Archive for March, 2008
What happens when you convince a small, remote town to modify their diet to restrict carbohydrate?
You get a study called “My Big Fat Diet,” where everyone participating agrees to shun the carbohydrate and dig in and enjoy meat, eggs, cream, real cheese and a variety of non-starchy vegetables.
Dr. Jay Wortman propsed such a study, and after months of ethics reviews and consultations, Wortman and his team of researchers tested the theory that high-calorie Western foods are the root cause of those health problems, not due to the dietary fat content, but the carbohydrate.
As the CBC reported, “[h]e set up a year-long study of the diet in Alert Bay, where 60 people agreed to live on a more traditional aboriginal diet of meat, seafood and non-starch vegetables such as cauliflower.His theory is that sharply reducing the consumption of carbohydrates and sugar will cut deeply into the very high rates of obesity and diabetes in native communities.
People who took part in the study lost significant amounts of weight, Wortman said. They also showed improvements in their cholesterol levels and diabetes control.”
The preliminary findings are captured in a poster abstract, available here.
The findings are, in a word, expected.
What Wortman and his team found is what others have found in other studies – those who modify their diet by restricting carbohydrates and eating protein and fat ad libitum lose weight, improve triglycerides and HDL, have no significant findings for LDL or total cholesterol, see improvement in glycemic control with reductions in HbA1c.
In this study’s subjects, it is reported that they:
- Lost 10.1% of body weight
- Shed 9.7% of their waist circumference
- Improved their waist-to-hip ratios significantly
- Triglycerides (TG) declined 19.9%
- HDL rose 17.4%
- TG/HDL ratio improved 30.2%
- TC/HDL ratio improved 11.5%
- Total Cholesterol (TC) and LDL had no significant change
More importantly, in the initial analysis, those with diabetes were found to have significant improvements in their HbA1c levels – seeing a decline from a mean 7.1% to a mean 6.1%. This is again a study that finds diet alone improves HbA1c significantly while also reducing or eliminating medication!
Now one would think that results like this, and others before it, would inspire those whom remain skeptical to see the value in such a dietary approach; after all, it is helping those with chronic health conditions to lose weight, improve specific risk markers and also reduce medication requirements.
Well, not so fast say the ‘experts’ sought for comment by the CBC for their article!
“The diet he is advocating has been compared with the high-protein, low-carbohydrate Atkins diet, which has been criticized by the American Society for Nutrition for causing dramatic weight fluctuations, leading to illness.
The Health Canada Aboriginal Food Guide still recommends native people eat rice, bread and pasta.”
So, Health Canada Aboriginal Food Guide is going to continue to tell native peoples to keep eating that rice, bread and pasta; despite evidence, from multiple studies now, showing eliminating these foods is benefiicial to health?
But worse still is the message that is now in vogue, that modifying diet to restrict carbohydrate is too hard to do, unsafe anyway, so don’t try.
As well, living on a more traditional diet may present challenges for many native communities, said Bernadette Dejonzague, a registered dietitian and a diabetes prevention program co-ordinator. This is because access to food sources such as sockeye salmon may be limited by contamination and transportation issues.
More insulting however, is the insinuation that native peoples are too stupid to modify their diet back to the traditional!
Many people who live in native communities “wouldn’t know what to do with a deer or moose, even if they were able to shoot one,” said Dejonzague, who is a member of the Abenaki First Nation and based in London, Ont.
Let’s just forget the fact that native peoples lived off the land for generations prior to the introduction of flour, sugar and refined carbohydrates!
As Canada.com reported, “Starchy food such as flour for bannock, potatoes and pasta were introduced about a century ago and the impact on the aboriginal diet was devastating. Because of our people’s low incomes we find it necessary to stretch out food and what better way than to add lots of starches such as bannock and potatoes. The Hudson Bay Company introduced us to bannock and we bought it hook, line and sinker. It found a market for flour at our expense.”
At least Canada.com had the guts to be open and honest about the choices one must make, “We need to return to our roots of healthy eating and exercising. Our people in both the urban areas and reserves must examine their eating habits and adjust accordingly.People who have diabetes have two choices: They can treat the symptoms through medication or they can go to the root of the problem and follow a more traditional diet.
So get off the couch and snare a rabbit, set a net, shoot a deer or moose, and when summer comes go out and pick a mess of berries. Walk past the junk food aisle at the supermarket and head to the vegetable section. Our good health depends on what we eat and the Namgis First Nation has thrown out the challenge.”
