to terms with the possibility that, by following medical orthodoxy, one may have harmed very many patients?”
Thank you, Dr. Tim Noakes, for the courage to speak out. Note: Dr. Gerald Reaven died in 2019, but Dr. Tim Noakes and Marika Sboros (FOODMED.COM) still speak out. Check out Dr. Noakes’s “Part 4” just published.