I had the pleasure of meeting Dr. Jay Wortman, a physician working with the Aboriginal population in British Columbia, Canada, a couple of years ago at the Scientific Sessions of the Nutrition & Metabolism Society in New York. Before I post about the recent preliminary findings from the study he led, I’d like to let readers get to know him, in his own words.
In the blog he recently launched to provide information about the dietary study, he included an introduction for readers to understand how he came to carbohydrate restriction as an individual and as a physician.
These are his words.
The story so far…
Jay Wortman, MD
There are two beginnings to the story that brought us to this point.
The first was something that happened when I was about four years old in my grandmother’s house in the small northern Alberta village of Fort Vermilion. This was an early settlement in the network of Hudson’s Bay fur-trading posts that dotted the northern Canadian landscape in the formative years of our country. My grandmother was the matriarch of a large Metis family and her log house sat next to the Hudson’s Bay store on the banks of the mighty Peace River. In my early childhood the store was still a place where trappers would bring the pelts of fur-bearing animals after a winter on the land. It was a creaky wooden building with an oiled floor and a wood stove for heat.
Typically, when a trapper was delivering the bounty of their winter’s work, they would stop to have tea with Grandma to catch up on the local gossip after their months on the land. It was during one of these visits that, as a young child, I was being a pest underfoot while the adults were trying to talk. I recall the old trapper reaching into his pack and pulling out a strip of dried moose-meat which then kept me occupied as I chewed this tough but tasty treat for the next hour. I always recall this vividly because of how delicious it was and how I could never find anything as good among the various kinds of store-bought jerky later in life. I also recall, as a young child, my grandmother baking all kinds of wonderful things in the wood stove she used to heat her house in the -50 degree winters. The smells of breads, cookies and cakes would fill the whole house, leaving vivid olfactory memories. Looking back on this, it is apparent to me that diet was changing and that, while the men were still eating traditional foods on the land, my grandmother was baking with sugar and flour, highly refined introduced foods in town. Both my grandparents developed type 2 diabetes as did other close relatives including my mother.
The second beginning occurred about 48 years later when I discovered that I, too, had type 2 diabetes; that the Aboriginal genetic tendency towards this disease had slowly snaked its way up through my family tree to bite me.
As a physician, you somehow believe that you are going to be immune to the diseases that you diagnose and treat in others, that you are going to know enough and be careful enough to avoid these pitfalls of the human condition. This, coupled with the fact that I had a very young son who was born the year I turned 50, made my self-diagnosis doubly shocking for me. I knew that diabetes shortened my life expectancy, that it was the leading cause of blindness and kidney failure, that my chances of dying from a heart attack were now significantly elevated and that I might face the indignity of limb amputations and severe disability along the way. Of all these concerns, however, the prospect of not seeing my two-year old son grow into maturity was the thing that disturbed me most.
I knew diabetes from my training and clinical experience. In fact, I took extra training in diabetes in my last year of family medicine residency to prepare to be the resident doctor for the children’s diabetes summer camp, something I did for four years after graduating. I knew about the diabetic diet, how life-style change was supposed to be the “cornerstone” of diabetes management and which drugs were to be prescribed to achieve normal blood sugar control and why. I also knew that, for the most part, newly diagnosed type 2 diabetics went on drug therapy immediately because of the ineffectiveness of life-style interventions and that, even then, most tended to struggle and fail in their attempts to maintain normal blood glucose values, the holy grail of diabetes management. Further complicating my situation was the fact that I abhorred the use of medication, often joking that “drugs were just poisons with some desirable side-effects”.
Clearly I had been in denial as the classic symptoms of type 2 diabetes had crept up on me. I had put on some weight and was fatigued all the time, I struggled to get through bouts of afternoon drowsiness, I was getting up at night to urinate and I was constantly thirsty and I started to have to squint to see the television news in the evenings. I had also had begun to notice that my blood pressure was rising into the zone that would require treatment. I rationalized all these developing problems as the natural and inevitable effects of ageing until it suddenly dawned on me that what I had were the typical signs and symptoms of diabetes. I tested myself and confirmed that my sugar was way too high. I clearly recall that moment in my bathroom at home on a weekend. I was stunned and I didn’t know what to do. I decided I needed some time to look at the recent science and to formulate a management plan for myself. In order to buy the time to do this, I decided, right then and there, not to eat anything that would exacerbate my soaring blood sugar. I stopped eating carbohydrates.
Now, although I obviously knew that these types of foods, starches and sugars, would raise my blood sugar, discontinuing them was not an accepted therapy for my condition and I never intended it to be; it was just a stalling tactic to be used until a suitable plan could be implemented. And, at the time, I didn’t have a clue about low-carb diets. Nevertheless, I instantly stopped eating carbs and thus embarked on an amazing journey of recovery and discovery.
The first thing that happened was that my blood sugar normalized. This was almost instant and was followed by a dramatic and steady loss of weight. I started dropping about a pound a day. My other symptoms swiftly vanished, too. I started seeing clearly, the excessive urination and thirst disappeared, my energy level went up and I began to feel immensely better. I bought an exercise bike and started riding it for 30 minutes every day as I continued to avoid starches and sugars. I still didn’t know anything about low-carb diets but I was beginning to figure out that something extraordinary was happening as I shunned these foods. It was my wife who pointed out that I was on the Atkins diet. Like many women, she had struggled to lose weight after the birth of our son and had tried various diets including Atkins. I recall that when she brought home an Atkins book I was dismissive, suggesting that it was just another of the fad diets and that it probably wouldn’t work over the long haul. Now that I was obviously more receptive she brought out the book and showed it to me and, sure enough, as I read it, I realized that I was “doing Atkins”. More or less, actually, as I wasn’t really following Dr. Atkins’ stepwise approach to carb restriction, I was still simply avoiding all carbs.
My job at the time was focussed on Aboriginal health and I was acutely aware of the high rates of diabetes in the Canadian Aboriginal population. We have rates that are three to five times higher than those of the general population. There are also very high rates of obesity and metabolic syndrome, precursor conditions to type 2 diabetes. These epidemics were devastating Aboriginal communities and causing huge costs for health care services to the affected. Millions were being spent on testing supplies, drugs and insulin across the country and much more on transporting people from remote communities for medical attention and the treatment of complications like kidney failure and amputations. A lot of money was dedicated to education and prevention but it appeared that the trajectory of the epidemic was still rising in spite of these best efforts. In my experience, travelling into the affected communities, there was almost a sense of fatalism, a feeling that it was hopeless. Even in communities where extra resources were being applied and research was being done to see what would work, we weren’t able to reverse the terrible trend. The problem was confounding everyone involved.
As I began to realize that my simple dietary intervention was rapidly and effectively resolving my own case of diabetes, I naturally started to look at the broader Aboriginal diabetes epidemic through the lens of diet. In the course of my duties, I would often travel into First Nations communities, some of them quite remote. On these visits, I started to question people, especially the elders, about their traditional foods and old ways of eating. It was common, especially in coastal communities, to be fed traditional foods like salmon, halibut and shellfish. Inland, one would be fed moose, deer and elk. It was also common to see modern foods next to the traditional fare. It was not unusual to have potato and pasta salads with the salmon and moose, cakes and cookies for dessert and all of it chased with juices and pop. And there was always the ubiquitous, much loved bannock bread, something almost everyone regarded as a true traditional food.
In my informal surveying of the old ways of eating, however, I began to understand that the actual traditional diet (before the introduction of bannock bread) did not have a significant source of starch or sugar. Everywhere people ate berries but it was apparent that this one food didn’t constitute a significant source of carbohydrate calories and that the vast majority of calories came in the form of protein and fat. There were also a number of seasonal wild plants eaten in various places but these were all low in starch or sugar, akin to modern greens. The traditional diet was looking very much like a modern day low-carb diet in terms of its macronutrient content.
It was around this point in time that a study was published in a medical journal where a group of overweight men were put on the Atkins diet and followed for six months. They lost significant weight and experienced an improvement in their cholesterol levels. This was getting media attention because it had always been thought that cholesterol would get worse on a low-carb diet as carbohydrate calories were replaced by fat calories. I had a couple of bright young community medicine specialists on my staff and I suggested to them that we should design a similar study for a cohort of First Nations subjects. They were successful in tracking down the author of the paper and we got him on the phone to discuss his study and our idea of replicating it. This is how I came to meet Dr. Eric Westman, a professor of medicine at Duke University in North Carolina, and the first in a succession of principled, inquisitive scientists and clinicians I was to encounter on my odyssey to understand why this unconventional dietary therapy was so successful in reversing my type 2 diabetes.
Dr. Westman was extraordinarily patient and generous as he helped us put together a proposal to run a dietary trial in a coastal First Nations community. We enlisted the health workers in a community a short distance from our office and proceeded to submit a funding proposal to the Canadian Institutes of Health Research. The rejection of our proposal gave me the first hint of what I came to understand was a deeply ingrained institutional aversion to low-carb diets. Dr. Westman’s stories of his own difficulties in getting funded, in passing institutional ethics review and in getting his study results published were also instructive. I had started speaking publicly about my ideas and had already begun to experience some push-back, as well. It soon became apparent that something that had so brilliantly improved my health was viewed with intense fear and suspicion by those who are supposed to be authorities on diet and nutrition. I found I was openly attacked by dieticians when I suggested that a low-carb diet might be a valid way to lose weight and manage diabetes. This surprised me, especially as I became more versed in the science that supported this view. I was also surprised to find that a debate that should be dispassionate and grounded in evidence would often become so emotional and irrational.
More studies began appearing in the scientific literature. Some randomized controlled trials were done where low-carb dieters were compared to people following the American Heart Association so-called prudent diet which was low in fat and saturated fat. In each case, the low-carb diet delivered better results in terms of compliance, weight loss and lipid improvements. These studies tended to get media attention because the Atkins diet was in the midst of a popular resurgence at the time. We began to see low-carb products appearing on store shelves. Shops dedicated to low-carb dieting sprang up. At one point, a survey determined that one in nine Americans was restricting dietary carbohydrates. Perhaps the most defining development in this trend was the emergence of several brands of low-carb beer.
The impact of the widening popularity of low-carb dieting began to be felt among the food producers whose products were high in carbohydrate content. There were news reports of declining sales of foods like orange juice, bread, potatoes and pasta. This led to the development of direct marketing strategies to reverse this trend by many sectors of the agri-food industry. More ominous and perhaps telling of things to come, however, was an announcement by the pasta producers after they held a global meeting in Rome to discuss strategies to counter the threat of low-carb dieting. Their spokesperson said they had decided against a direct marketing campaign in favour of a plan to “work behind the scenes”. This was interesting in light of the fact that, for every report of a study that supported low-carb dieting, it seemed there would be a negative report of some kind. Whenever something appeared in the media, I would track down the source study to see what actually happened. It became apparent to me that the research supportive of low-carb tended to be solid and well executed while the studies that were negative were not well done and often contrived. In spite of this, they tended to get the same air time in the media. I sometimes found that the media reports themselves skewed things against low-carb more than did the study they were reporting on. I began to wonder if people working “behind the scenes” were having a hand in this.
The eventual decline in popularity of low-carb dieting was clearly influenced by confusing messaging directed at the public. On the one hand, the results of good studies were being reported suggesting this was a good way to lose weight and improve related conditions while, on the other hand, most authoritative sources denounced the diet as dangerous and not to be adhered to over any length of time. People were told that it was not sustainable and that weight regain would be their fate if they tried it. This was an easily self-fulfilled prophesy, of course. As I had learned, it takes an effort of will to cut out all those comfort foods and sweets to which we have become accustomed and it is easy to succumb to the fear of harm, especially when authoritative sources are telling you that you need carbs for your brain to function, that your kidneys will suffer and that you increase your risk of heart disease, osteoporosis and bad breath, something most people fear even more than death itself. I think that “behind the scenes” efforts were successful in propelling this misinformation and were ultimately successful in protecting threatened economic interests by deflating the trend toward low-carb dieting. This was most unfortunate, but, in the meantime, the science in support of low-carb continued to accumulate.
I had started speaking to Aboriginal audiences about my ideas of a link between their changing diet and the epidemics of obesity and diabetes. At one meeting, a First Nations man, inspired by my idea, challenged another man to a diet competition. They agreed to go to their respective health clinics and get weighed and measured and to report their results at intervals. I started receiving e-mails from James Wilson, the Kwakiutl challenger who lived in Campbell River on Vancouver Island. He was a type 2 diabetic who had been on insulin for 17 years, yet was unable to get his blood sugar levels into normal range. He was also medicated for hypertension and had high cholesterol and he was considerably overweight. After two weeks I received an e-mail informing me that he was now consistently achieving normal blood sugar values and was completely off his insulin. He had lost17 lbs. After another two weeks, and another 13 lbs. weight loss, he was able to discontinue the blood pressure medications. I saw him again after 18 weeks at which point he had lost about 50 lbs. and was demonstrating excellent blood sugar, blood pressure and cholesterol readings without the need for any medication. I asked him at this point whether he used exercise to achieve these remarkable results. He hadn’t; all he had done was avoid starch and sugar, just as I had. Jimmy’s success was a further impetus for me to get a study going to see if this kind of result could be achieved among larger numbers of people in a First Nations community. I had come to realize that, in the face of deeply held views prejudicial to low-carb in many quarters, getting a study launched was not going to be as easy as I had initially thought. I developed a strategy to lay some groundwork from which another study proposal might get funded. Instrumental to this plan was someone who was become a friend and respected colleague, the Honourable Dr. Carolyn Bennett. At the time she was the Minister of Public Health and was working to develop what was to become the Public Health Agency of Canada. In her cross-country travels, she was making a visit to the region in which I worked and I was asked to accompany her to a meeting that was a 90 minute plane flight away. I used this opportunity to tell her about my theories on diet and diabetes, especially as to how it may be relevant to First Nations. I shared with her a sheaf of scientific papers I had collected on the topic. Much to my surprise and delight, she read the research literature and understood its importance. Later, when I was able to obtain some funding to support a small symposium on the topic, she generously agreed to host the meeting, graciously lending the credibility of her office to this endeavour.
In February 2003, a group of leading scientists in nutrition, research, public health and Aboriginal health gathered in Hull, Quebec to debate the issues around diabetes in the Aboriginal population, traditional diet and low-carb diet. As I began to plan this meeting, one of the first people I invited was Dr. Westman. He agreed to participate and suggested that I should also invite another researcher who he regarded highly, Dr. Steve Phinney, an internist with a doctorate in nutritional biochemistry. He directed me to a paper Dr. Phinney had recently written on the high-fat low-carb Inuit diet and his research at MIT where he applied an Inuit diet to bicycle athletes to demonstrate that there was no effect on stamina, something that challenged the conventional wisdom. I called Dr. Phinney and caught up to him as he was driving his diesel Jetta on a California freeway near UCDavis where he was professor emeritus. I think he figured I was perhaps a little nutty but agreed to attend the meeting anyway. A few days later, I got a call from Kansas from Dr. Mary Vernon, someone I knew only as the co-author of a book titled, “Atkins Diabetes Revolution”. Dr. Westman had provided Dr. Vernon with my number and suggested she call me to invite herself to my symposium which she did. It turned out that Dr. Vernon had years of experience successfully treating patients with metabolic syndrome and type 2 diabetes using a low-carb diet approach in her Kansas family medicine clinic. All this while she also trained national champion performance dogs.
In 2002, Dr. Walter Willett, the renowned Harvard nutrition researcher, had published an article in Scientific American in which he argued that the USDA Food Pyramid had it wrong, that the advice on fats and oils was misguided and that there were too many refined carbohydrates in their recommendations. Dr. Willett ranks among the top 25 scientists in the world in citations and is a giant in the area of nutrition research, something I did not fully appreciate when I naively invited him to attend my little symposium. I was pleased when he accepted and only much later did I appreciated how amazing a feat it was to have attracted such a prominent scientist.
I also invited public health people, nutritionists and some of my Aboriginal physician colleagues and Jimmy Wilson and his sister Prilla. We designed the symposium to consider three questions:
1. Does the extent of the epidemic of diabetes in Aboriginal populations constitute a public health emergency?
2. Is there enough evidence that traditional diets and low-carb diets are similar to support further research in this area?
3. Is there enough evidence to warrant immediate program activity in this area?
By the end of the symposium, the group answered a resounding “yes” to each of these questions. This laid the groundwork that allowed me to eventually get a dietary trial approved and funded. I was also able to spend two years on research leave at the University of British Columbia Department of Health Care and Epidemiology where Dr. Rick Mathias, a professor of medicine there, provided the necessary institutional support to get my study launched. Drs. Phinney, Westman and Vernon also participated as co-investigators. Dr. Vernon began calling our team the “Wortman Group”, something that I found very flattering considering that I was a relative neophyte in this area and was among clinicians and scientists whose knowledge and expertise was vastly superior to my own. Our meetings to plan the diet study were full of Socratic-like question and answer sessions with Dr. Phinney providing an inexhaustible font of scientific knowledge in the area of nutritional biochemistry. We literally talked nutritional science morning, noon and night anytime we were together, to the extent that I joked that we should get Continuing Medical Education credits for out time together.
Even with the promise of funding support from Health Canada and institutional support from UBC, actually getting the study started was still not a slam-dunk. I had to submit to two Institutional Review Boards, first at UBC and then at Health Canada. We ran into the typical to-ing and fro-ing at UBC and got through the process in a fairly reasonable time. I naively thought that having done the UBC review, getting through the second review would be easier. I was wrong. We got a barrage of questions and concerns and it looked like we might not get their endorsement at all as they informed us that they didn’t consider this to be something that could be defined as research. This was a source of puzzlement to me and my team. Westman had already had studies with a similar design published and Phinney, who has had numerous studies published, and sits on the editorial board of a major American scientific journal, found this incomprehensible. I was actually caught in a classic Catch 22. Health Canada had decided, correctly I thought, that my study was research using human subjects and therefore, according to their rules, could not be funded until it passed ethics review. Meanwhile, the ethics review people were telling me that it wasn’t research and therefore they would not approve it. After what seemed like interminable manoeuvring I was able to get approval to go ahead as a “pilot study”.
In the meantime, I had been in discussions with two First Nations communities as potential sites for the study. Both were on islands, had fairly large First Nations populations adjacent to non-native communities and received their health services from local clinics. These attributes were desirable in terms of the practicality of recruiting and supervising cohorts of subjects who would be asked to follow our study diet for a year. The study design, in order to pass ethics review, hinged on the involvement of a local physician who would be responsible for the medical management of the study subjects. On the one hand, I found it odd that, although nothing prevented anyone from buying an Atkins diet book and self-administering a low-carb diet, our proposed study was deemed too dangerous to go ahead without direct medical supervision. On the other hand, there were a number of good reasons for involving the local doctors, the primary one being that anyone who was taking medications for diabetes or blood pressure would have to rapidly reduce or discontinue their meds as they started the diet. Failure to do this would cause blood sugar and/or blood pressure to go too low potentially endangering the health of participants. While a nurse could easily manage this, the level of fear about the potential harms of this “radical” diet were such that only a doctor would do. We were sensitive to the fact that doctors practicing in small remote communities are often over-worked, so we designed the study protocol to minimize the amount of time and effort that would be required by the physicians with most of the work to be done by a study nurse who we would employ locally.
As it turned out, we were successful in getting the necessary physician support in only one of the two communities that we approached. Dr. Clayton Ham, the Namgis Health Centre physician, agreed to participate. He was open-minded but also displayed what I thought was a healthy scepticism. In the end, his attitude was that our current approach wasn’t working particularly well so maybe we should try something different. Over the course of the study, as he witnessed the improvements people achieved on the diet, his initial ambivalence changed to enthusiasm and he began to counsel his diabetic patients to consider joining the study.
Our study design required that we recruit 100 subjects in order to achieve statistical significance and we were planning on attracting 50 people in each community. We decided to get started recruiting in the community with the cooperative physician while we continued the search for an additional study site. As it turned out, the response in Alert Bay was greater than we had anticipated and we quickly realized that we would be able to achieve the desired numbers without involving another community. This turned out to be a blessing as it allowed me to invest in more nursing time and to spend more of my time in Alert Bay. I was able to recruit a local nurse, Deb Vermunt, whose husband was the director of the local band-operated health clinic. Deb was a quick study and enthusiastically threw herself into the task of learning about this dietary approach and our study protocols. She was well-liked by the subjects and was instrumental in our success in attracting people to the study and helping them remain compliant with the diet.
In my first approach to the Namgis First Nation, I had made a presentation to the Chief and Council explaining the rationale for the study and seeking their endorsement to go ahead. As it turned out, not only did they enthusiastically approve, but some of them immediately started to change their diet along the lines of the proposed study diet. After obtaining council’s approval it took several more months to get the actual study started but, in the meantime, we serendipitously acquired a couple of very strong local advocates. The Chief, Bill Cranmer, started avoiding carbs and was so pleased with his health improvements that he became a vocal advocate. The band manager, also a hereditary chief, interpreted our approach to mean that he should eat only traditional foods which he did. He lost 35 lbs and his wife lost 70 lbs. By the time we were ready to start recruiting subjects many people had heard all about the diet and had already witnessed its benefits.
Early in the planning for the study I was unsure whether I would get funding through the usual channels. I had heard about the Robert C. Atkins Foundation which had been established by the late famous low-carb diet doctor. I was visiting New York on other business and used that opportunity to meet with the Foundation’s director of research, Dr. Abby Bloch. I was hoping that the Atkins Foundation might consider funding my project. In preparing for the visit, I had Googled Dr. Bloch and discovered that she was a dietician. This intrigued me because my experience to that point was that dieticians were not favourably predisposed to low-carb diets. Dr. Bloch met me for dinner and told me a fascinating tale of how she had been a very sceptical critic of low-carb diets until she was recruited by Dr. Atkins to run his research foundation. She had worked at the Sloan Kettering Cancer Centre, had done nutritional research and was a contributor to the standard textbook of nutrition used in American universities. When she retired, someone talked her into meeting Dr. Atkins who was looking for a director of research. She told him what she thought of him and his diet but he offered her the job anyway. He said that her opinions didn’t matter; he was more concerned with ensuring that the research he funded was done to the highest scientific standards. On that basis, she took the job, much to her own surprise. Then she began to discover the scientific literature that supported low-carb diets and was surprised to find that there was already lots of it out there. As she began to fund more research, the results were so positive that it convinced her there was merit in this dietary approach. Since she was highly regarded in her profession she would still be invited to speak at conferences and would discuss the evidence that she was discovering that supported a diet that everyone had believed to be harmful. She was shocked to find that, not only did her colleagues not want to discuss the evidence, but that they attacked her personally. She told amazing stories of how they would launch emotional tirades, condemning her and telling her she should never be allowed to speak at their conferences again. Obviously upsetting to her, this was doubly disappointing for me, as I had hoped that I had finally found a dietician who could explain to me why there was such a negative attitude towards this diet. She was as mystified as I was.
In the end, the Atkins Foundation generously offered to fund my study; however, in the meantime I had also been able to secure Health Canada funding. I had a frank discussion with Dr. Bloch and her colleagues and declined their funding. I felt that because of its origins, the validity of the study results would be vulnerable to accusations of bias. They were very understanding as they knew more than anyone how politically charged an environment I was entering.
Abby introduced me to another wonderful person who had been associated with Dr. Atkins, his nurse of 30 years, Jacqueline Eberstein. Jackie told a similar story of how she was very sceptical when first recruited by Dr. Atkins and then, after seeing the results, how she became very committed to this way of treating people for obesity and related conditions. She had lots of personal stories to tell of what it was like to work with Dr. Atkins and would often tell me that, were he still alive, he would be very interested in the work I was doing. Jackie co-authored the book, “Atkins Diabetes Revolution” with Dr. Vernon and was a wealth of knowledge on how to manage diabetes through carbohydrate restriction. Both Abby and Jackie became my good friends and informal members of the study team and they both visited Alert Bay to help with the initial training of the local staff.
I began attending the conferences hosted by the Nutrition and Metabolism Society, an organization of scientists and clinicians dedicated to improving our understanding of the biological mechanisms of carbohydrate restriction. It was when I attended a NMS conference in Brooklyn that I experienced one of the high points of my journey. Veronica Atkins, the widow of Dr. Atkins, and a big supporter of the researchers working in this area attended the meeting. Much to my surprise and delight, she graciously invited me to her home for dinner. In her beautiful Manhattan apartment, high above Central Park with a view of the Statue of Liberty, eating a delicious low-carb osso bucco prepared by her personal chef, I reflected on how life can be such an amazing journey, how far I had come from that little village in northern Alberta and how my own illness had transformed my life into a quest to push the boundaries of diabetes management at a time when this disease was becoming a global health crisis. I wondered where this journey was going to eventually take me.
Along the way, in terms of my own health, I continued to maintain normal blood sugar and blood pressure simply by avoiding carbs. I experienced some trepidation after doing this for a few months when I decided to get my cholesterol checked. I had become accustomed to eating lots of fatty foods and I was certain I was eating much more than the prescribed amount of saturated fat. I had developed my own wickedly delicious low-carb chocolate ice-cream receipe which used heavy cream and egg yolks. I was eating that daily and having bacon and eggs for breakfast and steak and chicken with the skin on and other fatty foods for dinner. Lots of cheese, too. So when it came to checking my cholesterol, I have to admit I was afraid. I had been taught that a diet high in saturated fat would lead to an unhealthy lipid profile. Much to my surprise and relief, I had excellent cholesterol levels and, as an added bonus, my HgA1c (the long range measure of blood sugar control) was also well down into the normal range. I was clearly on the right track.
My most recent blood tests, done just a couple of months ago at about the five year point of my personal low-carb diet experiment, continue to demonstrate excellent results. It is also interesting to note that I have very low markers of inflammation; my white cell count and C-reactive protein are at the low end of the normal range. Higher levels of these markers are associated with metabolic syndrome, type 2 diabetes and an elevated risk of cardiovascular disease. This is something that I now understand from recent research to be another benefit of carbohydrate restriction. Although there continues to be a lack of long-term studies supporting low-carb diets, my own long-term experience has been excellent. Other members of the “Wortman Group” who have had years of clinical experience with low-carb dieting confirm that my results are the norm.
I have adhered to the diet and maintained a weight loss of about 25 lbs for over five years now. I am convinced that my health is better than it has ever been. I have learned an enormous amount in an area of science that physicians, unfortunately, tend to ignore. And I have come to understand that nutrition is the most important factor in determining one’s health status and how a simple nutritional change can have a powerful therapeutic effect when applied to diet-related illnesses like obesity, metabolic syndrome and type 2 diabetes.
The study and how it affected the people of the Namgis First Nation and other residents of Alert Bay is the subject of the documentary, “My Big Fat Diet”, by Mary Bissell and Barb Cranmer. I think Mary and Barb have done a wonderful job of capturing the beauty of the Namgis territory and the warmth and charm of the people who live there. I will let the film speak for itself.
When the data collection is complete we will do the usual statistical analyses and write a paper to be submitted for publication in a scientific journal. In the meantime, I have started this website to serve as a forum to discuss the documentary film and this dietary approach and to serve as a vehicle for me to continue to share with you what I am learning in the course of my personal odyssey.
Although the journey is far from over, I will pause on this occasion to thank the people who have helped me get this far: my research colleagues, Drs. Phinney, Vernon and Westman, Jacqueline Eberstein and Dr. Bloch, Drs. Richard Feinman and Jeff Volek for the Nutrition and Metabolism Society and their excellent research, my enlightened colleagues at Health Canada who made the study possible and who I suspect prefer to remain nameless, the staff of the Department of Health Care and Epidemiology at UBC, especially Dr. Rick Mathias, whose support has been instrumental, all the staff of the Namgis Health Centre and especially Dr. Ham, Deb Vermunt and Eva Dick, the Namgis Chief and Council, the people of Namgis First Nation and the community of Alert Bay and especially those who put their trust in me and tried the diet, Mary Bissell and Barb Cranmer and their crew for the excellent documentary, and Veronica Atkins and her late husband, the good doctor, whose pioneering work in this area has not yet achieved the recognition that it deserves, Dr. Robert C. Atkins.
While out this weekend, I passed by a Subway shop and noticed new posters up that promoted their “Fresh Fit Kids Meals.” I didn’t have time to stop and read the poster, but did take some time this morning to take a look at the website to see what they’re touting as a healthy alterntative for children.
Subway Fresh Fit™ Kids Meals
You no longer have to sacrifice nutrition or flavor when you’re short on time. Choose a Mini sub (ham, turkey or roast beef) and pair it with a delicious side, like fresh apple slices or raisins. Then select from 1% low fat white milk or 100% juice for a tasty, better-for-them meal that kids will love.
On the page above, the picture of the meal includes a black forest ham mini-sub, a box of raisins and Minute Maid 100% Juice Fruit Punch.
According to the page featuring the healthfulness of the kids meals, Subway promotes the meal as a better option than McDonald’s and Burger King’s kids meals.
With negligible differences in calories, it’s all about the fat content of their kids meal versus the others’ offerings. So if the calories of each are close, but the Subway meal is half the fat, what’s keeping the calories similar?
That’s right – when you choose the Subway kids meal, you’re giving your child more carbohydrate (basically, in the body, sugar).
In fact, after poking around on the Subway website, the nutrition information available reveals the kid’s meal noted above is the equivalent of almost 1/2 cup of sugar (after deducting the fiber, the meal provides 86g of digestible carbohydrate – or the equivalent in the metabolism as 21.5-teaspoons of sugar).
Would you willingly sit your child down, offer him/her a bowl filled with 1/2 cup of sugar and a spoon to dig in?
Well, that’s basically what you do if you order the kid’s meal with a ham mini, raisins and juice box….what Subway is promoting as “healthy” eating for kids!
While I have a number of posts in the works that I’ve mentioned in previous posts, I’m a bit swamped – so rather than not post anything, I thought I’d post some interesting news:
- Growing fruits and vegetables leads to penalties
The New York Times had an Op/Ed from a farmer who found growing watermelons and tomatoes to come with penalties from the Farm Service.
- Warning Labels for Cheese – Say it isn’t So!
DAIRY foods could soon have to carry cigarette-style health warnings in a bid to slash Britain’s soaring levels of obesity and heart disease, according to a report yesterday…the food watchdog is also considering asking manufacturers of products high in saturated fat, such as cheese and butter, to put cigarette-style warnings on packs which would urge consumers to eat such products in moderation or as a rare treat.
- ABC News: Atkins a Diet for your Wallet?
Video about rising grain prices.
- Jimmy Moore Interviews Dr. Dean Ornish
- Kevin at Low Carb HIT
Thinks Dr. Mike Eades and Anthony Colpo are both wrong about the metabolic advantage…read why!